“A person with a mental health problem might not necessarily be more likely to drink at harmful levels, they might be more likely not to drink at all”
Jo-Anne Puddephat is an SSA funded PhD student. Jo-Anne’s paper on the associations between alcohol, mental health and socio-economic status was recently published in Drug and Alcohol Dependence. We recently caught up with Jo-Anne to find out more:
SSA: You found associations between types of mental health problems and drinking behaviour. Can you say a bit more about your findings?
Jo-Anne: “Yes, so the study used a national dataset from England. We were interested in looking at differences in drinking between people with different types of mental health problems as well as with people with no mental health problems. So, we looked a people who met criteria for, say, depression or a type of personality disorder and how likely they were to be a non-drinker, a hazardous drinker or a harmful drinker.
We found that, compared to people who didn’t have a mental health problem, people with a mental health problem were more likely to be a non-drinker or drink at harmful levels. But actually the association was strongest for those with more serious mental health problems such as psychosis and some types of personality disorder. We also found that associations were strongest for being either a non-drinker or a harmful drinker. So, it seems that a person with a mental health problem might be more likely be at the extremes of drinking behaviour and less likely to drink moderately.”
I was really interested to read that people with psychotic type mental health problems were more likely to be non-drinkers whereas people with borderline personality disorder type disorders were more likely to have harmful drinking.
“Yes, so there’s research that has looked at elements of this in the past, but very little that has compared across different types of mental health disorders. We weren’t sure whether people with different types of mental health problems would drink in the same way and our findings suggested that they don’t.
It may be that people with psychotic type disorders have previously drunk alcohol to harmful levels, but that they now choose to not drink at all. This study used cross-sectional data from a single time point, so we can’t tell whether this is the case.
It might also be because it is advisable to not drink on some types of medication that are prescribed for different mental health problems.
We also thought that it might be to do with the types of symptoms that different people have. So, it might be that drinking is used to cope with different types of symptoms whereby drinking might be perceived to help with some symptoms, but to make other symptoms worse.
The explanation for these differences is something that I’ve been looking into for a qualitative study that has just finished recruiting. So hopefully that will add to the findings of this study.”
Were there any indications about people with multiple mental health problems?
“Yes, we ran a sensitivity analysis looking at whether people met criteria for more than one common mental health disorder such as depression, anxiety or phobias as well as people who met criteria for severe mental illness such as bipolar disorder or psychotic disorders. We found that the more common mental disorders participants had, or if they met criteria for both bipolar and psychotic disorders, the association with harmful drinking increased; as did the association with being a non-drinker.
But this was from a sensitivity analysis that we ran, and we didn’t look at all of the other mental health disorders.”
You included socio-economic status in your analysis. Can you explain what effect this had on your analysis?
“We know that socio-economic status is associated with drinking and that it is also associated with mental health problems. So, we controlled for participants’ levels of education, whether they were a renter or owned their own home and occupational grade to see whether socio-economic status affected the association between drinking and mental health.
What we found was that a person’s socio-economic status only partially accounted for the association between drinking and mental health; so, it didn’t fully explain those associations. Which suggests that there are other mechanisms going on in the relationship between alcohol and mental health.
So, it’s interesting because we would expect that socio-economic status would play a role in the association between drinking and mental health and although we did find that it explained some of the associations it didn’t fully. So that suggests that alcohol and mental health are still strongly associated even after accounting for a person’s socio-economic status.”
What are the implications of your research for policy, treatment or practice?
“I think what we show is that the relationship between drinking and mental health is perhaps more complex than we first thought. So, a person with a mental health problem might not necessarily be more likely to drink at harmful levels, they might be more likely not to drink at all.
We also found that associations between drinking and mental health problems were stronger for those with more severe mental health problems and perhaps that is a population that we need to target more appropriately and understand why some people are more likely to be either a non-drinker or a harmful drinker
We also need to work on how to treat both the drinking behaviour and the mental health problem at the same time, and to bring those services more in parallel. I think that our study has shown even more that we need to bring together the substance use and mental health services so that we can target both those things together.”
What are the next steps for your research programme?
“The qualitative study leads on from this. I’ve interviewed people with a diagnosis of a severe mental health problem. They had to be either a non-drinker or to drink alcohol. And if they were a non-drinker, they had to have a history of alcohol use.
I’m interested in understanding participants’ reasons to drink or not to drink and whether there are specific mental health symptoms that influence their decisions to drink. Also, about whether drinking changes according to mood and how this relates to mental health problems. I’ve just finished the interviews, so I just need to analyse the data now.
I’m also running a study at the minute that combines socio-economic status measures, to develop latent profiles of participants in terms of their socio-economic status to see whether, that explains the associations of being a non-drinker or a harmful drinker and having a mental health problem.”
The full-text article, Associations of alcohol use, mental health and socioeconomic status in England: Findings from a representative population survey is available at Drug and Alcohol Dependence
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