Heavy alcohol consumption, depression, their comorbidity and risk of all-cause and cause-specific mortality: a prospective cohort study. - National Genomics Data Center (CNCB-NGDC)

Advanced Search

Heavy alcohol consumption, depression, their comorbidity and risk of all-cause and cause-specific mortality: a prospective cohort study.

Chao Yan, Yan Ding, Hairong He, Jun Lyu, Ying Zhao, Zhenguo Yang, Heng Meng

Author Information

Chao Yan: Department of Gastroenterology, The First Affiliated Hospital of Jinan University, 613 West Huangpu Ave, Guangzhou, 510630, China.
Yan Ding: Department of Neurology and Stroke Center, The First Affiliated Hospital, & Clinical, Neuroscience Institute of Jinan University, 613 West Huangpu Ave, Guangzhou, 510630, China.
Hairong He: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
Jun Lyu: Department of Clinical Research, The First Affiliated Hospital of Jinan University, 613 West Huangpu Ave, Guangzhou, 510630, China.
Ying Zhao: Department of Neurology and Stroke Center, The First Affiliated Hospital, & Clinical, Neuroscience Institute of Jinan University, 613 West Huangpu Ave, Guangzhou, 510630, China.
Zhenguo Yang: Department of Neurology and Stroke Center, The First Affiliated Hospital, & Clinical, Neuroscience Institute of Jinan University, 613 West Huangpu Ave, Guangzhou, 510630, China. yangzhenguo@jnu.edu.cn.
Heng Meng: Department of Neurology and Stroke Center, The First Affiliated Hospital, & Clinical, Neuroscience Institute of Jinan University, 613 West Huangpu Ave, Guangzhou, 510630, China.

PMID: 40131379 DOI: 10.1007/s00127-025-02873-9

BACKGROUND: Alcohol consumption and depression commonly co-occur, and most current research has focused on the associations between either alcohol consumption or depression alone with mortality risk. However, the association of the comorbidity of heavy alcohol consumption and depression on the risk of all-cause and cause-specific mortality remains unclear in the U.S.
POPULATION:
AIM: The objective of our study was to analyze the risks of all-cause and cause-specific mortality in participants who have heavy alcohol consumption alone, depression alone, or both, by conducting a prospective cohort study with a sample in the National Health and Nutrition Examination Survey (NHANES) database.
METHOD: For this cohort study, we included 11,590 U.S. adults aged��20 years from a nationally representative sample. Data on depression and alcohol consumption were extracted from the NHANES conducted between 2005 and 2018, and mortality information was obtained from the NHANES Linked Mortality File through December 31, 2019. Drinking and depression were classified into four groups: only heavy alcohol consumption, only depression, both present, and neither present. By adjusting for confounding factors, we applied the Cox proportional hazards model to investigate the risk of all-cause mortality associated with alcohol consumption and depressive states, including cardiovascular disease (CVD), cancer, and other causes. The log-rank test and Kaplan-Meier (K-M) survival analysis were applied to investigate differences in survival probabilities. Additionally, we examined the correlation between heavy alcohol consumption and depression by assessing additive interaction using the synergy index (SI), the attributable proportion due to interaction (AP), and the relative excess risk due to interaction (RERI).
RESULTS: The adjusted HR (aHR) for all-cause mortality, as well as mortality due to CVD, cancer, and other causes, were highest among individuals with comorbid heavy alcohol consumption and depression (HR 2.68[95%CI 1.84,3.91]; 2.64 [95%CI 1.27, 5.48]; 2.55 [95%CI 1.22,5.35]; and 2.78[95%CI 1.64, 4.71]). However, the results of additive and multiplicative interactions indicated that the synergistic effect of heavy alcohol consumption and depression on all-cause and cause-specific mortality did not reach statistical significance.
CONCLUSIONS: Our findings confirmed that heavy alcohol consumption or depression was associated with an increased risk of all-cause and other-cause mortality. Although the synergistic effect of comorbid heavy alcohol consumption and depression on all-cause and cause-specific mortality did not reach statistical significance, the comorbidity of heavy alcohol consumption and depression was associated with the highest risk of all-cause and cause-specific mortality. This research could provide a foundation for further investigations into the mechanisms underlying the comorbidity of heavy alcohol consumption and depression, as well as interventions for depression among heavy alcohol consumers, with significant implications for public health and clinical practice.

Comorbidity Depression Heavy alcohol consumption Mortality NHANES

Nunes EV (2023) Alcohol and the etiology of depression. Am J Psychiatry 180(3):179��181. https://doi.org/10.1176/appi.ajp.20230004 [DOI: 10.1176/appi.ajp.20230004]
McHugh RK, Weiss RD (2019) Alcohol use disorder and depressive disorders. Alcohol Research: Curr Reviews 40. https://doi.org/10.35946/arcr.v40.1.01
Fernandes GS, Lewis G, Hammerton G et al (2020) Alcohol consumption and internalising disorders in young adults of ALSPAC: a population-based study. J Epidemiol Commun Health 74(12):1023��1027. https://doi.org/10.1136/jech-2020-213922 [DOI: 10.1136/jech-2020-213922]
Grant BF, Goldstein RB, Saha TD et al (2015) Epidemiology of DSM-5 alcohol use disorder: results from the National epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry 72(8):757��766. https://doi.org/10.1001/jamapsychiatry.2015.0584 [DOI: 10.1001/jamapsychiatry.2015.0584]
Schouten MJE, Ten Have M, Tuithof M et al (2023) Alcohol use as a predictor of the course of major depressive disorder: a prospective population-based study. Epidemiol Psychiatric Sci 32:e14. https://doi.org/10.1017/s2045796023000070 [DOI: 10.1017/s2045796023000070]
Xi B, Veeranki SP, Zhao M et al (2017) Relationship of alcohol consumption to All-Cause, cardiovascular, and Cancer-Related mortality in U.S. Adults. J Am Coll Cardiol 70(8):913��922. https://doi.org/10.1016/j.jacc.2017.06.054 [DOI: 10.1016/j.jacc.2017.06.054]
Tian Y, Liu J, Zhao Y et al (2023) Alcohol consumption and all-cause and cause-specific mortality among US adults: prospective cohort study. BMC Med 21(1):208. https://doi.org/10.1186/s12916-023-02907-6 [DOI: 10.1186/s12916-023-02907-6]
(2018) Alcohol use and burden for 195 countries and territories, 1990��2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (London England) 392(10152):1015��1035 https://doi.org/10.1016/s0140-6736(18)31310-2
Barber��a-Latasa M, Gea A, Mart��nez-Gonz��lez MA (2022) Alcohol, drinking pattern, and chronic disease. Nutrients 14(9). https://doi.org/10.3390/nu14091954
Ng CS, Au M, Ma R et al (2022) The impact of alcohol pricing policies on public health in Hong Kong, China: A modelling study. Lancet Reg Health Western Pac 26:100510. https://doi.org/10.1016/j.lanwpc.2022.100510 [DOI: 10.1016/j.lanwpc.2022.100510]
Wood AM, Kaptoge S, Butterworth AS et al (2018) Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet (London England) 391(10129):1513��1523. https://doi.org/10.1016/s0140-6736(18)30134-x [DOI: 10.1016/s0140-6736(18)30134-x]
(2024) Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990��2021: a systematic analysis for the global burden of disease study 2021. Lancet (London, England). https://doi.org/10.1016/s0140-6736(24)00757-8
(2020) Global burden of 369 diseases and injuries in 204 countries and territories, 1990��2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London England) 396(10258):1204��1222 https://doi.org/10.1016/s0140-6736(20)30925-9
Bruffaerts R, Caywood K, Axinn WG (2024) Early-life risk factors for depression among young adults in the united States general population: attributable risks and gender differences. J Affect Disord 363:206��213. https://doi.org/10.1016/j.jad.2024.07.090 [DOI: 10.1016/j.jad.2024.07.090]
Mangione CM, Barry MJ, Nicholson WK et al (2022) Screening for depression and suicide risk in children and adolescents: US preventive services task force recommendation statement. JAMA 328(15):1534��1542. https://doi.org/10.1001/jama.2022.16946 [DOI: 10.1001/jama.2022.16946]
Holma M, Holma I, Isomets�� E (2020) Comorbid alcohol use disorder in psychiatric MDD patients: A five-year prospective study. J Affect Disord 267:283��288. https://doi.org/10.1016/j.jad.2020.02.024 [DOI: 10.1016/j.jad.2020.02.024]
Bri��re FN, Rohde P, Seeley JR et al (2014) Comorbidity between major depression and alcohol use disorder from adolescence to adulthood. Compr Psychiatr 55(3):526��533. https://doi.org/10.1016/j.comppsych.2013.10.007 [DOI: 10.1016/j.comppsych.2013.10.007]
Kuria MW, Ndetei DM, Obot IS et al (2012) The association between alcohol dependence and depression before and after treatment for alcohol dependence. ISRN Psychiatry 2012(482802). https://doi.org/10.5402/2012/482802
Castillo-Carniglia A, Keyes KM, Hasin DS et al (2019) Psychiatric comorbidities in alcohol use disorder. Lancet Psychiatry 6(12):1068��1080. https://doi.org/10.1016/s2215-0366(19)30222-6 [DOI: 10.1016/s2215-0366(19)30222-6]
Sarich P, Gao S, Zhu Y et al (2024) The association between alcohol consumption and all-cause mortality: an umbrella review of systematic reviews using lifetime abstainers or low-volume drinkers as a reference group. Addiction (Abingdon England) 119(6):998��1012. https://doi.org/10.1111/add.16446 [DOI: 10.1111/add.16446]
Xia W, Jiang H, Di H et al (2022) Association between self-reported depression and risk of all-cause mortality and cause-specific mortality. J Affect Disord 299:353��358. https://doi.org/10.1016/j.jad.2021.12.018 [DOI: 10.1016/j.jad.2021.12.018]
Meng R, Yu C, Liu N et al (2020) Association of depression with All-Cause and cardiovascular disease mortality among adults in China. JAMA Netw Open 3(2):e1921043. https://doi.org/10.1001/jamanetworkopen.2019.21043 [DOI: 10.1001/jamanetworkopen.2019.21043]
Hjorth��j C, ��stergaard ML, Benros ME et al (2015) Association between alcohol and substance use disorders and all-cause and cause-specific mortality in schizophrenia, bipolar disorder, and unipolar depression: a nationwide, prospective, register-based study. Lancet Psychiatry 2(9):801��808. https://doi.org/10.1016/s2215-0366(15)00207-2 [DOI: 10.1016/s2215-0366(15)00207-2]
Stockwell T, Zhao J, Panwar S et al (2016) Do moderate drinkers have reduced mortality risk?? A systematic review and Meta-Analysis of alcohol consumption and All-Cause mortality. J Stud Alcohol Drug 77(2):185��198. https://doi.org/10.15288/jsad.2016.77.185 [DOI: 10.15288/jsad.2016.77.185]
Machado MO, Veronese N, Sanches M et al (2018) The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses. BMC Med 16(1):112. https://doi.org/10.1186/s12916-018-1101-z [DOI: 10.1186/s12916-018-1101-z]
Lee SY, Lee JP, Lee J et al (2023) Association between depressive symptoms and the risk of all-cause and cardiovascular mortality among US adults. Prog Neuro-psychopharmacol Biol Psychiatry 125:110755. https://doi.org/10.1016/j.pnpbp.2023.110755 [DOI: 10.1016/j.pnpbp.2023.110755]
Yang H, Sun D, Yang Y et al (2023) Association of depression with all-cause and cardiovascular mortality among US adults with high and low baseline risk of cardiovascular disease. Psychiatry Res 320:115051. https://doi.org/10.1016/j.psychres.2023.115051 [DOI: 10.1016/j.psychres.2023.115051]
Schuiling MD, Shell AL, Callahan CM et al (2024) Effect of depression treatment on health behaviors and cardiovascular risk factors in primary care patients with depression and elevated cardiovascular risk: data from the eIMPACT trial. Psychol Med 1��14. https://doi.org/10.1017/s0033291724001429
Khan FM, Kulaksizoglu B, Cilingiroglu M (2010) Depression and coronary heart disease. Curr Atheroscler Rep 12(2):105��109. https://doi.org/10.1007/s11883-010-0096-5 [DOI: 10.1007/s11883-010-0096-5]
Wang YH, Li JQ, Shi JF et al (2020) Depression and anxiety in relation to cancer incidence and mortality: a systematic review and meta-analysis of cohort studies. Mol Psychiatry 25(7):1487��1499. https://doi.org/10.1038/s41380-019-0595-x [DOI: 10.1038/s41380-019-0595-x]
van Tuijl LA, Basten M, Pan KY et al (2023) Depression, anxiety, and the risk of cancer: an individual participant data meta-analysis. Cancer 129(20):3287��3299. https://doi.org/10.1002/cncr.34853 [DOI: 10.1002/cncr.34853]
Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606��613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x [DOI: 10.1046/j.1525-1497.2001.016009606.x]
Laszkowska M, Rodriguez S, Kim J et al (2021) Heavy alcohol use is associated with gastric cancer: analysis of the National health and nutrition examination survey from 1999 to 2010. Am J Gastroenterol 116(5):1083��1086. https://doi.org/10.14309/ajg.0000000000001166 [DOI: 10.14309/ajg.0000000000001166]
Bao W, Liu B, Simonsen DW et al (2020) Association between exposure to pyrethroid insecticides and risk of All-Cause and Cause-Specific mortality in the general US adult population. JAMA Intern Med 180(3):367��374. https://doi.org/10.1001/jamainternmed.2019.6019 [DOI: 10.1001/jamainternmed.2019.6019]
Andersson T, Alfredsson L, K��llberg H et al (2005) Calculating measures of biological interaction. Eur J Epidemiol 20(7):575��579. https://doi.org/10.1007/s10654-005-7835-x [DOI: 10.1007/s10654-005-7835-x]
K��llberg H, Ahlbom A, Alfredsson L (2006) Calculating measures of biological interaction using R. Eur J Epidemiol 21(8):571��573. https://doi.org/10.1007/s10654-006-9037-6 [DOI: 10.1007/s10654-006-9037-6]
Zhou J, Wang N, Wang D et al (2021) Interactive effects of serum ferritin and high sensitivity C-reactive protein on diabetes in hypertensive patients. Journal of trace elements in medicine and biology: organ of the society for minerals and trace elements (GMS). 68126824. https://doi.org/10.1016/j.jtemb.2021.126824
Swendsen JD, Merikangas KR (2000) The comorbidity of depression and substance use disorders. Clin Psychol Rev 20(2):173��189. https://doi.org/10.1016/s0272-7358(99)00026-4
Leclercq S, Le Roy T, Furgiuele S et al (2020) Gut Microbiota-Induced changes in ��-Hydroxybutyrate metabolism are linked to altered sociability and depression in alcohol use disorder. Cell Rep 33(2):108238. https://doi.org/10.1016/j.celrep.2020.108238 [DOI: 10.1016/j.celrep.2020.108238]
Boden JM, Fergusson DM (2011) Alcohol and depression. Addiction (Abingdon, England). 106(5):906��914. https://doi.org/10.1111/j.1360-0443.2010.03351.x
Zhang Z, Jackson SL, Gillespie C et al (2023) Depressive symptoms and mortality among US adults. JAMA Netw Open 6(10):e2337011. https://doi.org/10.1001/jamanetworkopen.2023.37011 [DOI: 10.1001/jamanetworkopen.2023.37011]
Krittanawong C, Maitra NS, Qadeer YK et al (2023) Association of depression and cardiovascular disease. Am J Med 136(9):881��895. https://doi.org/10.1016/j.amjmed.2023.04.036 [DOI: 10.1016/j.amjmed.2023.04.036]
Palzes VA, Chi FW, Weisner C et al (2023) Risk profiles of adults with heavy alcohol use: drinking patterns, behavioral and metabolic factors, health problems, and Racial and ethnic disparities. Alcohol Clin Experimental Res 47(12):2301��2312. https://doi.org/10.1111/acer.15211 [DOI: 10.1111/acer.15211]
Ding C, O��Neill D, Bell S et al (2021) Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women. BMC Med 19(1):167. https://doi.org/10.1186/s12916-021-02040-2 [DOI: 10.1186/s12916-021-02040-2]
Rehm J, Rovira P, Llamosas-Falc��n L et al (2021) Dose-Response relationships between levels of alcohol use and risks of mortality or disease, for all people, by age, sex, and specific risk factors. Nutrients 13. https://doi.org/10.3390/nu13082652
Carr T, Kilian C, Llamosas-Falc��n L et al (2024) The risk relationships between alcohol consumption, alcohol use disorder and alcohol use disorder mortality: A systematic review and meta-analysis. Addiction (Abingdon, England) https://doi.org/10.1111/add.16456
Conner KR, Pinquart M, Gamble SA (2009) Meta-analysis of depression and substance use among individuals with alcohol use disorders. J Subst Abuse Treat 37(2):127��137. https://doi.org/10.1016/j.jsat.2008.11.007 [DOI: 10.1016/j.jsat.2008.11.007]
Bellos S, Skapinakis P, Rai D et al (2016) Longitudinal association between different levels of alcohol consumption and a new onset of depression and generalized anxiety disorder: results from an international study in primary care. Psychiatry Res 243:30��34. https://doi.org/10.1016/j.psychres.2016.05.049 [DOI: 10.1016/j.psychres.2016.05.049]
Guertler D, Moehring A, Krause K et al (2020) Copattern of depression and alcohol use in medical care patients: cross-sectional study in Germany. BMJ Open 10(5):e032826. https://doi.org/10.1136/bmjopen-2019-032826 [DOI: 10.1136/bmjopen-2019-032826]
Feng Z, Tong WK, Zhang X et al (2023) Prevalence of depression and association with all-cause and cardiovascular mortality among individuals with type 2 diabetes: a cohort study based on NHANES 2005��2018 data. BMC Psychiatry 23(1):490. https://doi.org/10.1186/s12888-023-04999-z [DOI: 10.1186/s12888-023-04999-z]
Low CE, Yau CE, Tan RY et al (2024) Association of depression with all-cause and cancer-specific mortality in older adults with cancer: systematic review, meta-analysis, and meta-regression. J Geriatric Oncol 15(4):101700. https://doi.org/10.1016/j.jgo.2023.101700 [DOI: 10.1016/j.jgo.2023.101700]
Cabello M, Borges G, Lara E et al (2020) The relationship between all-cause mortality and depression in different gender and age groups of the Spanish population. J Affect Disord 266:424��428. https://doi.org/10.1016/j.jad.2020.01.162 [DOI: 10.1016/j.jad.2020.01.162]
Li W, Chen D, Ruan W et al (2022) Associations of depression, sleep disorder with total and cause-specific mortality: A prospective cohort study. J Affect Disorders 298(Pt A) 134��141. https://doi.org/10.1016/j.jad.2021.10.131
Riper H, Andersson G, Hunter SB et al (2014) Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: a meta-analysis. Addiction (Abingdon England) 109(3):394��406. https://doi.org/10.1111/add.12441 [DOI: 10.1111/add.12441]

2025A03J4169/Funded by Science and Technology Projects in Guangzhou
2023A03J1026/Funded by Science and Technology Projects in Guangzhou
No.2023A1515010218/Basic and Applied Basic Research Foundation of Guangdong Province
82171344/National Natural Science Foundation of China

Journal Article

No available data.