title: Cross-cultural patterns of the association between varying levels of alcohol consumption and the common mental disorders of depression and anxiety: secondary analysis of the WHO Collaborative Study on Psychological Problems in General Health Care.
abstract: BACKGROUND
  Alcohol consumption is associated with several complications of both physical and mental health. Light or moderate alcohol consumption may have beneficial effects on physical or mental health but this effect is still controversial and research in the mental health field is relatively scarce. Our aim was to investigate the association between varying levels of alcohol consumption and the common mental disorders of depression and anxiety in a large international primary care sample.
  
  
  METHODS
  The sample consisted of 5438 primary care attenders from 14 countries who participated in the WHO Collaborative Study of Psychological Problems in General Health Care. Alcohol use was assessed using Alcohol Use Disorders Identification Test (AUDIT) and the mental disorders were assessed with the Composite International Diagnostic Interview (CIDI).
  
  
  RESULTS
  Light to moderate alcohol consumption was associated with a lower prevalence of depression and generalized anxiety disorder compared to abstinence while excessive alcohol consumption was associated with a higher prevalence of depression. This non-linear association was not substantially affected after adjustment for a range of possible confounding variables, including the presence of chronic disease and the current physical status of participants and was evident in different drinking cultures.
  
  
  CONCLUSIONS
  The study confirms that excessive drinking is associated with an increased prevalence of depression, but also raises the possibility that light/moderate drinking may be associated with a reduced prevalence of both depression and anxiety. Any causal interpretation of this association is difficult in the context of this cross-sectional study and further longitudinal studies are needed.
authors.affiliation: Department of Psychiatry, University of Ioannina School of Medicine, Ioannina 45110, Greece. Electronic address: bellos.stefanos@gmail.com.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Bellos
authors.forename: Petros
authors.initials: P
authors.lastname: Skapinakis
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Rai
authors.forename: Pedro
authors.initials: P
authors.lastname: Zitko
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.forename: Christos
authors.initials: C
authors.lastname: Lionis
authors.forename: Venetsanos
authors.initials: V
authors.lastname: Mavreas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology*; D019973:Alcohol-Related Disorders / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D001007:Anxiety / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D014944:World Health Organization; D055815:Young Adult
keywords: Alcohol drinking/*epidemiology; Alcohol drinking/*psychology; Anxiety disorders; Cross-cultural comparison; Depressive disorders; Primary health care