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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 1  |  Page : 11-14

A descriptive study to assess the level of anxiety and depression among alcohol use disorder patient in a tertiary care hospital of Western Maharashtra


1 PG Nursing Trainee Officer, College of Nursing, AFMC, Pune, Maharashtra, India
2 Principal, College of Nursing, AFMC, Pune, Maharashtra, India
3 Tutor, Department of Psychiatry Nursing, College of Nursing, AFMC, Pune, Maharashtra, India

Date of Web Publication14-Oct-2019

Correspondence Address:
Mrs. Seema Madhavan Nair
College of Nursing, AFMC, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IOPN.IOPN_7_19

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  Abstract 


Background: Alcoholism, also known as alcohol use disorder (AUD), is a broad term for any drinking of alcohol that results in mental or physical health problems. In addition to the direct pharmacological effects of alcohol on brain function, psychosocial stressors that commonly occur in heavy-drinking alcoholic patients (e.g., legal, financial, or interpersonal problems) may indirectly contribute to on-going alcohol-related symptoms, such as sadness, despair, and anxiety; the association of alcohol consumption and associated anxiety or depression need to be studied. The objectives of the study were to assess the (1) level of anxiety among the AUD patients and (2) level of depression among the AUD patients. Methodology: A descriptive study to assess the level of anxiety and depression among AUD patients in a tertiary care hospital of Western Maharashtra was conducted on 30 AUD patients from April 03 2018, to April 17, 2018. The Hospital Anxiety Depression Scale (HADS) containing 14 questionnaires, 7 for anxiety and 7 for depression, was administered; the collected data were analyzed and interpreted. Results: The analysis of the score has shown that 60% of the patients had mild anxiety and 40% possessed normal anxiety level in the anxiety component of HADS and 70% of the patients had mild depression and 30% of the patients had moderate depression in the depression component of the HADS. Those patients who have mild anxiety also have a mild or moderate level of depression. Conclusion: Assessment of associated anxiety and depression among AUD patients and subjecting to treatment if required will benefit the treatment compliance of AUD.

Keywords: Alcohol use disorder, anxiety, depression


How to cite this article:
Nair SM, Sharma PA, Das R. A descriptive study to assess the level of anxiety and depression among alcohol use disorder patient in a tertiary care hospital of Western Maharashtra. Indian J Psy Nsg 2019;16:11-4

How to cite this URL:
Nair SM, Sharma PA, Das R. A descriptive study to assess the level of anxiety and depression among alcohol use disorder patient in a tertiary care hospital of Western Maharashtra. Indian J Psy Nsg [serial online] 2019 [cited 2019 Nov 14];16:11-4. Available from: http://www.ijpn.in/text.asp?2019/16/1/11/269165




  Introduction Top


Alcoholism, also known as alcohol use disorder (AUD), is a broad term for any drinking of alcohol that results in mental or physical health problems. Alcohol use can affect all parts of the body but particularly affects the brain, heart, liver, pancreas, and immune system. This can result in mental illness, Wernicke–Korsakoff syndrome, an irregular heartbeat, liver failure, and an increase in the risk of cancer, among other diseases. As the debate over alcohol bans grows across India, 15 people die every day – or one every 96 min – from the effects of drinking alcohol, reveals an India Spend analysis of 2013 National Crime Records Bureau data, the latest available. It is neither normal nor healthy to be in a constant state of dread, despair, or worthlessness. This is true whether you are male or female or whether you are a child, teenager, or adult. When these depressed feelings, and/or worries and anxieties persist, when they are interfering with daily life, and/or when they are out of proportion to any triggering event, there may be an underlying clinical disorder that requires intervention [1].

Over 30% of people diagnosed with a mood or anxiety disorder have both existing at the same time. There are two possible explanations for the association between AUD s and major depression: first, it may be that both disorders have common underlying genetic and environmental factors that jointly increase the risk of both disorders. Second, the two disorders may have a causal effect with each disorder increasing the risk of developing the other [2].

Binge drinking on the weekend, overuse of prescription drugs, consuming “club drugs” at a rave, drinking more than five cups of coffee, and smoking cocaine are all potentially problematic forms of substance use. Usually, when problems arise from substance use, there are a range of other factors at work. Moreover, when depression or anxiety is in the mix, substance use may be a sign of self-medicating. “Self-medicating” is using substances (without physician supervision) to attempt to dull, numb, or distract oneself from negative symptoms, pain, and stress. Through substances such as alcohol and other drugs, a person may be seeking to alleviate a sense of anxiety, depression, powerlessness, pain, or boredom that may pervade their life.

The interactions between anxiety or depression and alcohol use are complex. While alcohol use may be used as coping mechanisms by people with mental health problems, this can also worsen or trigger anxiety or depression. Acute alcohol withdrawal can often increase anxiety levels. Depression and anxiety are also associated with long-term use or withdrawal from alcohol and can also occur from other substance abuse.

Need for the study



According to the study conducted by Anthenelli and Schuckitin (1993) and Anthenelli (1997), an alcohol-dependent patient appears morbidly depressed when acutely intoxicated and appears anxious and panicky when acutely withdrawing from the drug. In addition to the direct pharmacological effects of alcohol on brain function, psychosocial stressors that commonly occur in heavy-drinking alcoholic patients (e.g., legal, financial, or interpersonal problems) may indirectly contribute to on-going alcohol-related symptoms, such as sadness, despair, and anxiety [3].

There is also a strong link between serious alcohol use and depression. The question is, does regular drinking lead to depression, or are depressed people more likely to drink too much? Both are possible. Nearly one-third of people with major depression also have an alcohol problem. Often, the depression comes first. The research shows that depressed kids are more likely to have problems with alcohol a few years down the road. Furthermore, teens who have had a bout of major depression are twice as likely to start drinking as those who have not.

The prevalence of alcohol use in India reported by the National Household Survey revealed that the current 1-month period use for alcohol is found to be 21.4% [4]. There are 62.5 million alcohol users in India, of which 10.6 million are dependent users. Up to 40% of people who drink heavily have symptoms that resemble a depressive illness. However, when these people are not drinking, only 5%–10% have depressive symptoms [5].

The patient who is seeking treatment for alcoholic dependent syndrome requires long-term hospitalization and follow-up care. Many give the history of some significant past depressive episodes/stress factors which led them to be alcoholic and some become depressive or anxious thinking about the future, social stigma associated with being labeled as mentally ill, and insecurity about job, etc.

It is not always clear which comes first: AUD or another mental health disorder, and how each affects the other. Researchers are continuing to study AUD and other mental health disorders, including the effects of stress and gender differences on these disorders. With a fuller understanding of all the ways, alcohol and other mental health disorders affect one another; researchers may be able to better tailor treatment to individuals suffering from comorbid addiction and mental health disorders.


  Methodology Top


The present study aimed at assessing the level of anxiety and depression in AUD patients. A descriptive approach was used. The setting of the study was in a mental health department in a tertiary care hospital; population of all AUD patients got treatment in the specific mental health department of the tertiary care hospital. All the admitted AUD patients who are willing to participate in the study were selected by convenient sampling technique. All 30 patients diagnosed as a case of AUD for 7 days were included in the sample. The purpose of the study was to assess the level of and anxiety/depression in AUD patients. It was considered necessary to derive information directly from them. The Hospital Anxiety Depression Scale (HADS) was administered to patients. The questionnaire comprised two sections. Section 1 consisted of sociodemographic data in which patients' age, type of admission, educational qualification, family involvement in treatment and family support, type of case, etc., were included. Section II contained 14 questions, of which seven questions were related to anxiety and seven questions were for depression [Table 1] and took 2–5 min to complete. Although the anxiety and depression questions were interspersed within the questionnaire, it was vital that these were scored separately. Cutoff scores were available for quantification, for example, a score of 8 or more for anxiety had a specificity of 0.78 and sensitivity of 0.9, and for depression, a specificity of 0.79 and a sensitivity of 0.83 which has not been analyzed in the present study.
Table 1: For both scales, scores of <7 indicate noncases

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  Results Top


  • The maximum number of patients was in the age group of 30–35 (50%) and 40% were in the age group of 36–40
  • Of the total of 30 patients, only 6 (20%) patients sought medical help voluntarily
  • Among the total sample size of 30, 18 cases were newly detected cases of AUD and 12 cases were chronic or relapsed
  • 70% of families were informed about the treatment of a patient to mental health ward and were actively/passively involved in the treatment modalities, and 30% of the patients reported no family involvement
  • Of the 30 patients, 60% were educated till 10 + 2, 30% were10th passed, and 10% were graduate
  • The analysis of the score has shown that 60% of the patients had mild anxiety and 40% possessed normal anxiety, 70% of the patients had mild depression, and 30% of the patients had moderate depression in the depression component of the HADS [Figure 1]. Those patients who had mild anxiety also had a mild or moderate level of depression [Figure 2].
Figure 1: Distribution of anxiety and depressive score among patients

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Figure 2: Distribution of depression and anxiety in alcohol use disorder patient

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  Discussion Top


In the present study, the mean age of participants was 35.3 years, which is corresponding to the maximum alcoholic use in the age group of 31–50 years according to the substance use and addiction research in India and in the age group of 20–39 years globally according to the statistics released by the WHO in Jan 2015. The present study shows the onset of AUD only after adulthood which exactly did not have a direct relationship with their educational qualification, but it has certainly affected their efficiency in their career as brought out by the study. The analysis of the score has shown that 60% the patients had mild anxiety and 40% possessed normal anxiety level in the anxiety component of HADS and 70% of the patients had mild depression and 30% of the patients had moderate depression in the depression component of the HADS. Those patients who had mild anxiety also had a mild or moderate level of depression.

Forty percent of the patients had normal level of anxiety which is expected of a person who is visiting/admitted in the hospital for any treatment. The difference between normal anxiety and abnormal anxiety is this: anxiety is considered normal and adaptive when it serves to improve peoples' functioning or well-being. In contrast, abnormal anxiety is a chronic condition that impairs people's functioning and interferes with their well-being. This impairment causes them significant distress.

In the present study, 70% of the AUD patients were found to have mild depression and 30% had moderate depression. In mild depression, people experience less interest in doing routine tasks or things that they used to enjoy. Mild depression makes life much harder but does not stop people from continuing with their usual day-to-day life. In moderate depression, people experience a real lack of interest and motivation – it can take a big effort to complete everyday things so that some tasks are left undone. Moderate depression can also affect self-confidence which makes it even harder to continue with day-to-day life, creating a “vicious cycle.”


  Conclusion Top


It is neither normal nor healthy to be in a constant state of dread, despair, or worthlessness. This is true whether you are male or female or whether you are a child, teenager, or adult. When these depressed feelings, and/or worries and anxieties persist, when they are interfering with daily life, and/or when they are out of proportion to any triggering event, there may be an underlying clinical disorder that requires intervention. Seventy percent of the total patients with AUD had mild depression and 60% had mild anxiety. 30% of the patients had moderate depression in the HAD rating scale whether needs to be further investigated for the benefit of any treatment modalities.

Implications

The implications of the present study extend to nursing practice, education as well as nursing research. Nurses have a very important role in various treatment modalities including identification of anxiety and depression levels, assessing the level of anxiety and depression, and carrying out various interventions including pharmacological and psychological interventions under the guidance of treating psychiatrists. It is still not very clearly established that whether AUD is the cause for depression or anxiety or is it vice versa. More and more studies are required in this field to establish this.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
The Health and Social Care Information Centre. The NHS Information Centre Lifestyle Statistics: Statistics on Alcohol: England, London: The Health and Social Care Information Centre; 2012.  Back to cited text no. 1
    
2.
Department of Health. Alcohol Needs Research Assessment Project; The 2004 National Alcohol Needs Assessment for England. London: Department of Health: 2012.  Back to cited text no. 2
    
3.
Treating depression in alcohol misuse. Drugs Ther Bull 2008;46:11.  Back to cited text no. 3
    
4.
Grant BF, Harford TC. Comorbidity between DSM-IV alcohol use disorders and major depression: Results of a national survey. Drug Alcohol Depend 1995;39:197-206.  Back to cited text no. 4
    
5.
Ross HE. DSM-III-R alcohol abuse and dependence and psychiatric comorbidity in Ontario: Results from the mental health supplement to the Ontario health survey. Drug Alcohol Depend 1995;39:111-28.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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Abstract
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