The Socioeconomic Patterning of Alcohol Use and Mental Health Comorbidity

Some individuals with a mental health problem are more likely to drink at harmful levels and report using alcohol to cope with declines in their mental health whilst others no longer use alcohol due to declines in their mental health. Individuals of lower socioeconomic status (SES) are disproportionately more likely to experience alcohol harms and poorer mental health, respectively, compared to those of higher SES. It is also suggested that other factors, such as neighbourhood disadvantage and social support, play a role in these co-occurrences. This thesis aims to understand the prevalence of alcohol use across a range of mental health problems in the general population, examine the role of SES and other factors on this co-occurrence, and explore experiences of alcohol use and how it is used over time among individuals with a mental health problem living in the general population. Using a multi-methods approach, this thesis conducts a systematic review and meta-analysis to establish the prevalence of alcohol use among individuals with and without common mental disorders (CMD). A secondary data analysis using a large, representative survey in England, 2014 Adult Psychiatric Morbidity Survey, is then used to establish the prevalence of alcohol use (including non-drinking) across a range of mental health problems. This thesis then focusses on individuals who meet criteria for a mental health problem to establish how i) individuals are clustered based upon different indicators of SES, ii) SES is associated with alcohol use and, iii) the indirect effect of social support and neighbourhood disadvantage on this co-occurrence. Finally, qualitative interviews explore changes in drinking based upon the mental health symptoms individuals experience and how these differ among drinkers and non-drinkers who have a severe mental illness (SMI). Findings from the thesis show that individuals with a CMD are twice as likely to report an alcohol use disorder compared to those without. Secondary data show that those meeting criteria for a range of mental health problems are more likely to be non-, hazardous or harmful/probable dependent drinkers, compared to low-risk drinkers. This data also shows that, among those with a mental health problem, lower SES groups are more likely to be non-drinkers, compared to those of higher SES. Qualitative findings show that alcohol is used to cope specifically with trauma, mental health symptoms or stress among individuals with a SMI. Non-drinkers change their drinking habits before or during getting formal support and after experiencing significant declines in their mental health. Whereas drinkers change their drinking habits either during or after getting formal support and now currently drink alcohol for enjoyment and in a controlled way. The evidence lends support for the self-medication and drinking motives models and highlights that the co-occurrence of alcohol and mental health problems are complex. Findings have important implications for how drinking habits may change over time and the role of mental health, previous trauma and appropriate and timely support

Socioeconomic status, alcohol use and the role of social support and neighbourhood environment among individuals meeting criteria for a mental health problem: a cross-sectional study

PurposeIndicators of socioeconomic status (SES), such as education and occupational grade, are known to be associated with alcohol use but this has not been examined among individuals with a mental health problem. This study developed latent classes of SES, their associations with alcohol use, and examined the indirect effect via social support and neighbourhood environment.MethodsA secondary analysis of the 2014 Adult Psychiatric Morbidity Survey was conducted among participants with a mental health problem (N = 1,436). SES classes were determined using a range of indicators. Alcohol use was measured using the Alcohol Use Disorder Identification Test. Social support and neighbourhood neighbourhood environment were measured using validated questionnaires. A latent class analysis was conducted to develop SES classes. Multinomial logistic regression examined associations of SES and alcohol use. Structural equation models tested indirect effects via social support and neighbourhood environment.ResultsA four-class model of SES was best-fitting; “economically inactive, GCSE-level and lower educated, social renters”, “intermediate/routine occupation, GCSE-level educated, mixed owner/renters”, “retired, no formal education, homeowners”, and “professional occupation, degree-level educated, homeowners”. Compared to “professional occupation, degree-level educated, homeowners”, SES classes were more likely to be non-drinkers; odds were highest for “economically inactive, GCSE-level and lower educated, social renters” (OR = 4.96,95%CI 3.10–7.93). “Retired, no formal education, homeowners” were less likely to be hazardous drinkers (OR = 0.35,95%CI 0.20–0.59). Associations between “economically inactive, GCSE-level and lower educated, social renters” and “retired, no formal education, homeowners” and non- and harmful drinking via social support and neighbourhood environment were significant.ConclusionsIn contrast to the alcohol harms paradox, among individuals with a mental health problem, lower SES groups were more likely to be non-drinkers while no associations with harmful drinking were found. There is also a need to examine the alcohol harms paradox in the context of the area in which they live

Understanding alcohol use and changes in drinking habits among people with a severe mental illness: a qualitative framework analysis study

Introduction: Individuals with a severe mental illness (SMI) are more likely to drink at harmful levels or abstain. While it is known that drinking patterns change over time, the reasons for this among those with a SMI are unclear. This study aimed to (i) explore the experiences with alcohol, particularly in relation to mental health symptoms, and (ii) how drinking patterns have changed over time, among individuals who have a SMI diagnosis, who either currently drink alcohol or no longer drink.Methods: One-to-one semi-structured telephone interviews were conducted to address the study aims. Current drinkers' alcohol use was assessed using the Alcohol Use Disorder Identification Test. A framework analysis was used to address the study aims with a specific focus on the differences in the experiences with alcohol use between current and former drinkers.Results: 16 participants were interviewed, and five themes were developed. The analysis highlighted how alcohol was increasingly used to cope with (i) trauma, (ii) SMI-related symptoms, or (iii) stress. Among those with a SMI, non-drinking was facilitated through declines in SMI-related symptoms, previous negative consequences due to alcohol and changing the social environment. Current drinking habits were facilitated through changes in the reasons for drinking and adopting different alcohol moderation techniques.Discussion: Among those with a SMI diagnosis and who either currently drink alcohol or no longer drink, our findings support the self-medication hypothesis and drinking motives model. However, our findings indicate the need for further development of drinking to cope with a focus on symptoms of a SMI and trauma. Our findings also have implications on specialist alcohol and mental health services, the need to improve individuals' understanding of SMI, and the need to identify reasons for drinking among those with a recent diagnosis of a SMI

Exploring experiences with alcohol and how drinking has changed over time among minority ethnic groups with a diagnosed mental health problem

Introduction: Minority ethnic groups are more likely to experience poor mental health but lesslikely to seek formal support. Mental health problems and alcohol use (including non-drinking)co-occur, the reasons for this among minority ethnic groups are not well understood. This studyexplored i) alcohol use among minority ethnic individuals with a mental health problem,ii) howalcohol was used before individuals received support for their mental health,iii) how alcoholchanged whilst and after individuals received treatment for their mental health.Methods: Participants were purposively sampled through community/online mental healthorganisations. Participants took part if they i)were not White British, ii) had a mental healthdiagnosis, iii) drank at hazardous and above levels or former drinkers. Telephone/online semistructured interviews were conducted. Data were analysed using framework analysis with anintersectional lens.Results: 25 participants took part. Four themes were developed; “drinking motivations”, “mentalhealth literacy and implications on drinking behaviour”, “cultural expectations and its influenceon mental health problems and drinking practices”, and “reasons for changes in drinking”. Themesreflect reasons for drinking and the role of understanding the range of mental health problems andimplicit cultural expectations. An intersectional lens indicated gendered, ethnic and religiousnuances in experiences with alcohol and seeking support. Engaging with formal support promptedchanges in drinking which were facilitated through wider support.Conclusion: There were specific reasons to cope among minority ethnic individuals who have amental health problem. Applying an intersectional lens provided an insight into the role of culturaland gendered expectations on mental health and drinking practices. Mental health literacy andimplicit cultural expectations within specific minority ethnic groups can affect both mental healthand drinking practices. Healthcare professionals and wider community play an important role inprompting changes in drinking among minority ethnic groups who have a mental health problem.<br/

Exploring experiences with alcohol and how drinking has changed over time among minority ethnic groups with a diagnosed mental health problem.

IntroductionMinority ethnic groups are more likely to experience poor mental health but less likely to seek formal support. Mental health problems and alcohol use (including non-drinking) co-occur, the reasons for this among minority ethnic groups are not well understood. This study explored i) alcohol use among minority ethnic individuals with a mental health problem,ii) how alcohol was used before individuals received support for their mental health,iii) how alcohol changed whilst and after individuals received treatment for their mental health.MethodsParticipants were purposively sampled through community/online mental health organisations. Participants took part if they i)were not White British, ii) had a mental health diagnosis, iii) drank at hazardous and above levels or former drinkers. Telephone/online semi-structured interviews were conducted. Data were analysed using framework analysis with an intersectional lens.Results25 participants took part. Four themes were developed; "drinking motivations", "mental health literacy and implications on drinking behaviour", "cultural expectations and its influence on mental health problems and drinking practices", and "reasons for changes in drinking". Themes reflect reasons for drinking and the role of understanding the range of mental health problems and implicit cultural expectations. An intersectional lens indicated gendered, ethnic and religious nuances in experiences with alcohol and seeking support. Engaging with formal support prompted changes in drinking which were facilitated through wider support.ConclusionThere were specific reasons to cope among minority ethnic individuals who have a mental health problem. Applying an intersectional lens provided an insight into the role of cultural and gendered expectations on mental health and drinking practices. Mental health literacy and implicit cultural expectations within specific minority ethnic groups can affect both mental health and drinking practices. Healthcare professionals and wider community play an important role in prompting changes in drinking among minority ethnic groups who have a mental health problem