Psychological Medicine

Original Articles

Alcohol-use disorder severity predicts first-incidence of depressive disorders

L. Boschlooa1a2, W. van den Brinka3, B. W. J. H. Penninxa1a2, M. M. Walla4a5 and D. S. Hasina4a5a6 c1

a1 Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands

a2 EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

a3 Academic Medical Center University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands

a4 Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, NY 10032, USA

a5 College of Physicians and Surgeons, Department of Psychiatry, Columbia University, New York, NY 10032, USA

a6 New York State Psychiatric Institute, New York, NY 10032, USA


Background Previous studies suggest that alcohol-use disorder severity, defined by the number of criteria met, provides a more informative phenotype than dichotomized DSM-IV diagnostic measures of alcohol use disorders. Therefore, this study examined whether alcohol-use disorder severity predicted first-incident depressive disorders, an association that has never been found for the presence or absence of an alcohol use disorder in the general population.

Method In a national sample of persons who had never experienced a major depressive disorder (MDD), dysthymia, manic or hypomanic episode (n=27 571), we examined whether a version of DSM-5 alcohol-use disorder severity (a count of three abuse and all seven dependence criteria) linearly predicted first-incident depressive disorders (MDD or dysthymia) after 3-year follow-up. Wald tests were used to assess whether more complicated models defined the relationship more accurately.

Results First-incidence of depressive disorders varied across alcohol-use disorder severity and was 4.20% in persons meeting no alcohol-use disorder criteria versus 44.47% in persons meeting all 10 criteria. Alcohol-use disorder severity significantly predicted first-incidence of depressive disorders in a linear fashion (odds ratio 1.14, 95% CI 1.06–1.22), even after adjustment for sociodemographics, smoking status and predisposing factors for depressive disorders, such as general vulnerability factors, psychiatric co-morbidity and subthreshold depressive disorders. This linear model explained the relationship just as well as more complicated models.

Conclusions Alcohol-use disorder severity was a significant linear predictor of first-incident depressive disorders after 3-year follow-up and may be useful in identifying a high-risk group for depressive disorders that could be targeted by prevention strategies.

(Received April 13 2011)

(Revised July 08 2011)

(Accepted July 29 2011)

(Online publication August 26 2011)


c1 Address for correspondence: D. S. Hasin, PhD, Columbia University, College of Physicians & Surgeons, 1051 Riverside Drive #123, New York, New York 10032, USA. (Email: