Comorbid alcohol use disorder in psychiatric MDD patients: A five-year prospective study

Background: Comorbid alcohol use disorder (AUD) is common among patients with major depressive disorder (MDD), and often complicates presentation and treatment. However, there is a scarcity of clinical studies investigating the characteristics and outcome of psychiatric MDD patients with AUD. Methods: In the Vantaa Depression Study (VDS), a five-year prospective study of psychiatric out- and inpatients (N = 269) with MDD, we investigated the clinical features of MDD, comorbid Axis I and II disorders, psychosocial factors, and long-term outcome of patients with or without AUD. Results: Depressed patients with comorbid AUD at baseline (n = 66/269, 24.5%) were more often male (OR= 3.57, [95% CI 1.72 - 7.41], p = 0.001), had more suicidal ideation (OR=1.06 [1.02 - 1.11],p = 0.008), comorbid panic disorders (OR = 3.44 [1.47 - 8.06], p = 0.004), symptoms of any personality disorder (OR =1.04 [1.00 - 1.08], p = 0.038), and more often smoked daily (OR =2.79 [1.32 - 5.88], p = 0.007) than those without. At five years, 13.9% (25/180) still had AUD. More specifically, alcohol abuse was associated with suicide attempts, and dependence with suicidal ideation, and Cluster B personally disorder. Patients with AUD spent more time depressed and had more suicide attempts during follow-up. Limitations: We did not investigate other substance use disorders. The AUD diagnoses were based on DSM-IV criteria. Conclusions: Psychiatric MDD patients with comorbid alcohol use disorders have characteristics consistent with the epidemiology of AUDs in the general population. They are more often males and smoke, and have more comorbid mental disorders and suicidal behavior. Prospectively they spend more time depressed, thus having worse outcomes than patients without AUDs.