title: Alcohol consumption and depressive symptoms over time: a longitudinal study of patients with and without HIV infection.
abstract: BACKGROUND
  The impact of alcohol consumption on depressive symptoms over time among patients who do not meet criteria for alcohol abuse or dependence is not known.
  
  
  OBJECTIVE
  To evaluate the impact of varying levels of alcohol consumption on depressive symptoms over time in patients with and without HIV infection.
  
  
  METHODS
  We used data from the Veterans Aging Cohort Study (VACS). We used generalized estimating equation models to assess the association of alcohol-related categories, as a fixed effect, on the time-varying outcome of depressive symptoms.
  
  
  METHODS
  VACS is a prospectively enrolled cohort study of HIV-infected patients and age-, race- and site-matched HIV uninfected patients.
  
  
  METHODS
  Hazardous, binge drinking, alcohol abuse and alcohol dependence were defined using standard criteria. Depressive symptoms were measured by the Patient Health Questionnaire (PHQ-9).
  
  
  RESULTS
  Among the 2446 patients, 19% reported past but not current alcohol use, 50% non-hazardous drinking, 8% hazardous drinking, 14% binge drinking, and 10% met criteria for alcohol or dependence. At baseline, depressive symptoms were higher in hazardous and binge drinkers than in past and non-hazardous drinkers (OR=2.65; CI=1.50/4.69; p<.001) and similar to those with abuse or dependence. There was no difference in the association between alcohol-related category and depressive symptoms by HIV status (OR=0.99; CI=.83/1.18; p=.88). Hazardous drinkers were 2.53 (95% CI=1.34/4.81) times and binge drinkers were 2.14 (95% CI=1.49/3.07) times more likely to meet criteria for depression when compared to non-hazardous drinkers. The associations between alcohol consumption and depressive symptoms persisted over three years and were responsive to changes in alcohol-related categories.
  
  
  CONCLUSIONS
  HIV-infected and HIV-uninfected hazardous and binge drinkers have depressive symptoms that are more severe than non-hazardous and non-drinkers and similar to those with alcohol abuse or dependence. Patients who switch to a higher or lower level of drinking experience a similar alteration in their depressive symptoms. Interventions to decrease unhealthy alcohol consumption may improve depressive symptoms.
authors.affiliation: Yale University School of Medicine, New Haven, CT 06520-8093, United States. lynn.sullivan@yale.edu
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Sullivan
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Goulet
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology* / Q000639:trends; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology*; D015331:Cohort Studies; D003625:Data Collection; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D006787:Hospitals, Veterans; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D014481:United States; D055815:Young Adult