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Post alcoholic depression and mental health

Post alcoholic depression and mental health


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We all might have experienced a post-alcoholic hangover after heavy drinking. I think this includes a depressive state, which doesn't last long and wears off once we take rest.

My question is whether occasional excess alcohol consumption can make you depressed permanently? Specifically, I'm wondering whether occasional binge-drinking can lead to a permanent depressive state in the brain?


There have been several studies that show links between binge drinking and depressive symptoms.

However, it's hard to make any strong statement about a particular level of drinking, because drinking behaviors are so variable, and also to quantify the "level" of the effect on depression, because depression symptoms are also variable.

Finally, it's hard to make causal statements because alcohol use could be a coping mechanism for depressive symptoms rather than causal: many studies approach the relationship from the opposite direction, implying the depressive symptoms are causal for alcohol use.

I've pulled a few papers and can discuss them briefly, though this is not a comprehensive review.


Paljärvi, T., Koskenvuo, M., Poikolainen, K., Kauhanen, J., Sillanmäki, L., & Mäkelä, P. (2009). Binge drinking and depressive symptoms: a 5‐year population‐based cohort study. Addiction, 104(7), 1168-1178.

"This study found a positive association between baseline binge drinking and depressive symptoms 5 years later." "Binge drinking was related to symptoms of depression independently of average intake."

I'd note that this study shows some truly massive relationships, odds ratios of 4-9 for some subcategories; it also seems to have some potential for demonstrating a causal role when they are comparing time 1 drinking to time 2 depression, though still not conclusive.

I think this study gets closest to testing what your question is asking, because it explicitly includes measures of hangovers/binging that are missing from some other studies. It also shows a dose-dependent relationship where more frequent binge drinking is associated with more depressive symptoms, but the relationship is still present even at lower levels of binge drinking compared to non-binge drinking.


Grant, B. F., & Harford, T. C. (1995). Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey. Drug and alcohol dependence, 39(3), 197-206.

"Virtually all odds ratios were significantly greater than 1.0, demonstrating that comorbidity of alcohol use disorders and major depression is pervasive in the general population. The magnitude of the association remained stable across the three time frames but diagnostic and subgroup variations in comorbidity were noted. The association between alcohol dependence and major depression was greater than the association between abuse and major depression and the association between alcohol abuse and major depression was consistently greater for females and blacks, compared to their male and non-black counterparts."

This studied focused on older adults, age 57+.


Hill, K. G., White, H. R., Chung, I. J., Hawkins, J. D., & Catalano, R. F. (2000). Early adult outcomes of adolescent binge drinking: person‐and variable‐centered analyses of binge drinking trajectories. Alcoholism: Clinical and Experimental Research, 24(6), 892-901.

"Adolescent alcohol use did not predict educational attain-ment, crime, family roles, or depression."

This study patterned adolescent (<18yo) drinking behaviors into several categories and showed relationships between alcohol use and several other outcomes, but not depression, at age 21.


Okoro, C. A., Brewer, R. D., Naimi, T. S., Moriarty, D. G., Giles, W. H., & Mokdad, A. H. (2004). Binge drinking and health-related quality of life: do popular perceptions match reality?. American journal of preventive medicine, 26(3), 230-233.

"After adjusting for confounding factors, frequent binge drinkers were more likely than non-binge drinkers to experience ≥14 unhealthy days (physical or mental) in the past month (adjusted odds ratio [AOR]=1.39, 95% confidence interval [CI]=1.24-1.56), primarily because they had more mentally unhealthy days than non-binge drinkers (AOR=1.52, 95% CI=1.32-1.75)."

This study combines depressive symptoms with other categories of mental/physical health to assay general quality of life.


And finally I'll end with one meta-analysis:

Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106(5), 906-914.

The current state of the literature suggests a causal linkage between alcohol use disorders and major depression, such that increasing involvement with alcohol increases risk of depression.

They seem to make some arguments for a causal alcohol use -> depression relationship, though I haven't read closely enough to decide whether I am convinced by those arguments.


The authors declare that they have no competing financial interests.

Ames, G., and Cunradi, C. Alcohol use and preventing alcohol-related problems among young adults in the military. Alcohol Research & Health 28:252&ndash257, 2004.

Bray, R.M., and Hourani, L.L. Substance use trends among active duty military personnel: Findings from the United States Department of Defense Health Related Behavior Surveys 1980&ndash2005. Addiction 102(7):1092&ndash 1101, 2007. PMID: 17567397

Bremner, J.D. Southwick, S.M. Darnell, A. and Charney, D.S. Chronic PTSD in Vietnam combat veterans: Course of illness and substance abuse. American Journal of Psychiatry 153(3):369&ndash375, 1996. PMID: 8610824

Breslau, N. Davis, G.C. Andreski, P. and Peterson, E. Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry 48(3):216&ndash222, 1991. PMID: 1996917

Brown, P.J. Stout, R.L. and Mueller, T. Substance use disorder and posttraumatic stress disorder comorbidity: Addiction and psychiatric treatment rates. Psychology of Addictive Behaviors 13:115&ndash122, 1999.

Corrigan, J.D., and Cole, T.B. Substance use disorders and clinical management of traumatic brain injury and posttraumatic stress disorder. JAMA: Journal of the American Medical Association 300(6):720&ndash721, 2008. PMID: 18698070

Department of Defense Task Force on Mental Health. An Achievable Vision: Report of the Department of Defense Task Force on Mental Health [article online], 2007. Falls Church, VA: Defense Health Board. Available from: http://intransition.dcoe.mil/sites/default/files/MHTFReportFinal.pdf. Accessed November 24, 2009.

Department of Veterans Affairs. Report of Consensus Conference: Practice Recommendations for Treatment of Veterans with Comorbid Substance Use Disorder and Posttraumatic Stress Disorder. Washington, DC: Department of Veterans Affairs. 2009.

Dickstein, B.D. Suvak, M. Litz, B.T. and Adler, A.B. Heterogeneity in the course of posttraumatic stress disorder: Trajectories of symptomatology. Journal of Traumatic Stress 23(3):331&ndash339, 2010. PMID: 20564365

Foa, E.B. Keane, T.M. Friedman, M.J. and Cohen, J.A. Eds. Effective Treatments for PTSD, Second Edition. New York: Guilford, 2009.

Foa, E.B., and Kozak, M.J. Emotional processing of fear: Exposure to corrective information. Psychological Bulletin 99(1):20&ndash35, 1986. PMID: 2871574

Ford, J. Russo, E. and Mallon, S. Integrating treatment of posttraumatic stress disorder and substance use disorder. Journal of Counseling & Development 85:475&ndash 489, 2007.

Fredman, S.J. Monson, C.M. and Adair, K.C. &ldquoApplication of Cognitive-Behavioral Conjoint Therapy for PTSD to OEF/OIF Couples.&rdquo Symposium conducted at the 44th Annual Convention of the Association for Cognitive and Behavioral Therapies, San Francisco, CA, November 18&ndash21, 2010.

Gradus, J.L. Street, A.E. Kelly, K. and Stafford J. Sexual harassment experiences and harmful alcohol use in a military sample: Differences in gender and the mediating role of depression. Journal of Studies on Alcohol and Drugs 69(3):348&ndash351, 2008. PMID: 18432376

Grant, B.F., and Dawson, D.A. Alcohol and drug use, abuse, and dependence: Classification, prevalence, and comorbidity. In McCrady, B.S., and Epstein, E.E., Eds. Addictions: A Comprehensive Guidebook. New York: Oxford, 1999, pp. 9&ndash29.

Harwood, H.J. Zhang, Y. Dall, T.M. et al. Economic implications of reduced binge drinking among the military health system&rsquos TRICARE Prime plan beneficiaries. Military Medicine 174(7):728&ndash736, 2009. PMID: 19685845

Hien, D.A. Cohen, L.R. Miele, G.M. et al. Promising treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry 161(8): 1426&ndash1432, 2004. PMID: 15285969

Hien, D. Wells, E.A. Jiang, H. et al. Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. Journal of Consulting and Clinical Psychology 77(4):607&ndash619, 2009. PMID: 19634955

Hoge, C.W. McGurk, D. Thomas, J.L. et al. Mild traumatic brain injury in U.S. soldiers returning from Iraq. New England Journal of Medicine 358(5):453&ndash463, 2008. PMID: 18234750

Jacobsen, L.K. Southwick, S.M. and Kosten, T.R. Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry 158(8):1184&ndash1190, 2001. PMID: 11481147

Jakupcak, M. Tull, M.T. McDermott, M.J. et al. PTSD symptom clusters in relationship to alcohol misuse among Iraq and Afghanistan war veterans seeking post-deployment VA care. Addictive Behaviors 35(9):840&ndash 843, 2010. PMID: 20471180

Khantzian, E.J. Treating Addiction as a Human Process. London: Jason Aronson, 1999.

Maguen, S. Lucenko, B.A. Reger, M.A. et al. The reported impact of direct and indirect killing on mental health symptoms in Iraq War Veterans. Journal of Traumatic Stress 23(1):86&ndash90, 2010a. PMID: 20104592

Maguen, S. Vogt, D.S. King, L.A. et al. The impact of killing on mental health symptoms in Gulf War Veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 3(1): 21&ndash26. 2010b.

McLeod, D.S. Koenen, K.C. Meyer, J.M. et al. Genetic and environmental influences on the relationship among combat exposure, posttraumatic stress disorder symptoms, and alcohol use. Journal of Traumatic Stress 14(2):259&ndash275, 2001. PMID: 11469155

Messer, S.C. Liu, X. Hoge, C.W. et al. Projecting mental disorder prevalence from national surveys to populations-of-interest: An illustration using ECA data and the U.S. Army. Social Psychiatry and Psychiatric Epidemiology 39(6):419&ndash426, 2004. PMID: 15205725

Miller, W.R., and Rollnick, S. Motivational Interviewing: Preparing People for Change. New York: Guilford, 2002.

Milliken, C.S. Auchterlonie, J.L. and Hoge, C.W. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq War. JAMA: Journal of the American Medical Association 298(18):2141&ndash2148, 2007. PMID: 18000197

Najavits, L.M. Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: Guilford, 2002.

Ouimette, P.C. Finney, J.W. and Moos, R.H. Two-year posttreatment functioning and coping of substance abuse patients with posttraumatic stress disorder. Psychology of Addictive Behaviors 13:105&ndash114, 1999.

Scherrer, J.F. Xian, H. Lyons, M.J. et al. Posttraumatic stress disorder combat exposure and nicotine dependence, alcohol dependence, and major depression in male twins. Comprehensive Psychiatry 49(3):297&ndash304, 2008. PMID: 18396190

Seal, K.H. Metzler, T.J. Gima, K.S. et al. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002&ndash2008. American Journal of Public Health 99(9):1651&ndash1658, 2009. PMID: 19608954

Stahre, M.A. Brewer, R.D. Fonesca, V.P. and Naimi, T.S. Binge drinking among U.S. active-duty military personnel. American Journal of Preventative Medicine 36(3): 208&ndash217, 2009. PMID: 19215846

Suris, A., and Lind, L. Military sexual trauma: A review of prevalence and associated health consequences in veterans. Trauma, Violence & Abuse 9(4):250&ndash269, 2008. PMID: 18936282


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The U.S. nursing experts conducted various evidence-based studies to identify the signs and symptoms of depression and suicide. Studies show that different psychological disorders may bear the signs and symptoms of depression (University of Michigan Depression Center, n.d.). For example, moral dilemma, emotional issues, cognitive syndromes, and different clinical perspectives may initiate inadequate behavior. Nursing experts found various evidence-based signs and symptoms of depression. Furthermore, different characteristics are visible on a patient who suffers from a psychological problem or wants to commit suicide. Initially, a person may suffer from stress for a long time. He or she may not communicate with people or avoid social life. Also, the patients may create an inadequate feeling about their ability and self-esteem. Sometimes, these patients may stop their regular works due to anxiety. These mental conditions affect a person’s physique. Therefore, the patient may lose weight in a short time. Nevertheless, depression may make a patient physically weak and ill. Thus, these signs and symptoms show that a patient is suffering from depression (University of Michigan Depression Center, n.d.).


Understanding alcohol use disorders and their treatment

People with alcohol use disorders drink to excess, endangering both themselves and others. This question-and-answer fact sheet explains alcohol problems and how psychologists can help people recover.

For many people, drinking alcohol is nothing more than a pleasant way to relax. People with alcohol use disorders, however, drink to excess, endangering both themselves and others. This question-and-answer fact sheet explains alcohol problems and how psychologists can help people recover.


Alcoholism And Mental Health

The link between mental health and alcohol abuse should not come as a surprise. Dozens of studies can prove that alcohol holds influence on the brain by changing its chemistry. It is only a matter of time before one develops a mental illness from excessive drinking.

Regions of the brain are affected by drinking spirits. Initially, it triggers a sense of pleasure by stimulating the mesolimbic pathway also known as the reward pathway and releasing dopamine. This can eventually turn into an addiction. The hippocampus in the mesolimbic system can trigger fear and anxiety due to lack of motivation. This substance impedes the continuous growth of new brain cells.

Brain mass is also reduced for a drunkard. The decrease in the number of neurons along the prefrontal cortex can lead to changes in emotions and personality.


Envisioning Sobriety

One key to successful sober living is to map out real-life social scenarios.

“Go to the events with a goal in mind,” Murphy of the University of Memphis says. “If your goal is moderate drinking, have a very specific plan for the amount and type of alcohol you'll consume, and how you'll space your drinks. If your goal is abstinence, remind yourself of why​​​ you are making this choice.”

Rehearse how you'll turn down drinks, Murphy says. What alcohol-free beverages will you order? What's your plan if you get hit with a strong craving? It can also help to line up some “safe” people who'll respect your stance.

Also, know you can step away from the party or even leave at any time, Murphy says. “You are under no obligation to tell people why you aren't drinking.”

Lara agrees. “Never compromise your mental health for the sake of going to an event,” she says. “If you're super anxious about a first date or a party where there'll be booze, it's OK to back out or leave early. Anyone who cares about you will understand. Sobriety is about taking care of yourself, not people-pleasing.”

She now loves being sober at big events, such as concerts and weddings. “I actually remember conversations and moments that took place.”


Appropriateness and Outcomes of Mental Health Services

During the past decade, many guidelines for treating mental disorders have been offered to ensure the provision of evidence-based care. Even though few American Indians or Alaska Natives were included in the studies that led to their development, such professional practice guidelines offer the clearest, most carefully considered recommendations available regarding appropriate treatment for this population. They therefore warrant special attention.

The DSM-IV, both within the main text and in its "Outline for Cultural Formulation," does provide clear guidelines for addressing cultural matters, including those specific to this population, in the assessment and treatment of mental health problems Manson & Kleinman, 1998 Mezzich et al., 1999. A growing body of case material demonstrates the utility of applying these guidelines to American Indian children (Novins et al., 1997), as well as to adults Fleming, 1996 Manson, 1996 O'Nell, 1998.

Novins and colleagues (1997) critically analyzed the extension of the "Outline for Cultural Formulation" to American Indian children. Drawing upon rich clinical material, they demonstrated the merits and utility of this approach for understanding the emotional, psychological, and social forces that often buffet Native children. However, Novins and his colleagues underscored the importance of obtaining the perspectives of adult family members and teachers, as well as the children themselves, which is not explicitly considered in the formulation.

No studies have been published regarding the outcomes associated with standard psychiatric care for American Indians and Alaska Natives. Hence, it is not known if practitioners accurately diagnose the mental health needs of American Indians and Alaska Natives, nor whether they receive the same benefits from guideline-based psychiatric care as do whites. For this we must await related studies of treatment outcome, studies that venture beyond the limitations of current thinking with respect to intervention technology and best practices.


Religiousness and mental health: a review

Objective: The relationship between religiosity and mental health has been a perennial source of controversy. This paper reviews the scientific evidence available for the relationship between religion and mental health.

Method: The authors present the main studies and conclusions of a larger systematic review of 850 studies on the religion-mental health relationship published during the 20th Century identified through several databases. The present paper also includes an update on the papers published since 2000, including researches performed in Brazil and a brief historical and methodological background.

Discussion: The majority of well-conducted studies found that higher levels of religious involvement are positively associated with indicators of psychological well-being (life satisfaction, happiness, positive affect, and higher morale) and with less depression, suicidal thoughts and behavior, drug/alcohol use/abuse. Usually the positive impact of religious involvement on mental health is more robust among people under stressful circumstances (the elderly, and those with disability and medical illness). Theoretical pathways of the religiousness-mental health connection and clinical implications of these findings are also discussed.

Conclusions: There is evidence that religious involvement is usually associated with better mental health. We need to improve our understanding of the mediating factors of this association and its use in clinical practice.


What is the connection between depression and alcohol?

We know that there is a connection – self-harm and suicide are much more common in people with alcohol problems 12 13 . It seems that it can work in two ways:

  • you regularly drink too much including (including 'binge drinking') which makes you feel depressed OR
  • you drink to relieve anxiety or depression.
  • Alcohol affects the chemistry of the brain, increasing the risk of depression.
  • Hangovers can create a cycle of waking up feeling ill, anxious, jittery and guilty.
  • Life gets more difficult – arguments with family or friends, trouble at work, memory and sexual problems.

Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal

Background: Evidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.AimEvaluating the clinical value of adding psychological treatments, delivered by community-based counsellors, to primary care-based mental health services for depression and alcohol use disorder (AUD), as recommended by the Mental Health Gap Action Programme (mhGAP).

Method: Two randomised controlled trials, separately for depression and AUD, were carried out. Participants were randomly allocated (1:1) to mental healthcare delivered by mhGAP-trained primary care workers (psychoeducation and psychotropic medicines when indicated), or the same services plus individual psychological treatments (Healthy Activity Program for depression and Counselling for Alcohol Problems). Primary outcomes were symptom severity, measured using the Patient Health Questionnaire - 9 item (PHQ-9) for depression and the Alcohol Use Disorder Identification Test for AUD, and functional impairment, measured using the World Health Organization Disability Assessment Schedule (WHODAS), at 12 months post-enrolment.

Results: Participants with depression in the intervention arm (n = 60) had greater reduction in PHQ-9 and WHODAS scores compared with participants in the control (n = 60) (PHQ-9: M = -5.90, 95% CI -7.55 to -4.25, β = -3.68, 95% CI -5.68 to -1.67, P &lt 0.001, Cohen's d = 0.66 WHODAS: M = -12.21, 95% CI -19.58 to -4.84, β = -10.74, 95% CI -19.96 to -1.53, P= 0.022, Cohen's d = 0.42). For the AUD trial, no significant effect was found when comparing control (n = 80) and intervention participants (n = 82).

Conclusion: Adding a psychological treatment delivered by community-based counsellors increases treatment effects for depression compared with only mhGAP-based services by primary health workers 12 months post-treatment.Declaration of interestNone.

Keywords: Nepal Psychological treatment effectiveness low- and middle-income settings primary healthcare.


Alcoholism And Mental Health

The link between mental health and alcohol abuse should not come as a surprise. Dozens of studies can prove that alcohol holds influence on the brain by changing its chemistry. It is only a matter of time before one develops a mental illness from excessive drinking.

Regions of the brain are affected by drinking spirits. Initially, it triggers a sense of pleasure by stimulating the mesolimbic pathway also known as the reward pathway and releasing dopamine. This can eventually turn into an addiction. The hippocampus in the mesolimbic system can trigger fear and anxiety due to lack of motivation. This substance impedes the continuous growth of new brain cells.

Brain mass is also reduced for a drunkard. The decrease in the number of neurons along the prefrontal cortex can lead to changes in emotions and personality.


Understanding alcohol use disorders and their treatment

People with alcohol use disorders drink to excess, endangering both themselves and others. This question-and-answer fact sheet explains alcohol problems and how psychologists can help people recover.

For many people, drinking alcohol is nothing more than a pleasant way to relax. People with alcohol use disorders, however, drink to excess, endangering both themselves and others. This question-and-answer fact sheet explains alcohol problems and how psychologists can help people recover.


The authors declare that they have no competing financial interests.

Ames, G., and Cunradi, C. Alcohol use and preventing alcohol-related problems among young adults in the military. Alcohol Research & Health 28:252&ndash257, 2004.

Bray, R.M., and Hourani, L.L. Substance use trends among active duty military personnel: Findings from the United States Department of Defense Health Related Behavior Surveys 1980&ndash2005. Addiction 102(7):1092&ndash 1101, 2007. PMID: 17567397

Bremner, J.D. Southwick, S.M. Darnell, A. and Charney, D.S. Chronic PTSD in Vietnam combat veterans: Course of illness and substance abuse. American Journal of Psychiatry 153(3):369&ndash375, 1996. PMID: 8610824

Breslau, N. Davis, G.C. Andreski, P. and Peterson, E. Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry 48(3):216&ndash222, 1991. PMID: 1996917

Brown, P.J. Stout, R.L. and Mueller, T. Substance use disorder and posttraumatic stress disorder comorbidity: Addiction and psychiatric treatment rates. Psychology of Addictive Behaviors 13:115&ndash122, 1999.

Corrigan, J.D., and Cole, T.B. Substance use disorders and clinical management of traumatic brain injury and posttraumatic stress disorder. JAMA: Journal of the American Medical Association 300(6):720&ndash721, 2008. PMID: 18698070

Department of Defense Task Force on Mental Health. An Achievable Vision: Report of the Department of Defense Task Force on Mental Health [article online], 2007. Falls Church, VA: Defense Health Board. Available from: http://intransition.dcoe.mil/sites/default/files/MHTFReportFinal.pdf. Accessed November 24, 2009.

Department of Veterans Affairs. Report of Consensus Conference: Practice Recommendations for Treatment of Veterans with Comorbid Substance Use Disorder and Posttraumatic Stress Disorder. Washington, DC: Department of Veterans Affairs. 2009.

Dickstein, B.D. Suvak, M. Litz, B.T. and Adler, A.B. Heterogeneity in the course of posttraumatic stress disorder: Trajectories of symptomatology. Journal of Traumatic Stress 23(3):331&ndash339, 2010. PMID: 20564365

Foa, E.B. Keane, T.M. Friedman, M.J. and Cohen, J.A. Eds. Effective Treatments for PTSD, Second Edition. New York: Guilford, 2009.

Foa, E.B., and Kozak, M.J. Emotional processing of fear: Exposure to corrective information. Psychological Bulletin 99(1):20&ndash35, 1986. PMID: 2871574

Ford, J. Russo, E. and Mallon, S. Integrating treatment of posttraumatic stress disorder and substance use disorder. Journal of Counseling & Development 85:475&ndash 489, 2007.

Fredman, S.J. Monson, C.M. and Adair, K.C. &ldquoApplication of Cognitive-Behavioral Conjoint Therapy for PTSD to OEF/OIF Couples.&rdquo Symposium conducted at the 44th Annual Convention of the Association for Cognitive and Behavioral Therapies, San Francisco, CA, November 18&ndash21, 2010.

Gradus, J.L. Street, A.E. Kelly, K. and Stafford J. Sexual harassment experiences and harmful alcohol use in a military sample: Differences in gender and the mediating role of depression. Journal of Studies on Alcohol and Drugs 69(3):348&ndash351, 2008. PMID: 18432376

Grant, B.F., and Dawson, D.A. Alcohol and drug use, abuse, and dependence: Classification, prevalence, and comorbidity. In McCrady, B.S., and Epstein, E.E., Eds. Addictions: A Comprehensive Guidebook. New York: Oxford, 1999, pp. 9&ndash29.

Harwood, H.J. Zhang, Y. Dall, T.M. et al. Economic implications of reduced binge drinking among the military health system&rsquos TRICARE Prime plan beneficiaries. Military Medicine 174(7):728&ndash736, 2009. PMID: 19685845

Hien, D.A. Cohen, L.R. Miele, G.M. et al. Promising treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry 161(8): 1426&ndash1432, 2004. PMID: 15285969

Hien, D. Wells, E.A. Jiang, H. et al. Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. Journal of Consulting and Clinical Psychology 77(4):607&ndash619, 2009. PMID: 19634955

Hoge, C.W. McGurk, D. Thomas, J.L. et al. Mild traumatic brain injury in U.S. soldiers returning from Iraq. New England Journal of Medicine 358(5):453&ndash463, 2008. PMID: 18234750

Jacobsen, L.K. Southwick, S.M. and Kosten, T.R. Substance use disorders in patients with posttraumatic stress disorder: A review of the literature. American Journal of Psychiatry 158(8):1184&ndash1190, 2001. PMID: 11481147

Jakupcak, M. Tull, M.T. McDermott, M.J. et al. PTSD symptom clusters in relationship to alcohol misuse among Iraq and Afghanistan war veterans seeking post-deployment VA care. Addictive Behaviors 35(9):840&ndash 843, 2010. PMID: 20471180

Khantzian, E.J. Treating Addiction as a Human Process. London: Jason Aronson, 1999.

Maguen, S. Lucenko, B.A. Reger, M.A. et al. The reported impact of direct and indirect killing on mental health symptoms in Iraq War Veterans. Journal of Traumatic Stress 23(1):86&ndash90, 2010a. PMID: 20104592

Maguen, S. Vogt, D.S. King, L.A. et al. The impact of killing on mental health symptoms in Gulf War Veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 3(1): 21&ndash26. 2010b.

McLeod, D.S. Koenen, K.C. Meyer, J.M. et al. Genetic and environmental influences on the relationship among combat exposure, posttraumatic stress disorder symptoms, and alcohol use. Journal of Traumatic Stress 14(2):259&ndash275, 2001. PMID: 11469155

Messer, S.C. Liu, X. Hoge, C.W. et al. Projecting mental disorder prevalence from national surveys to populations-of-interest: An illustration using ECA data and the U.S. Army. Social Psychiatry and Psychiatric Epidemiology 39(6):419&ndash426, 2004. PMID: 15205725

Miller, W.R., and Rollnick, S. Motivational Interviewing: Preparing People for Change. New York: Guilford, 2002.

Milliken, C.S. Auchterlonie, J.L. and Hoge, C.W. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq War. JAMA: Journal of the American Medical Association 298(18):2141&ndash2148, 2007. PMID: 18000197

Najavits, L.M. Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: Guilford, 2002.

Ouimette, P.C. Finney, J.W. and Moos, R.H. Two-year posttreatment functioning and coping of substance abuse patients with posttraumatic stress disorder. Psychology of Addictive Behaviors 13:105&ndash114, 1999.

Scherrer, J.F. Xian, H. Lyons, M.J. et al. Posttraumatic stress disorder combat exposure and nicotine dependence, alcohol dependence, and major depression in male twins. Comprehensive Psychiatry 49(3):297&ndash304, 2008. PMID: 18396190

Seal, K.H. Metzler, T.J. Gima, K.S. et al. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002&ndash2008. American Journal of Public Health 99(9):1651&ndash1658, 2009. PMID: 19608954

Stahre, M.A. Brewer, R.D. Fonesca, V.P. and Naimi, T.S. Binge drinking among U.S. active-duty military personnel. American Journal of Preventative Medicine 36(3): 208&ndash217, 2009. PMID: 19215846

Suris, A., and Lind, L. Military sexual trauma: A review of prevalence and associated health consequences in veterans. Trauma, Violence & Abuse 9(4):250&ndash269, 2008. PMID: 18936282


Appropriateness and Outcomes of Mental Health Services

During the past decade, many guidelines for treating mental disorders have been offered to ensure the provision of evidence-based care. Even though few American Indians or Alaska Natives were included in the studies that led to their development, such professional practice guidelines offer the clearest, most carefully considered recommendations available regarding appropriate treatment for this population. They therefore warrant special attention.

The DSM-IV, both within the main text and in its "Outline for Cultural Formulation," does provide clear guidelines for addressing cultural matters, including those specific to this population, in the assessment and treatment of mental health problems Manson & Kleinman, 1998 Mezzich et al., 1999. A growing body of case material demonstrates the utility of applying these guidelines to American Indian children (Novins et al., 1997), as well as to adults Fleming, 1996 Manson, 1996 O'Nell, 1998.

Novins and colleagues (1997) critically analyzed the extension of the "Outline for Cultural Formulation" to American Indian children. Drawing upon rich clinical material, they demonstrated the merits and utility of this approach for understanding the emotional, psychological, and social forces that often buffet Native children. However, Novins and his colleagues underscored the importance of obtaining the perspectives of adult family members and teachers, as well as the children themselves, which is not explicitly considered in the formulation.

No studies have been published regarding the outcomes associated with standard psychiatric care for American Indians and Alaska Natives. Hence, it is not known if practitioners accurately diagnose the mental health needs of American Indians and Alaska Natives, nor whether they receive the same benefits from guideline-based psychiatric care as do whites. For this we must await related studies of treatment outcome, studies that venture beyond the limitations of current thinking with respect to intervention technology and best practices.


Effectiveness of psychological treatments for depression and alcohol use disorder delivered by community-based counsellors: two pragmatic randomised controlled trials within primary healthcare in Nepal

Background: Evidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.AimEvaluating the clinical value of adding psychological treatments, delivered by community-based counsellors, to primary care-based mental health services for depression and alcohol use disorder (AUD), as recommended by the Mental Health Gap Action Programme (mhGAP).

Method: Two randomised controlled trials, separately for depression and AUD, were carried out. Participants were randomly allocated (1:1) to mental healthcare delivered by mhGAP-trained primary care workers (psychoeducation and psychotropic medicines when indicated), or the same services plus individual psychological treatments (Healthy Activity Program for depression and Counselling for Alcohol Problems). Primary outcomes were symptom severity, measured using the Patient Health Questionnaire - 9 item (PHQ-9) for depression and the Alcohol Use Disorder Identification Test for AUD, and functional impairment, measured using the World Health Organization Disability Assessment Schedule (WHODAS), at 12 months post-enrolment.

Results: Participants with depression in the intervention arm (n = 60) had greater reduction in PHQ-9 and WHODAS scores compared with participants in the control (n = 60) (PHQ-9: M = -5.90, 95% CI -7.55 to -4.25, β = -3.68, 95% CI -5.68 to -1.67, P &lt 0.001, Cohen's d = 0.66 WHODAS: M = -12.21, 95% CI -19.58 to -4.84, β = -10.74, 95% CI -19.96 to -1.53, P= 0.022, Cohen's d = 0.42). For the AUD trial, no significant effect was found when comparing control (n = 80) and intervention participants (n = 82).

Conclusion: Adding a psychological treatment delivered by community-based counsellors increases treatment effects for depression compared with only mhGAP-based services by primary health workers 12 months post-treatment.Declaration of interestNone.

Keywords: Nepal Psychological treatment effectiveness low- and middle-income settings primary healthcare.


What is the connection between depression and alcohol?

We know that there is a connection – self-harm and suicide are much more common in people with alcohol problems 12 13 . It seems that it can work in two ways:

  • you regularly drink too much including (including 'binge drinking') which makes you feel depressed OR
  • you drink to relieve anxiety or depression.
  • Alcohol affects the chemistry of the brain, increasing the risk of depression.
  • Hangovers can create a cycle of waking up feeling ill, anxious, jittery and guilty.
  • Life gets more difficult – arguments with family or friends, trouble at work, memory and sexual problems.

Envisioning Sobriety

One key to successful sober living is to map out real-life social scenarios.

“Go to the events with a goal in mind,” Murphy of the University of Memphis says. “If your goal is moderate drinking, have a very specific plan for the amount and type of alcohol you'll consume, and how you'll space your drinks. If your goal is abstinence, remind yourself of why​​​ you are making this choice.”

Rehearse how you'll turn down drinks, Murphy says. What alcohol-free beverages will you order? What's your plan if you get hit with a strong craving? It can also help to line up some “safe” people who'll respect your stance.

Also, know you can step away from the party or even leave at any time, Murphy says. “You are under no obligation to tell people why you aren't drinking.”

Lara agrees. “Never compromise your mental health for the sake of going to an event,” she says. “If you're super anxious about a first date or a party where there'll be booze, it's OK to back out or leave early. Anyone who cares about you will understand. Sobriety is about taking care of yourself, not people-pleasing.”

She now loves being sober at big events, such as concerts and weddings. “I actually remember conversations and moments that took place.”


Calculate the price

The U.S. nursing experts conducted various evidence-based studies to identify the signs and symptoms of depression and suicide. Studies show that different psychological disorders may bear the signs and symptoms of depression (University of Michigan Depression Center, n.d.). For example, moral dilemma, emotional issues, cognitive syndromes, and different clinical perspectives may initiate inadequate behavior. Nursing experts found various evidence-based signs and symptoms of depression. Furthermore, different characteristics are visible on a patient who suffers from a psychological problem or wants to commit suicide. Initially, a person may suffer from stress for a long time. He or she may not communicate with people or avoid social life. Also, the patients may create an inadequate feeling about their ability and self-esteem. Sometimes, these patients may stop their regular works due to anxiety. These mental conditions affect a person’s physique. Therefore, the patient may lose weight in a short time. Nevertheless, depression may make a patient physically weak and ill. Thus, these signs and symptoms show that a patient is suffering from depression (University of Michigan Depression Center, n.d.).


Religiousness and mental health: a review

Objective: The relationship between religiosity and mental health has been a perennial source of controversy. This paper reviews the scientific evidence available for the relationship between religion and mental health.

Method: The authors present the main studies and conclusions of a larger systematic review of 850 studies on the religion-mental health relationship published during the 20th Century identified through several databases. The present paper also includes an update on the papers published since 2000, including researches performed in Brazil and a brief historical and methodological background.

Discussion: The majority of well-conducted studies found that higher levels of religious involvement are positively associated with indicators of psychological well-being (life satisfaction, happiness, positive affect, and higher morale) and with less depression, suicidal thoughts and behavior, drug/alcohol use/abuse. Usually the positive impact of religious involvement on mental health is more robust among people under stressful circumstances (the elderly, and those with disability and medical illness). Theoretical pathways of the religiousness-mental health connection and clinical implications of these findings are also discussed.

Conclusions: There is evidence that religious involvement is usually associated with better mental health. We need to improve our understanding of the mediating factors of this association and its use in clinical practice.



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