Screening of coexisting depression or anxiety disorders among Danish patients with alcohol use disorder in outpatient treatment

Abstract

Background

Depression and anxiety are highly prevalent among patients seeking outpatient treatment for alcohol use disorders (AUD) and if depression and anxiety are addressed the prognosis is improved. Screening instruments for depression and anxiety have been validated in populations suffering from drug use disorders, but not in populations suffering from AUD. The aim of this study was to validate four self-administrated screening instruments (PHQ-9, GAD-7, Kessler-6, and SRQ) and calculate the optimal cut-off value for identifying depression and anxiety.

Methods

The study included 73 patients with self-reported depression or anxiety during AUD treatment. Each patient filled out the above-mentioned instruments and was subsequently interviewed by trained clinicians blinded to the results of the instruments with the Present State Examination to establish a diagnosis of depression or anxiety according to ICD-10. ROC curves were constructed for each instrument and the area under the curve (AUC) was calculated using patients with no depression or anxiety as reference. Youden’s index was calculated to assess the optimal cut-off for each instrument.

Results

A total of 33 (45.2%) were diagnosed with depression or anxiety. The AUC for PHQ-9, GAD-7, Kessler-6, and SRQ were 0.767, 0.630, 0.793, and 0.698 respectively. Kessler-6, the instruments performing best based on the AUC, identified 27 (82%) of the 33 patients using a cut-off of 10 points.

Conclusion

Kessler-6 seems to be valid and reliable in identifying patients requiring treatment for depression or anxiety among patients seeking treatment for AUD who are reporting depression or anxiety.

Keywords:

• Alcohol use disorder
• depression
• anxiety
• screening
• ROC curves
• Youden’s index

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, KA, upon reasonable request.

Additional information

Funding

The study was funded by an unconditional grant from Trygfonden, grant number 124844.

Notes on contributors

Kjeld Andersen

Kjeld Andersen is a professor of psychiatry at the Department of Clinical Research, University of Southern Denmark and at the Department of Psychiatry Odense, Region of Southern Denmark, where he also has a position as senior consultant in geriatric psychiatry. His research is focused broadly on geriatric psychiatry, including dementia, psychoses, and alcohol use disorders. He has been involved in epidemiological population studies, clinical studies and register based studies.

Bent Nielsen

Bent Nielsen is a professor MSO of psychiatry at the institute og Clinical Research, University of Southern Denmark. His research is focused on alcohol use disorders.

Morten Hesse

Morten Hesse is associate professor at the Centre for Alcohol and Drug Research, Aarhus University. His research is focused on the cross-section between mental health and substance use disorders. He has been involved in clinical trials of behavioral interventions for drug and alcohol use disorders.

Anna Mejldal

Anna Mejldal PhD, works as a biostatistician at Open Patient Data Explorative Network (OPEN), where she advices health researchers in the Region of Southern Denmark on statistical methods and performs data management and statistical analysis on research projects. She is especially interested in studies combining clinical data and data from national registers.

Randi Bilberg

Randi Bilberg is a nurse, Master of Health Science, a Ph.D. in Psychology, and a Master of Project – and Innovation Management and the project manager of the current project. She has nine years of experiences with being a project manager.

Anette Søgaard Nielsen

Anette Søgaard Nielsen is professor at the Institute of Clinical Research, University of Southern Denmark. Anette Søgaard Nielsen’s research interest is treatment for alcohol use disorders.