International Psychogeriatrics: page 1 of 9 © International Psychogeriatric Association 2016

doi:10.1017/S1041610216002209

Alcohol use, depression, and life satisfaction among older

persons in Jamaica
...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Roger C. Gibson,1 Norman K. Waldron,2 Wendel D. Abel,1 Denise Eldemire-Shearer,2

Kenneth James1 and Kathryn Mitchell-Fearon1
1
Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston 7, Jamaica
2
Mona Ageing and Wellness Centre, The University of the West Indies, Mona, Kingston 7, Jamaica

ABSTRACT

Background: We aimed to determine the prevalence of alcohol use among older Jamaicans as well as to explore
among this population the relationships between alcohol use and: age, sex, depressive symptoms, and life
satisfaction. Although the nature of these relationships among the proposed study population were uncertain,
in other settings alcohol use has tended to decline with increasing age, occur more commonly among men
than women, and show non-linear relationships with depressive symptoms and life satisfaction.
Methods: Data gathered by two-stage cluster sampling for a nationally representative health and lifestyle
survey of 2,943 community-dwelling older Jamaicans, aged 60 to 103 years, were subjected to secondary
analysis using the Student’s t-test and χ 2 test as appropriate.
Results: Current alcohol use was reported by 21.4% of the participants. It steadily declined with age and was
six times more prevalent among men (37.6%) than women (6.2%). These findings were statistically significant
as were associations of current alcohol use with comparatively lower levels of depressive symptoms. Current
alcohol use was also more prevalent among persons who were either highly satisfied or highly dissatisfied with
their lives, compared to others who had levels of life satisfaction between these two extremes.
Conclusions: Current alcohol use among older Jamaicans occurs primarily among men, declines with
increasing age, and is associated with a relatively low likelihood of depression. It is also associated with very
high and very low levels of life satisfaction.

Key words: alcohol, depression, life satisfaction, elderly, Jamaica

Introduction An awareness of the prevalence of alcohol use

and its associated factors among older persons
In recent years, there has been an increasing is useful given the potential impact of alcohol
appreciation of the phenomenon of the aging consumption on the health of individuals in this
world population (Lloyd-Sherlock, 2000). This age group. Among older persons, moderate alcohol
has led to greater attention being paid to issues use has been linked to lower rates of mortality than
affecting older persons that previously might have those that are found in non-drinkers (Paganini-Hill
been overlooked. Included among these issues has et al., 2007). On the other hand, heavy alcohol use
been alcohol use (Wang and Andrade, 2013). has been associated with greater severity or poorer
A number of studies have now explored alcohol outcome for a raft of medical illnesses (Rigler,
use among older persons (Mirand and Welte 2000; Liu et al., 2010; Skliros et al., 2012) as
1996; Choi and DiNitto, 2011; Rao et al., 2015). well as increased mortality (Jayasekara et al., 2014).
However, to date, there have been few focused Knowledge of the extent of alcohol use among
or comprehensive reports on alcohol use among older persons may give some indication about the
older persons in Jamaica or the rest of the English- urgency with which attention should be paid to
speaking Caribbean. encourage healthier practices pertaining to their
consumption of alcohol.
Identifying the most common users of alcohol
Correspondence should be addressed to: Roger C. Gibson, Department of among older persons is also important for enhan-
Community Health and Psychiatry, The University of the West Indies, Mona, cing targeted approaches to addressing possible
Kingston 7, Jamaica. Phone: +876-927-2492; Fax: +876-927-2116. Email:
roger.gibson02@uwimona.edu.jm. Received 9 Jun 2016; revision requested 8
problems with alcohol use. In this regard, an
Jul 2016; revised version received 7 Nov 2016; accepted 13 Nov 2016. examination of the prevalence of alcohol use

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https://doi.org/10.1017/S1041610216002209
 2 R. C. Gibson et al.
by age and sex is potentially valuable. Whereas
past research has indicated that among older
persons alcohol use declines with age (Mirand
and Welte, 1996; Breslow et al., 2003) and is
more prevalent among men than women (Mirand
and Welte, 1996; Blazer and Wu, 2009), the
extent to which these findings are relevant for
Jamaica and the wider English-speaking Caribbean
has not been firmly established. Findings from a
general lifestyle survey of Jamaicans between 15
and 74 years of age indicate that rates of current
alcohol use peak at 83% in persons aged 25
to 34 years and steadily decline to 48% among
persons in the 65 to 74 age range (Wilks et al.,
2008). Alcohol use beyond age 74 years was not
explored. Neither were any differences of alcohol
consumption with age investigated within the
cohort of older persons. In the same survey, for all
age groups, alcohol use was more common among
men than women and was mostly restricted to
weekends.
Apart from concerns about possible adverse
associations between alcohol use and physical
health, alcohol use has also shown some association
with mental health problems including addiction
(Bommersbach et al., 2015), cognitive decline
(Hendrie et al., 1996), depression (Hartka et al.,
1991; Alati et al., 2005; Graham et al., 2007),
and suicide (Yi et al., 2016). Although the
current study’s methodology did not allow for any
investigation of most of these mental health issues,
it did facilitate an exploration of the relationship
between alcohol use and depression. Various types
of relationships between alcohol use and depression
have previously been described including even
a lack of any association (Osborn et al., 2003)
in a study of older persons. More commonly
described is the phenomenon of the use of alcohol
as a self-medicating strategy by persons who are
depressed (Bolton et al., 2009) as well as a non-
linear relationship between depression severity and
alcohol consumption (Alati et al., 2005; Graham
et al., 2007; Kim et al., 2015). Knowledge of
the nature of the relationship between alcohol
use and depression among older persons of the
English-speaking Caribbean could contribute to a
better appreciation overall of the complex issues
that underlie alcohol use among members of this
population.
Besides depression, another useful parameter
for exploration of association with alcohol use is
life satisfaction. As Veenhoven (1996) pointed out,
life satisfaction relates to the extent to which an
individual appraises his or her life as a whole as
being of an acceptable standard and also helps
to determine the extent to which changes (to
remediate any deficiencies) should be pursued.
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The relationship between alcohol use and life
satisfaction is especially relevant for older persons
given the fact that threats to life satisfaction that
are attributable to alcohol use (such as chronic
medical illnesses) may not become apparent until
during the later years of life. Massin and Kopp
(2014) reported a non-linear relationship between
heaviness of alcohol use and satisfaction with
life. The nature of the relationship between
alcohol use and life satisfaction has not previously
been described among older Jamaicans and could
potentially broaden the general understanding of
the emotional correlates of alcohol use among this
group of persons.
In this study, we sought to determine how
prevalent alcohol use was among older Jamaicans
as well as the extent to which it was associated
with age, sex, depression, and life-satisfaction.
Considerations of alcohol use were, however,
restricted to the presence or absence of current
alcohol use which was defined as use within the last
12 months.
Methods
The research on which we report met legal and
ethical standards, and was approved by the relevant
institutional review board.
A secondary analysis was conducted on data
from a cross-sectional, nationally representative
survey on health-related issues of 2,943 older
persons, undertaken in four (4) of Jamaica’s twelve
(12) parishes in 2012. Details of the survey
methods are contained in a report on previous
analyses (Mitchell-Fearon et al, 2014).
Study population
The study population included a representative
sample of men and women, 60 years of age
and older, living in the parishes of St Catherine;
Kingston and St. Andrew; and St Thomas.
Together these four parishes reflect the profile of
the national population and comprise approxim-
ately 47% (1,272,546 persons) of the national
population (Table 1).
Sampling strategy
A two-stage cluster sampling methodology was
used to recruit persons into the survey, with the
first and second cluster units being enumeration
districts and households, respectively. An enu-
meration district is a geographical area within
a parish, enumerated by a single enumerator,
and consists of up to 400 dwellings. The
sampling strategy was designed in accordance
 Alcohol use among Jamaican elderly 3

Table 1. Population and sample distribution by parish

pa r i s h
ED samples po p u l at i o n
no of as % of as % of
no of EDs pa rt i c i pa n t s n at i o n a l n at i o n a l
selected by selected by ED charac- po p. ( =E D po p.
pa r i s h po p u l at i o n pa r i s h ( N , % ) pa r i s h ( N , % ) a teristics % × 0.47) (26,97,983)
............................................................................................................................................................................................................................................................................................................................

Kingston 89,057 (7) 2 (6) 53 (1.8) Urban, 2.7 3.3

inner-city
St. Andrew 573,369 (45) 16 (46) 1,387 (47.1) Largely urban 21.5 21.3
St. Thomas 93,902 (7) 3 (7) 218 (7.4) Rural 3.5 3.5
St. 516,218 (41) 14 (40) 1,284 (43.6) Mix of rural, 18.8 19.1
Catherine urban,
semi-urban
TOTAL 1,272,546 35 (100) 2,942 (100) N/A 47.0 47.2
(100)

Note: ED = enumeration districts.

a Parish of origin not recorded for one participant.

with the “WHO common cluster survey sampling largest of the minimum sample sizes that could be
principles,” and sample size defined through use derived from a consideration of any of the relevant
of the “C-Survey” software. This software was chronic illnesses (sample size calculations that use
specifically designed by University of Indonesia prevalence rates greater or less than 50% would
and University of California, Los Angeles (UCLA) yield smaller minimum sample sizes).
faculty to inform these surveys in developing “Number of clusters” to be included in the
countries. survey was pre-defined by the WHO principles
Given the variations in the population size of to be a minimum of 25. The total number of
enumeration districts, a “probability proportional clusters in our survey was 35. “Design effect”
to size” (PPS) sampling strategy was undertaken. (DE) adjustments were employed to compensate
Under this strategy, larger districts had a higher for intra-cluster similarities resulting from not
likelihood of being included in the sample than did using simple random sampling. The selection of
smaller districts. a DE of 2 was informed by previous surveys
C-survey, which uses the PPS sampling strategy, concerning health issues in Jamaica (Fletcher, et al.,
was used to determine the overall survey sample 2013; Baker-Henningham et al., 2012; Le Franc
size and the size of the clusters as well as to select et al., 2008).
the enumeration districts/clusters for inclusion in Based on these parameters, C-Survey indicated
the survey. Based on the software requirements, the a minimum required sample size of 2,660 with each
input variables were as follows: cluster having 76 participants. Participants were
contacted via home visits beginning at a random
starting point and proceeding sequentially in a
Attribute proportion 0.69 predetermined direction (also randomly selected)
Number of clusters 35 emanating from a central location in the cluster.
Design effect 2
The minimum requirements were adhered to,
One-half length of Confidence Interval 0.0250
and exceeded in the data collection phase, with
Confidence level 95%
approximately 85 persons per cluster and 2,943 in
the total survey.
“Attribute proportion” was assigned a value of Participants ranged in age from 60 to 103 years.
0.69, after using hypertension as the relevant The mean (SD) age was 72.2 (8.9) years and
“attribute” to be measured. Based on national 1,531 (52.0%) of the participants were women.
surveys, the proportion of this attribute in the As shown in Table 2, the age and sex distribution
elderly population is estimated to be 69% (Wilks of participants was representative of the Jamaican
et al., 2008). Because a main focus of the survey was population over 60 years of age. Of note, of the
on the health profile of older persons, the chronic persons approached for participation in the survey,
medical condition with the highest prevalence 95% consented and took part. The distribution
within older Jamaicans, i.e. hypertension, was of participants by parish is also shown in
chosen so as to allow a determination of the Table 1.

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 4 R. C. Gibson et al.

Table 2. Characteristics of participants compared with characteristics of the national population of age 60
years or oldera
c e n s u s (2011)b sample

a g e - g ro u p s ( y e a r s ) m a l e (%) f e m a l e (%) m a l e (%) f e m a l e (%)

............................................................................................................................................................................................................................................................................................................................

60–69 53.00 47.15 48.04 40.71

70–79 30.63 30.74 32.62 34.85
≥80 16.37 22.11 19.34 24.44
a Data pertaining to age were missing for three male and five female participants.
b Source: Statistical Institute of Jamaica.

Instruments mild, moderate, or severe depressive symptoms),

T h e s u rv e y q u e s t i o n n a i r e and satisfaction with life in general (very dissatis-
Data on age, sex, alcohol use, and life satisfaction fied, dissatisfied, neither satisfied nor dissatisfied,
were gleaned from participants’ responses to satisfied or very satisfied).
a 200-item survey questionnaire with questions Because of issues with the quality of the data
on functional status, community, and social collected, there were no usable data on alcohol
relationships, lifestyle behaviors, health status, and consumption besides current alcohol use.
access to and utilization of health services. The life satisfaction variable was derived
from responses to a single item on the survey
questionnaire which asked the question “Taking
T h e Z u n g S e l f - r at i n g D e p r e s s i o n S c a l e all things together, how satisfied are you with life
(ZSDS) as a whole these days?” Similar single questions
Data on depressive symptoms were obtained from have been used to assess individuals’ overall life
participants’ responses on the Zung Self-rating satisfaction in previous research and have been
Depression Scale (ZSDS) (Zung, 1965) which considered valid. (Veenhoven, 1996; Massin and
has been widely used in previous research on Kopp, 2014).
depression. It has shown significant correlation
with clinical diagnoses of depression (Griffin and
Statistical analyses
Kogut, 1988) and similarity with other measures
of the severity of depressive symptoms (Agrell and Data were analyzed using the Statistical Package
Dehlin, 1989), e.g. the Geriatric Depression Scale for the Social Sciences (SPSS; version 18.0).
(GDS) (Yesavage et al., 1982). The instrument has Frequencies were calculated for sex and the
also been validated in Jamaica (Ward et al., 2001). presence or absence of current alcohol use. Means
In this study, it was not self-administered. Rather, and standard deviations (SD) were determined for
the questions were asked by trained interviewers age and ZSDS score.
in order to avert potential problems with literacy, The absence of any usable data on the quantities
visual disability, and cognitive deficits among the of alcohol consumed by respondents precluded
targeted population of older persons. Scores of the any analyses involving alcohol consumption beyond
ZSDS range from 20 to 80 with higher scores considerations of the presence or absence of current
representing greater levels of depression. Scores of use.
50 or more are indicative of at least mild levels Bivariate explorations of associations between
of depression. Conventionally, scores between 50 the presence or absence of current alcohol use
and 59 are interpreted to connote mild depressive and the other variables of interest were carried out
symptoms; 60–69 moderate symptoms, and 70 or using the Student’s t-test for ZSDS score and the
greater severe symptoms (Lam et al., 2005). These χ 2 test for sex, age category, ZSDS category, and
cut scores were applied to the analysis of data in this satisfaction with life in general. For all analyses,
study. statistical significance was considered to be present
at p < 0.05.
Variables of interest
The variables of interest were age in years (60– Results
69, 70–79, 80–89, and 90 or more years),
sex (male/female), current alcohol use (present Information on current alcohol use was obtained
if having drunk alcohol during the last 12 for 2,873 (97.6%) of the participants and of
months), ZSDS score, ZSDS category (absent, this number 615 (21.4%) reported having drunk

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 Alcohol use among Jamaican elderly 5

Table 3. Prevalence of current alcohol use by category of depressive symptom severitya among males,
females, and the total sample
c u r r e n t a lco h o l u s e

d e p r e s s i o n s ym p t o m s ev e r i t y a b s e n t N (%) present N (%) t ota l (%)

............................................................................................................................................................................................................................................................................................................................

Total sample
Absent or minimal 1,028 (72.9) 383 (27.1) 1,411 (100)
Mild 474 (80.7) 113 (19.3) 587 (100)
Moderate 251 (85.4) 43 (14.6) 294 (100)
Severe 85 (94.4) 5 (5.6) 90 (100)
Total 1,838 (77.2) 544 (22.8) 2,382 (100)
Males
Absent or minimal 456 (57.6) 335 (42.4) 791 (100)
Mild 176 (64.5) 97 (35.5) 273 (100)
Moderate 68 (70.8) 28 (29.2) 96 (100)
Severe 23 (82.1) 5 (17.9) 28 (100)
Total 723 (60.9) 465 (39.1) 1,188 (100)
Females
Absent or minimal 572 (92.3) 48 (7.7) 620 (100)
Mild 298 (94.9) 16 (5.1) 314 (100)
Moderate 183 (92.4) 15 (7.6) 198 (100)
Severe 62 (100) 0 (0) 62 (100)
Total 1,115 (93.4) 79 (7.6) 1,194 (100)
a Data pertaining to category of depressive symptom severity were missing for 497 (17%) of the total sample [207 (15%) males and 290
(19%) females]. Data pertaining to current alcohol use were missing for 70 (2.4%) of the total sample [21 (1.5%) males and 49 (3.2%)
females].

alcohol in the previous 12 months. These persons [t(1186) = 4.60, p <0.001] and women [t(1192)
were regarded as current alcohol users. = 3.12, p = 0.02) were analyzed separately.
Current alcohol use steadily declined with age. It Statistically significant differences were also
was most prevalent among persons between 60 and found with respect to comparing current alcohol
69 years (29.4%; 95% CI: 27.7%, 31.1%), followed users and non-users according to ZSDS categories.
by persons between 70 and 79 years (17.6%; 95% The proportion of current alcohol users steadily
CI: 16.2%, 19.0%), then by persons between 80 declined as categories of increasingly severe
and 89 years (11.8%; 95% CI: 10.6%, 13.0%), depressive symptoms were considered (Table 3).
and then finally by persons of 90 years of age Of the total sample, just over one in every four
or older (9.0%; 95% CI: 8.0%, 10.0%). These persons (27.1%; 95% CI: 25.5%, 28.7%) who
differences were found to be statistically significant showed no substantial depressive symptoms were
on application of the χ 2 test [χ 2 (3) = 95.2, p < current users of alcohol, compared to almost one
0.001]. in twenty persons (5.6%; 95% CI: 4.8%, 6.4%)
Current alcohol use was six times more prevalent with severe depressive symptoms [χ 2 (3) = 45.6, p
among men (37.6%; 95% CI: 35.2%, 38.8%) < 0.001]. In men, these proportions were 42.4%
than women (6.2%; 95% CI: 5.3%, 7.1%). This (95% CI: 39.6%, 45.2%) and 17.9% (95% CI:
difference was also statistically significant [χ 2 (1) = 15.7%, 20.8%), respectively [χ 2 (3) = 14.3, p =
420.7, p < 0.001]. 0.003]. Among women, they were 7.7% (95% CI:
With regard to depression among the total 6.2%, 9.2%) and 0%, respectively [χ 2 (3) = 7.1,
sample, on average current users of alcohol had p = 0.68].
lower mean (SD) ZSDS scores [34.7 (8.8)], Satisfaction with life in general was also
and therefore lower levels of depressive symptom significantly associated with current alcohol use
severity, than persons who were not current users (Table 4). Of the total sample, persons who were
[38.8 (9.3)]. There was a mean difference in scores very satisfied and persons who were very dissatisfied
of 4.1 which was found to be statistically significant showed the highest rates of current use of alcohol
with the Student’s t-test [t(2380) = 9.18, p < (28.3%; 95% CI: 26.7%, 29.9% and 27.3%; 95%
0.001]. The association between current use of CI: 25.7%, 28.9%, respectively), compared to rates
alcohol and a lower level of depression symptom ranging from 16.9% (95% CI: 15.5%, 18.3%) to
severity was also found when data from men 22.0% (95% CI: 20.5%, 23.5%) for the other

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 6 R. C. Gibson et al.

Table 4. Prevalence of current alcohol use by category of satisfaction with life in generala among males,
females, and the total sample
c at e g o r i e s o f c u r r e n t a lco h o l u s e
s at i s fa c t i o n w i t h l i f e i n
general
a b s e n t N (%) present N (%) t ota l ( % )
............................................................................................................................................................................................................................................................................................................................

Total sample
Very satisfied 390 (71.7) 154 (28.3) 544 (100)
Satisfied 1,238 (79.9) 311 (20.1) 1,549 (100)
Neither satisfied nor dissatisfied 350 (83.1) 71 (16.9) 421 (100)
Dissatisfied 216 (78.0) 61 (22.0) 277 (100)
Very dissatisfied 32 (72.7) 12 (27.3) 44 (100)
Total 2,226 (78.5) 609 (21.5) 2,835 (100)
Males
Very satisfied 155 (54.4) 130 (45.6) 285 (100)
Satisfied 469 (64.1) 263 (35.9) 732 (100)
Neither satisfied nor dissatisfied 141 (69.5) 62 (30.5) 203 (100)
Dissatisfied 84 (60.9) 54 (39.1) 138 (100)
Very dissatisfied 13 (54.2) 11 (45.8) 24 (100)
Total 862 (62.4) 520 (37.6) 1,383 (100)
Females
Very satisfied 235 (90.7) 24 (9.3) 259 (100)
Satisfied 769 (94.1) 48 (5.9) 817 (100)
Neither satisfied nor dissatisfied 209 (95.9) 9 (4.1) 218 (100)
Dissatisfied 132 (95.0) 7 (5.0) 139 (100)
Very dissatisfied 19 (95.0) 1 (5.0) 20 (100)
Total 1,364 (93.9) 89 (6.1) 1,453 (100)
a Datapertaining to satisfaction with life in general were missing for 39 (1.3%) of the total sample [9 (0.6%) males and 30 (2.0%) females].
Data pertaining to current alcohol use were missing for 70 (2.4%) of the total sample [21 (1.5%) males and 49 (3.2%) females].

categories between these two extremes [χ 2 (4) = aged 55 years and older (Blazer and Wu, 2009).
23.1, p < 0.001]. For men, the rates of current The rate of current alcohol use found in the current
alcohol use were 45.6% (95% CI: 42.9%, 48.2) study is also lower than that which had been
for those who were very satisfied; 45.8% (95% CI: obtained from a previous lifestyle survey in Jamaica
43.2%, 48.4%) for those who were very dissatisfied (Wilks et al., 2008). In that study, for both sexes
and 30.5% (95% CI: 28.1%, 32.9%) – 39.1% (95% combined, current alcohol use was found to be
CI: 36.5%, 41.7%) for other categories [χ 2 (4) = present in 66% of persons aged 55–64 years and
13.8, p = 0.008]. Among women, there were no 48% of persons aged 65–74 years.
significant differences in current alcohol use across An examination of the rates of alcohol use by
categories of life satisfaction [χ 2 (4) = 6.4, p = sex for the current study may give some indication
0.167]. about the reasons for the overall low rate in
comparison to other studies. From our sample,
women were six times less likely to report current
alcohol use than men. This may reflect culturally
Discussion
determined, gender-related patterns of alcohol use
Almost one in every five participants consumed among older Jamaicans and may also have resulted
alcohol in the 12-month period prior to being in a dilution effect on the overall rate of current
interviewed. Alcohol use is therefore a prominent alcohol use. The rate of alcohol use among men
practice among older Jamaicans. The prevalence was 37.6% which is not very far removed from
figure is, however, lower than has been observed the 48% previously observed by Wilks et al. (2008)
among older persons in other settings. Studies on among Jamaican men and women between 65 and
older persons in the USA have yielded rates of 74 years of age. In the study of Wilks et al. (2008),
current alcohol use (defined, as in the current men outnumbered women in the 55–74 age group
study, as use within the last 12 months) of 72% and thus possibly exaggerating overall rates of current
57% among males and females, respectively aged alcohol use. Taking into consideration the findings
60 years and older (Mirand and Welte, 1996) and and participant characteristics of the current study
66% and 55%, respectively for men and women as well as those of the previously mentioned studies

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from the USA (Mirand and Welte 1996; Blazer and
Wu 2009) and Jamaica (Wilks et al., 2008), it would
appear that older Jamaicans have a relatively low,
but appreciable, rate of current alcohol use and that
this issue is primarily relevant for Jamaican men.
The finding of declining levels of current alcohol
use with increasing age is not surprising and is
similar to findings elsewhere (Mirand and Welte,
1996; Breslow et al., 2003). This may be related
to age-related physiological changes that affect
the body’s handling of alcohol and make older
adults more sensitive to its effects (Breslow, et al.,
2003) including untoward ones such as altered
consciousness and confusion. For this reason,
greater avoidance of alcohol would be expected
with advancing age. In addition, chronic medical
illnesses are more likely with increasing age and
the possible worsening of these conditions with
alcohol use is fairly well established (Rigler, 2000;
Liu et al., 2010; Skliros et al., 2012). In recognition
of the issue, older persons may opt to reduce or
discontinue their use of alcohol.
Past research has suggested that persons at the
extremes of alcohol use (abstinence and heavy
use) have higher rates of depression than persons
who drink alcohol in moderation (Alati et al.,
2005; Graham et al., 2007; Kim et al., 2015).
These findings tend to yield a J-shaped curve when
depression severity is plotted against alcohol use
on a graph and has been found in diverse age-
groups and settings (Alati et al., 2005; Graham
et al., 2007; Kim et al., 2015). The current
study did not explore the intensity of alcohol
use beyond the categories of “current use” and
“no current use.” Its findings cannot, therefore,
inform a comprehensive conclusion about the
applicability of the J-curve phenomenon to the
population of older Jamaicans. There was, however,
some indication that at least some of the J-curve
phenomenon may exist among this population:
Abstainers had higher rates of depression than
current users (no conclusions can be formulated
about moderate versus heavy drinkers).
The reasons for the high rate of depression
among abstainers may be related to the social aspect
of drinking alcohol. Persons who are depressed
are less likely to engage in social activities (Fiske
et al., 2009) (which include alcohol use). This
finding and explanatory hypothesis contrast with
the often observed phenomenon of high rates
of depression among heavy drinkers of alcohol,
ostensibly because alcohol is used by depressed
individuals as self-medication for their depressive
symptoms (Bolton et al., 2009). However, given
the usual low proportion of heavy drinkers in
the general population (Mirand and Welte, 1996;
Blazer and Wu, 2009), it is likely that, overall,
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Alcohol use among Jamaican elderly 7
excessive users of alcohol were in the minority
of the study participants who were identified
as current users. Thus, the inverse relationship
between alcohol use and depression observed
in this study may reflect a phenomenon found
when comparing abstainers with primarily low and
moderate users of alcohol, as opposed to what
might obtain had the current users of alcohol been
predominantly heavy users.
Results from another aspect of our current
analysis also tend to support our hypotheses about
social and self-medicating issues playing a role in
older Jamaicans’ motivation for consuming alcohol.
The highest rates of current alcohol use were found
among persons who were either highly satisfied or
highly dissatisfied with their lives. Highly satisfied
persons are likely to engage in social activities
(Kelly et al., 1987) which might include alcohol
use. On the other hand, highly dissatisfied persons
are intuitively more likely than others to experience
frustration and distress which could lead to alcohol
intake as another type of self-medication strategy.
Of note, the association between current alcohol
use and depression was less significant among wo-
men than men (with statistically significant findings
from analyses of women’s depression severity scores
but not from analyses of the relevant depression
categories). Also, the association between current
alcohol use and life satisfaction was not at
all significant among women although statistical
significance was encountered among men. These
sex differences may reflect the fact that current
alcohol use among women was very low so that
the demonstration of any significant associations
would have been difficult. It is also possible that
the associations in question lack relevance for the
much less prominent public health issue of alcohol
use among older women (in comparison to its use
among older men).
Future research which incorporates quantifica-
tion of past and current use of alcohol as well
as participants’ stated reasons for drinking alcohol
should be able to more definitively determine the
extent to which the explanatory hypotheses that
have been proposed for the current study’s findings
are true.
Apart from the absence of detailed quantification
of alcohol use and of information on persons’
stated reasons for drinking alcohol, there are
other limitations of the current study. The data
were not collected with the objective of answering
our research questions. Hence, the measures
and variables of interest were selected based on
availability rather than design. Additional measures
of life satisfaction, in particular, could have
made the analyses more robust. The absence
of analyses to control for potential confounding
 8 R. C. Gibson et al.
variables, the inability to make causal inferences
from the findings, and the participation of only
community-dwelling older persons (thus restricting
generalizability) are other limitations of the study.
Conclusion
In summary, alcohol use among older persons in
Jamaica is fairly common but less so than in some
other parts of the world. It is much more common
among older men than older women and tends
to be associated with low levels of depression and
either low or high levels of satisfaction with life.
Conflicts of interest
None.
Description of authors’ roles
R.C. Gibson formulated the research questions,
analyzed the data, and wrote the paper. N.K.
Waldron contributed to the conceptualization of
the research and the design of the study; he was
involved in the supervision of data collection and
critically reviewed drafts of the paper. W.D. Abel
contributed to the conceptualization of the research
and the design of the study; he also critically
reviewed drafts of the paper. D. Eldemire-Shearer
conceptualized the research and the design of
the study; she supervised the data collection and
critically reviewed drafts of the paper. K. James
contributed to the conceptualization of the study
and was responsible for its statistical design; he also
critically reviewed drafts of the paper. K. Mitchell-
Fearon contributed to the conceptualization of the
study and its statistical design; she also critically
reviewed drafts of the paper.
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