Alcohol-use disorders and depression commonly coexist, presenting unique challenges for both individuals who suffer from this "comorbidity" as well as their treatment providers. A study in the August issue of Alcoholism: Clinical & Experimental Research examines co-occurring alcohol-use and depression symptoms among pregnant and postpartum women. The findings indicate that women who experience depression, binge drink, or smoke at any point during their pregnancy may be at risk for depression and alcohol use during their first postpartum year.
"Individuals suffering from depression may experience changes in eating or sleeping habits, a loss of interest in activities, fatigue, difficulty sleeping, poor concentration, low self-esteem, and in some cases, thoughts of harming themselves," explained Gregory G. Homish, research associate at the Research Institute on Addictions at the University at Buffalo - SUNY and first author of the study. "Individuals with an alcohol-use disorder tend to drink more alcohol than intended, may unsuccessfully try to reduce the amount they consume, may change their involvement in social, work or other activities, and may continue to use alcohol despite awareness that it is harmful or causing problems in their lives. Individuals with coexisting conditions often are more difficult to treat and have a poorer prognosis."
"I don't think that the general public is aware of how common the coexistence of alcohol-use disorders and depression is," said Rina Das Eiden, a senior scientist at the Research Institute on Addictions at the University at Buffalo - SUNY. "People generally think of these problems as being completely separate from each other. This is true for medical treatment of these problems as well; treatment of depression does not generally involve treatment for alcohol problems and vice versa."
"Not only does much of what we know about comorbidity come from studies of men involved in treatment," added Homish, "but individuals already involved in treatment are not likely to be the same as individuals not in treatment. Furthermore, there has been little research on comorbidity of alcohol use and depression in pregnant and postpartum women. This is unfortunate, as alcohol use and depression during pregnancy can be a marker for women at risk for later difficulties with alcohol and depression, which can adversely affect both women and the development of their children. Children whose mothers have alcohol use disorders and/or depression tend to have more physical and psychological development deficits and have fewer resources directed towards their care. Thus, identifying women at risk for these conditions can benefit both the mother and child."
Researchers examined data collected from an ongoing, longitudinal study of pregnancy outcomes, the Maternal Health Practices and Child Development Project (MHPCD). The MHPCD recruited women in their fourth prenatal month from a large, urban prenatal clinic in Pittsburgh, PA between 1983 and 1985, assessing them in their fourth and seventh prenatal month, at delivery, and then together with their children at eight and 18 months, then three, six, 10, 14, 16 and 21 years later. For this particular study, five groups of prenatal variables (psychological standing, substance use, social factors, obstetrical complications, and demographics) were collected at four points in time (the 4th and 7th month of pregnancy, delivery, and 8 months postpartum) for 595 women.
"We found that women who experience depressive symptoms, binge drink, or smoke at any point during their pregnancy may be at risk for depression and alcohol use during their first postpartum year," said Homish. "The fact that these factors were not trimester specific is important, as it suggests that women’s mental health should be evaluated throughout their pregnancy and, for women identified as being at greater risk, into the postpartum period."
"One major implication of these findings is that women experiencing these co-occurring problems during pregnancy should seek help for both of these problems as soon as possible," said Eiden. "Given the challenges of the postpartum period due to the stresses of parenting and changes in hormone levels, which can themselves sometimes result in postpartum depression, treatment during pregnancy is vital."
"Although we know about the harmful effects of alcohol use and depression on women and their children during pregnancy and the postpartum," added Homish, "routine obstetric care often does not identify these women. One of the goals of this study was to raise awareness for the general population that substance use and depression do occur in perinatal populations, screening should be used to identify women who may be at risk, and when warranted, treatment can be initiated sooner. Additionally, a clear understanding of early risk factors for postpartum alcohol use and depressive symptomatology can allow clinicians to more closely monitor these women for changes in their mental-health status during the first postpartum year."
"These findings tell us that comorbidity in the prenatal period is not limited to the prenatal period, but predicts comorbidity in the postnatal period as well," said Eiden. "This not only provides further justification for treating these disorders together, it also indicates that further research on the prevalence of these comorbid conditions may be helpful because currently, most prevalence studies on substance use during pregnancy are limited to substance use alone and do not address dual-diagnosis issues. Future research may also target treatment strategies that address both these issues, instead of treating them separately and in isolation from each other. They may be causally linked. That is, women may engage in binge drinking during pregnancy because they are depressed; and increased alcohol use may enhance levels of depression."
Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Homish, G.G., Cornelius, J.R., Richardson, G.A., & Day, N.L. Antenatal risk factors associated with postpartum comorbid alcohol use and depressive symptomatology. (August 2004). Alcoholism: Clinical & Experimental Research, 28(8) 1242-1248.