Journal presentation:

A Longitudinal study of the order of

onset of alcohol dependence and major
depression (Gilman and Abraham, 2001)

by Andrew MCGovern
Introduction
Points covered:
• The relationship between alcohol dependence
and depression.

• A summary of the subject paper.

• Discussion of the methods

and results.
Alcohol dependence and depression

• Alcohol dependence and major depression commonly

occur together. (Deykin et al., 1987, Regier et al., 1990)

• The prevalence of one condition is significantly higher

if the other condition is present, when compared to the
general population. (Kessler et al., 1996, Kessler et al., 1997)

• Rates of both conditions are increasing at younger ages.

(Helzer et al., 1990, Wittchen et al., 1994)
The study
A Longitudinal study of the order of onset of alcohol
dependence and major depression.

• Objective: to examine the temporal relationship

between depression and alcohol dependence.

• Hypothesis: diagnosis of depression or alcohol

dependence increases risk of developing the other
disorder.
The data
Data from the Epidemiological Catchment Area
community survey (ECA) was used.

The ECA was conducted at 5 locations in the United

States between 1980 and 1985.

The suitable population consisted of 18,571 (78%)

subjects who were re-interviewed after 1 year.
Data collection
The subjects were interviewed using the Diagnostic
Interview Schedule (DIS).
It is designed for non-clinician interviewers to estimate psychiatric
diagnosis.

DIS kappa (κ) values for predicting:

• Alcohol dependence
• Depression
• Depression test-retest
κ = 0.68 (Heltzer et al., 1985)
κ = 0.86 (Robins et al., 1981)
κ = 0.63 (Heltzer et al., 1985)
κ = 0.33 (Robins et al., 1981)
κ = 0.66 (Semler et al., 1987)
κ = 0.41 (Vandiver and Sher, 1991)
Analytical procedures
Prevalent cases of the outcome disorder at baseline were
excluded from each group.

Groups were controlled for age, gender, socio-economic

status, ethnicity and ECA site.

Sampling weights were used to standardise the study

population to the age, race and sex distribution of the
United States according to the 1980 census.
Results: Risk of alcohol dependence
For both sexes there was no significant association
between depression at baseline and alcohol
dependence after one year.

For females there is a correlation between alcohol

dependence and number of depressive
symptoms at baseline.

There is a marginally significant relationship in

males.
Results: Risk of major depression
For both sexes there were increased odds of
depression associated with alcohol dependence
at baseline.
Study limitations
DIS diagnosis is imperfect:
• Inaccuracies at first and second interviews.
• Lifetime cases misclassified as incident cases at second
interview.

Self reported symptoms are inconsistent.

Interview technique may be gender biased.

Population sample may not be geographically universal.

Data was recorded 1980-1985.

Conclusion
Alcohol dependence and major depression commonly
occur together.

There is correlation between the number of depressive

symptoms and the onset of alcoholism in women only.

Alcoholism is an independent risk factor for

developing depression in both women and men.
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