Increased screening of alcohol habits among patients with depression is needed

Depression is a common, recurrent, and impairing condition that predicts an increased mortality rate, substance abuse and problems in social networks and working life [1]. Over the past decade in Sweden, work absence due to mental ill-health has risen markedly, and depression is a major factor [2]. Substantial societal costs are associated with the disorder which affects up to 15% of the population at any one time and tends to be recurrent [3].

Alcohol use disorders and other alcohol-related problems frequently co-exist with mood disorders [4], and several studies have shown that depression treatment may be compromised by alcohol use [5,6]. In Sweden, national guidelines recommend screening and assessment of alcohol habits within health care [7,8]. Clinicians are increasingly trained in screening and brief intervention (SBI) techniques to identify individuals with alcohol use problems or who exhibit hazardous drinking behaviours. Early detection of risky use reduces the likelihood that patients will develop health problems or an alcohol use disorder. This is especially important in patients with mental disorders who are already at greater risk of developing alcohol-related problems. At present, routine screening of alcohol consumption habits is still not an entrenched part of clinical practice [9]. This is potentially problematic because most people with depression and related mood disorders initially seek help within the primary care sector, which is the recommended first step and regarded as first line psychiatry. According to Holmqvist et al. [10], there are few studies reporting the extent to which Swedish primary health care professionals address alcohol issues. Geirsson et al. [11] found that the frequency of obtaining information on alcohol among patients in primary care was lower compared to four other lifestyle behaviours. We argue that health care professionals should discuss drinking patterns to a much greater extent than they currently do. Primary health care initiatives have not reached the levels motivated by the significant public health impact of alcohol [12].

To date, research examining the prevalence of alcohol problems in depression has focussed mainly on patients with alcohol dependence in psychiatric inpatient clinics. This research has shown that alcohol dependence is substantially more common among psychiatric inpatients compared to the general population [13]. Recent Swedish studies indicate that hazardous drinking is also highly prevalent among outpatients presenting with mental health concerns. For example, Nehlin et al. [14] found that among 1811 outpatients visiting a general psychiatric clinic, 28.3% of women and 31.3% of men scored above the cut-off for hazardous drinking. Similarly, Eberhard et al. [15] reported that among 1670 non-psychotic outpatients, that 19% of women and 24% of men were hazardous drinkers. In addition to increased screening and assessment, more information is needed about the alcohol habits in patients with less severe forms of depression who present in outpatient clinics [14].

Routine screening of alcohol habits in patients presenting with mood disorders in primary care will likely improve treatment outcomes and may reduce the number of patients who subsequently develop serious substance abuse problems, including alcohol use disorders. In this context, the Alcohol Use Disorders Identification Test (AUDIT) is an efficient and validated instrument that could be used for this purpose [16].