Comorbidity between major depression and alcohol use disorder from adolescence to adulthood

Abstract

Background: Limited information exists regarding the long-term development of comorbidity between Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD; abuse/dependence). Using a representative prospective study, we examine multiple aspects pertaining to MDD+AUD comorbidity, with a focus on the relation between disorders across periods (adolescence, early adulthood, adulthood) and cumulative impairments by age 30.

Method: 816 participants were diagnostically interviewed at ages 16, 17, 24, and 30.

Results: Rates of comorbid MDD+AUD were low in adolescence (2%), but increased in early adulthood (11%) and adulthood (7%). Rates of cumulative comorbidity were elevated (21%). Most individuals with a history of MDD or AUD had the other disorder, except for women with MDD. Prospectively, adolescent AUD predicted early adult MDD, while early adult MDD predicted adult AUD. Compared to pure disorders, MDD+AUD was associated with higher risk of alcohol dependence, suicide attempt, lower global functioning, and life dissatisfaction.

Conclusions: Lifetime rates of comorbid MDD+AUD were considerably higher than in cross-sectional studies. Comorbidity was partly explained by bidirectional and developmentally-specific associations and predicted selected rather than generalized impairments. Clinically, our findings emphasize the need to always carefully assess comorbidity in patients with MDD or AUD, taking into account concurrency and developmental timing.

Figure 1. Subtypes of Cumulative Lifetime Comorbidity between MDD and AUD as a Function of Concurrency and Temporal Ordering

Figure 2. Overall and Gender-Specific Associations between MDD and AUD from Adolescence to Adulthood

Model fit: CFI=0.982; TLI=982; RMSEA=0.022. Associations are standardized regression coefficients. Full lines represent gender invariant associations. Dashed arrows represent gender specific associations. The model adjusts for anxiety disorders, disruptive behavior disorders, and other substance use disorders in adolescence (not shown). Controls were specified to predict MDD and AUD in early adulthood and adulthood and to correlate together and with MDD and AUD in adolescence.