Depresión y consumo de alcohol en mujerescomorbilidad, prevalencia y factores asociados

Resumen

INTRODUCTION: The Disorder of Excessive Alcohol Consumption is very relevant because of its association with a high comorbidity and mortality. The socio-psycho-cultural factors related to gender influence in a decisive manner the patterns of alcohol consumption. The comorbidity between excessive alcohol consumption and the depressive disorders is particularly worrisome among female patients. OBJECTIVES: General: To know in the context of Primary Health Care the Point Prevalence and the Life Prevalence of Depressive Disorder in women and its relation with the Prevalence of alcohol consumption. Specifics: 1. Analyze the prevalence of depression at the time of the study and along the life of the subjects and the risk factors associated. Classify the women according to alcohol consumption. To study the association between the presence of depressive disorders and the degree of alcohol consumption. To find out the main risk factors associated with alcohol risk consumption or abuse/dependence of alcohol as well as with depression in the actual moment or along the life. To find out the comorbidity between depression and alcohol consumption. MATERIAL AND METHOD: We carried out a descriptive observational study: transversal and prospective. The final sample consisted of 256 adult women consulting in Primary Health Care. The method for data collection was the interview, this interview included: 1. Sociodemographic variables, 2. Variables related with drugs consumption : alcohol consumption pattern, frequency and amount of alcohol intake, Cage Cuestionary (short out of alcohol consumption risk and alcohol abuse/dependency), diagnostic criteria for alcohol dependency syndrome (DSM-V), 3. Variables related to depressive pathology: DIS-III-R (diagnosis of depression along the whole life), and Beck Scale (quantitative evaluation of the presence of depression). The statistical analysis was performed using the SPSS 24.0 program comprehending univariate analysis, bivariate analysis, and multivariate. RESULTS: The sample mean age was of 41 years (SD: 11, 69, range: 18-65 years). The 11,7% of the women ingested 20 grams per day or more (risk consumption). 16% answered affirmatively to some of CAGE questions. The consumptions of other drugs different from alcohol was the main risk factor associated with alcohol consumption (associated to risk consumption with an OR=23,43 [IC 95%: 3,33-164,54] and to abuse/dependency with an OR=35,21 [IC 95%: 6,201-199,936]). Other factors associated to alcohol consumption were: living without partner (p=0, 02), unemployment (p=0,043), consumption of antidepressant medication (p=0,031). The prevalence of depression in the moment of the study was 38,67% and the life time prevalence 25,39%. In the logistic regression analysis the main factor associated with depression in the present moment was the diagnosis of alcohol dependency with an OR of 5, 6 [CI 95%: 1,170-27,741].Other factors associated were the age of initiation of alcohol consumption (OR= 1,95) [CI 95%: 1,139- 3,339],the diagnosis of depression along the life time (OR= 1,9) [CI 95%: 1,065- 3,416] and living without partner (OR= 1,7) [CI 95%: 1,001- 2,913]. There is a significant association between the mean daily alcohol consumption in grams and the severity of the depression (p=0,002). Out of the 256 women included in the study, 99 (38,7%) had a depression in the moment of the study (Beck ? 17); 30 (11,7%) were consumers of risk ( ? 20 grams of alcohol/day ) and 14 (5,5%) had both diagnoses (depression and risk consumption). CONCLUSSIONS: 1. The 11, 7% of the women have alcohol consumption at the risk level, 9,8% had abuse/dependence and 5,5% dependence 2. The pattern of alcohol consumption at the risk level and /or alcohol dependence occurs mainly at home and /or celebrations with a daily mean of alcohol consumption during the last month higher than 50 g. These patterns of alcohol consumption are significantly associated with the consumption of other drugs and found in a significantly higher percentage among women of nationalities other than Spaniard, without partner or unemployed.3. The prevalence of depression at the time of the study was 38, 67% and the 25,39% had a depressive episode along their lives.4. The mean duration of the depressive episode was 25 months and benzodiazepine was the treatment of choice ;4,2% of the women did not receive any kind of medical treatment nor consulted any kind of health professional.5. The level of depression was associated in a positive and significant fashion with the grams of alcohol ingested daily.6. The use of other drugs is the main risk factor associated to alcohol consumption, both for risk consumption (CAGE?1) and for abuse/dependency (CAGE?2). The fact of been immigrant and of been taken antidepressant medication are also risk factors for the abuse/dependency of alcohol.7. The diagnosis of depression at the time of the study is associated with the suffering of a previous depressive episode. It is also associated with variables related to alcohol consumption patterns (diagnosis of alcohol dependence, late age of consume initiation and not living with a partner).8. The comorbidity between depression and the different stages of alcohol consumption varies between 3, 5% and 6,6%.9.The high consumption of alcohol and depression show a high prevalence, comorbidity and morbi mortality. For this reason the measures of selective prevention directed towards those women with a high probability of falling into risk situations of alcohol consumption and /or depression , as well as those strategies of prevention directed towards the already identified subjects at risk must be priority objectives in Primary Health Care.