Changes in alcohol consumption reported on routine healthcare screenings are associated with changes in depression symptoms

Kevin A Hallgren; Helen E Jack; Malia Oliver; Douglas Berger; Jennifer F Bobb; Daniel R Kivlahan; Katharine A Bradley

doi:10.1111/acer.15075

Changes in alcohol consumption reported on routine healthcare screenings are associated with changes in depression symptoms

Alcohol Clin Exp Res (Hoboken). 2023 Jun;47(6):1132-1142. doi: 10.1111/acer.15075. Epub 2023 Jun 16.

Authors

Kevin A Hallgren^{1

2

3}, Helen E Jack⁴, Malia Oliver², Douglas Berger^{4

5}, Jennifer F Bobb², Daniel R Kivlahan⁶, Katharine A Bradley^{2

3

4}

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.
² Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
³ Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA.
⁴ Division of General Internal Medicine, University of Washington, Seattle, Washington, USA.
⁵ General Medicine Service VA Puget Sound, Seattle, Washington, USA.
⁶ Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, Veteran Affairs Puget Sound HealthCare System, Seattle, Washington, USA.

PMID: 37326806
PMCID: PMC10330324 (available on 2024-06-16)
DOI: 10.1111/acer.15075

Abstract

Background: The Alcohol Use Disorders Identification Test-Consumption version (AUDIT-C) has been robustly validated as a point-in-time screen for unhealthy alcohol use, but less is known about the significance of changes in AUDIT-C scores from routine screenings over time. Unhealthy alcohol use and depression commonly co-occur, and changes in drinking often co-occur with changes in depression symptoms. We assess the associations between changes in AUDIT-C scores and changes in depression symptoms reported on brief screens completed in routine care.

Methods: The study sample included 198,335 primary care patients who completed two AUDIT-C screens 11 to 24 months apart and the Patient Health Questionnaire-2 (PHQ-2) depression screen on the same day as each AUDIT-C. Both screening measures were completed as part of routine care within a large health system in Washington state. AUDIT-C scores were categorized to reflect five drinking levels at both time points, resulting in 25 subgroups with different change patterns. For each of the 25 subgroups, within-group changes in the prevalence of positive PHQ-2 depression screens were characterized using risk ratios (RRs) and McNemar's tests.

Results: Patient subgroups with increases in AUDIT-C risk categories generally experienced increases in the prevalence of positive depression screens (RRs ranging from 0.95 to 2.00). Patient subgroups with decreases in AUDIT-C risk categories generally experienced decreases in the prevalence of positive depression screens (RRs ranging from 0.52 to 1.01). Patient subgroups that did not have changes in AUDIT-C risk categories experienced little or no change in the prevalence of positive depression screens (RRs ranging from 0.98 to 1.15).

Conclusions: As hypothesized, changes in alcohol consumption reported on AUDIT-C screens completed in routine care were associated with changes in depression screening results. Results support the validity and clinical utility of monitoring changes in AUDIT-C scores over time as a meaningful measure of changes in drinking.

Keywords: alcohol use; changes in drinking; depression; measurement-based care; mental health; primary care; screening.

Abstract

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