Anxiety and Depression Among Patients With Alcohol Dependence Syndrome in a Selected Deaddiction Facility

INTRODUCTION

Alcohol is a clear liquid with a strong, burnt taste. Excessive consumption of alcohol adversely impacts vital body systems, including the cardiovascular, central nervous, gastrointestinal, and immune systems.^[1,2] Even at low doses, alcohol may cause nausea, dizziness, and loss of appetite, while higher doses can result in aggressive behaviour, impaired mobility, and double vision. Overconsumption within 8–12 hours may lead to headaches, nausea, tremors, vomiting, and in severe cases, death.^[3]

Alcohol Dependence Syndrome (ADS), commonly known as alcoholism, is a condition marked by compulsive alcohol use despite its detrimental effects on mental health and functioning.^[3] According to a 2016 World Health Organization (WHO) report, around 380 million people worldwide, representing 5.1% of those aged ≥15 years, suffer from alcoholism. In India, Arunachal Pradesh reported the highest alcohol consumption rates among males (53%) and females (24%), followed by Telangana and Sikkim. Additionally, regions like the Chhota Nagpur plateau in Jharkhand and Odisha, as well as parts of Assam, show male consumption rates exceeding 40%. Alcohol use is notably more prevalent among scheduled tribes compared to other castes and communities.^[4]

A study conducted in Karnataka revealed that 33.6% of participants reported current alcohol use, with males (49.2%) outnumbering females (14.48%). Of these, 32.78% of males and 12.57% of females had been consuming alcohol for over 20 years, and 18.56% of males and 1.90% of females reported consumption for more than two decades.^[5] Alcohol use is often linked to mental health disorders, with anxiety frequently observed during alcohol withdrawal.^[6] While some individuals use alcohol to manage emotional distress, long-term consumption or abstinence often exacerbates anxiety and depression, sometimes leading to additional substance use.^[2,5]

Alcohol dependence symptoms include increased consumption, binge drinking, confusion, tremors, uncontrollable behaviour, and withdrawal symptoms.^[3] Anxiety and depression, though distinct, often coexist. Global research from 2015 found that 41.6% of respondents experienced both severe anxiety and depression within a year.^[7] WHO data from 2023 estimated that 3.8% of the global population, including 5% of adults and 5.7% of older adults, suffer from depressive disorders. Depression is 50% more prevalent among women compared to men.^[8]

Globally, 20–40% of individuals with Alcohol Use Disorder (AUD) also experience anxiety and depression, with alcohol often exacerbating these conditions.^[9] These mental health issues significantly contribute to the global disease burden. However, treatment access remains limited, with only about one in four individuals receiving care due to stigma and resource constraints. In India, depression rates among individuals with AUD are estimated at 30–40%, mirroring global trends of limited access to mental health services.^[9]

In 2019, suicides linked to alcohol and drug use accounted for 5.6% of over 1.3 lakh global suicides, with Maharashtra and Karnataka reporting the highest numbers.^[10] A study revealed that 75% of individuals with alcohol dependence had significant depressive symptoms, including 43.3% with moderate and 10% with severe depression. The severity of alcohol dependence was significantly associated with increased suicidal ideation.^[11]

Patients with severe alcohol dependence often require hospitalisation for deaddiction and management of anxiety and depression. Comprehensive treatment must integrate deaddiction therapy with psychosocial interventions to address these mental health challenges. This study aims to underscore the prevalence and severity of anxiety and depression among individuals with ADS, contributing to improved treatment strategies and better quality of life outcomes for affected patients.

MATERIAL AND METHODS

This quantitative cross-sectional survey aimed to assess anxiety and depression levels among 138 patients with alcohol dependence, recruited using purposive sampling. The study was conducted in the psychiatry outpatient department, deaddiction ward, family psychiatry ward, and general psychiatry ward of a selected hospital. Ethical clearance was obtained (IEC No: FMMC/FMIEC/331/2022), along with hospital permissions. Standardised tools were used with prior authorisation from the authors. A pilot study involving 10 participants confirmed the study’s feasibility. Participants provided informed consent, ensuring confidentiality.

Patients included in the study were aged 20–60 years, diagnosed with ADS, had mild or no withdrawal symptoms (CIWA-Ar score <8),^[12] and could read or understand English, Malayalam, or Kannada. Those with co-morbid psychiatric illnesses other than anxiety and depression were excluded. The sample size was calculated using a previous study by Sayed et al.,^[13] estimating a requirement of 117 participants.

The instruments used in this study were the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar),^[12] is a 10-item tool that evaluates alcohol withdrawal severity through symptoms like nausea, tremors, anxiety, sensory disturbances, and orientation. Baseline Proforma consists of 12 items that collect demographic and clinical details of the participants. The Hospital Anxiety Depression Scale (HADS) is a 14-item self-report scale that assesses anxiety and depression.^[14]

Screening was conducted using the CIWA-Ar. Of the 138 participants, 125 with mild or no withdrawal symptoms were selected. Data collection included a baseline proforma and the HADS. For nine participants with no formal education, an interview method was used to gather data.

Statistical analysis was conducted using SPSS Version 16. Frequencies and percentages summarised the baseline data. Karl Pearson’s correlation coefficient assessed the relationship between anxiety and depression, while Chi-Square or Fisher’s Exact Test examined associations between anxiety and depression scores and baseline variables among patients with ADS.

RESULTS

Correlation between anxiety and depression among patients with alcohol dependence syndrome

To assess the relationship between anxiety and depression in patients with ADS, Pearson’s correlation coefficient was computed. The results, presented in Figure 1, reveal a significant positive correlation between anxiety and depression (r = 0.306, p < 0.05). This finding indicates that higher anxiety levels are associated with increased depression levels, emphasising the interrelated nature of these mental health conditions in individuals with alcohol dependence.

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Figure 1:

Scattered diagram showing correlation between anxiety and depression among patients with alcohol dependence syndrome.

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The chi-square test was computed to find the association between anxiety and depression in patients with alcohol dependence syndrome. The results in Table 1 indicate that there is no significant association between anxiety and depression when considering selected baseline variables. Hence, the null hypothesis is accepted at p<0.05 level of significance. This suggests that the levels of anxiety and depression are independent of the baseline characteristics examined, implying that other factors may influence these mental health issues in this population.

Table 1: Association between anxiety and depression with selected baseline variables among patients with alcohol dependence syndrome. n=125

SI. No	Variables	Chi-square/Fisher’s exact test
		Anxiety (p value)	Depression (p value)
1	Age (in years)	0.467	0.112
2	Gender	0.108	0.119
3	Education	0.824	0.250
4	Occupation	0.549	0.244
5	Marital Status	0.105	0.418
6	Income/month (in rupees)	0.957	0.553
7	Type of family	0.371	0.282
8	Place of living	0.627	0.596
9	Age at first alcohol use	0.657	0.972
10	Duration of alcohol use	0.365	0.141
11	Any medical/surgical illness	0.928	0.474
12	Concurrent use of other psychoactive substances with alcohol	0.815	0.619

P<0.05 level of significance.

DISCUSSION

The findings of this study provide critical insights into the demographic pattern among patients with ADS. A significant proportion of participants were aged between 31 and 40 years, predominantly male, aligning with recent research indicating higher prevalence rates of AUD in these demographics.^[15] The predominance of males in this study corroborates the findings of the previous study and highlights the gender disparities in alcohol consumption, with men generally reporting higher levels of drinking and associated problems compared to women.^[16]

The occupational status revealed that most participants were employed as private workers. This is consistent with the findings of a study that suggested that workplace stress can significantly influence alcohol consumption behaviours.^[17] Additionally, nearly half of the participants reported a monthly income <10,000 INR. A study finding stated that lower socioeconomic status is linked to increased alcohol-related problems and poorer mental health outcomes.^[18]

The chronicity of alcohol use, with many participants consuming alcohol for over 10 years, is particularly concerning. This pattern is associated with a greater likelihood of developing both physical and mental health comorbidities, further complicating treatment outcomes. ^19] The finding showed that most participants reported no medical or surgical illnesses, yet over half used tobacco products. Previous research stated that co-occurring tobacco use is commonly observed among individuals with alcohol dependence and can significantly impact treatment efficacy and recovery.^[20]

The current study results showed that most of the patients with ADS had symptoms of severe anxiety, whereas the highest number of participants had symptoms of severe depression. These results are congruent with the literature stating that more than one in every three alcoholics has experienced symptoms of severe depression and anxiety.^[21] In another study, it was found that 60% of participants experienced mild anxiety, while 40% reported no anxiety symptoms. In contrast, the depression scale indicated that nearly 70% of the subjects had mild depression, with 30% presenting with moderate depression, highlighting a significant prevalence of depressive symptoms among the participants.^[2] A similar study identified internalising symptoms, including anxiety and depression, in alcohol-dependent adolescents, underscoring the significant mental health risks associated with alcohol dependence.^[22]

The current study reveals a significant positive correlation between anxiety and depression (r = 0.306, p = 0.001**), indicating that higher anxiety levels are associated with increased depressive symptoms among patients with ADS. This finding aligns with previous research that highlighted the interconnected nature of these mental health conditions and underscores the necessity for effective treatment strategies that address both simultaneously.^[19,23] Furthermore, the results are corroborated by authors who also reported significant relationships between anxiety and depression within this population (p=0.001).^[24,25] The findings of a parallel study showed a significant positive correlation between anxiety and depression scores (p<0.001), further supporting the need for comprehensive treatment strategies for patients with alcohol use disorders.^[26]

The results of this study indicate that no significant association was observed between anxiety or depression levels and baseline demographic variables (such as age, gender, education, occupation, marital status, income/month, type of family, place of living, age of first alcohol use, duration of alcohol use, and concurrent use of other psychoactive substances with alcohol) among patients with ADS, as confirmed through Chi-square analysis. This outcome aligns with the findings of a study that similarly found no substantial correlation between these baseline factors and mental health conditions in this demographic.^[27] Recent studies underscore that anxiety and depression in alcohol-dependent individuals tend to be more closely related to the shared characteristics of these mental health conditions rather than demographic or baseline variables. For instance, similar research demonstrated that shared symptoms of anxiety and depression predict alcohol use patterns, irrespective of demographic factors, underscoring a general tendency toward emotional dysregulation that transcends specific baseline characteristics.^[28]

However, reviews stated that these insights point toward a more generalised vulnerability to emotional disorders among individuals with alcohol dependence, emphasising the need for interventions that address these common underlying emotional traits rather than focusing on demographic associations.^[28,29]

In the current study findings, the lack of a significant association suggests that these mental health conditions are influenced by different factors rather than being directly linked to each other or to the selected baseline variables. It may also suggest that the association between anxiety and depression in this population is more complex, potentially influenced by other unexamined variables such as social support, substance use history, or treatment engagement. Therefore, further research is necessary to explore these other factors that may impact the mental health outcomes of individuals with ADS.

This study had several limitations. It was conducted among a sample of 125 patients with ADS within a single setting, which may limit the generalisability of the findings. Additionally, this study has not included any intervention. However, the necessary treatment and counselling were delivered by the doctors and the health care team. Further research is recommended to employ a multi-centric design with targeted interventional strategies to address these symptoms among patients with alcohol dependence effectively.

CONCLUSION

The present study concluded that patients addicted to alcohol showed moderate to severe anxiety with severe depressive symptoms. However, the results depicted a highly significant positive correlation between anxiety and depression. The authors strongly recommend that health care professionals must educate the public about the prevention of addictive behaviour by promoting a healthy lifestyle. Specific interventions must be implemented for the addicted patients to overcome the symptoms of anxiety and depression.