European Journal of Cardiovascular Medicine

Alcohol use disorders (AUDs) are a major public health concern globally, with significant medical, psychological, and social consequences. The World Health Organization estimates that approximately 3 million deaths annually are attributable to harmful alcohol use^1-2. In India, epidemiological studies have shown prevalence rates of 16-50% for alcohol dependence.

Patients with AUDs often have co-occurring psychiatric conditions that can complicate diagnosis and treatment. Studies have reported prevalence rates of 57-84% for psychiatric comorbidity among those with alcohol abuse or dependence^3-6. Common comorbid conditions include mood disorders, anxiety disorders, and personality disorders. The presence of psychiatric comorbidity is associated with poorer treatment outcomes and increased risk of relapse in alcohol-dependent individuals.

Psychological assessment plays a crucial role in identifying comorbid psychiatric conditions and personality traits that may influence the course and treatment of AUDs. Standardized assessment tools can help clinicians detect depression, anxiety, and other mental health issues that may be masked by alcohol use. Additionally, evaluation of personality factors can provide insights into underlying vulnerabilities and inform individualized treatment approaches.

However, comprehensive psychological assessment is not routinely conducted for all patients presenting with alcohol-related problems, particularly in busy tertiary care settings. There is a need for more research on the prevalence of psychiatric comorbidities and personality profiles in treatment-seeking individuals with AUDs in India.

The present study aimed to assess the frequency, pattern and distribution of psychiatric morbidity and personality profiles in patients with alcohol-related disorders presenting to a tertiary care center in India. Specifically, the objectives were to:

1. Evaluate psychiatric comorbidity using standardized assessment tools
2. Identify predominant personality traits
3. Examine associations between sociodemographic factors, alcohol use patterns, and psychological profiles

The findings can help inform screening and assessment protocols as well as guide the development of integrated treatment approaches for this population. Understanding the complex interplay between alcohol use, psychiatric symptoms, and personality factors is crucial for improving outcomes in the management of AUDs.

Study Design and Setting:

This was a cross-sectional, hospital-based study conducted at MediCiti Institute of Medical Sciences and Hospital, a tertiary care center in Medchal, Ranga Reddy district, Andhra Pradesh, India. The study was carried out from November 2022 to June 2024.

Participants :

Consecutive patients presenting to the Psychiatry outpatient department with alcohol-related disorders were screened for eligibility. The inclusion criteria were:

• Age 18-70 years
• Presenting with alcohol-related disorders
• Willing and able to provide informed consent

Exclusion criteria were:

• Critically ill patients
• Patients with delirium
• Patients with dementia or gross cognitive impairment
• Patients with head injury or other medical conditions precluding completion of questionnaires

Sample Size:

A total of 50 patients were initially screened. After applying exclusion criteria and obtaining consent, the final study sample consisted of 30 patients.

Ethical Considerations:

The study protocol was approved by the institutional ethics committee. Written informed consent was obtained from all participants prior to enrollment.

Data Collection:

Sociodemographic data was collected using a structured proforma. The following standardized instruments were administered:

1. CAGE Questionnaire - Used to screen for alcohol use disorders
2. DSM-IV-TR criteria - Used to diagnose alcohol use disorders
3. General Health Questionnaire-28 (GHQ-28) - Assessed somatic symptoms, anxiety/insomnia, social dysfunction and severe depression
4. Hamilton Depression Rating Scale (HAM-D) - Evaluated severity of depressive symptoms
5. Eysenck Personality Questionnaire (EPQ) - Assessed personality traits of psychoticism, neuroticism and extraversion

Statistical Analysis:

Data was analyzed using SPSS version 22. Descriptive statistics were calculated for sociodemographic and clinical variables. Chi-square test was used to assess associations between categorical variables. Pearson's correlation coefficient was calculated to evaluate correlations between continuous variables. A p-value <0.05 was considered statistically significant.

RESULTS

TABLE 1: HAMILTON DEPRESSION RATING IN PATIENTS

YATES CHI2 =3.875; DF =4; P= 0.4 NOT SIGNIFICANT

The depression rating in the sample as calculated by using HAM-D was seen to be mild in most of the cases 10 (33.33%) followed by severe 8 (26.67%), then moderate 5 (16.67%) then normal 4 (13.33%) and very severe 3 (10%).

TABLE 2: DEPRESSION STATUS IN PATIENTS

YATES CHI2 =0.833; DF =1; P= 0.3 NOT SIGNIFICANT

The total number of people found to be depressed as assessed by Ham-D with 16 as a cut-off in the score was seen as 12 to be Depressed and 18 as Not Depressed. Statistically, depression is not significant in patients in the study (HAM-D >16) p=0.3

TABLE 3: GHQ and Depression

YATES CHI2 =17.633; DF =3; P= 0.00002 SIGNIFICANT

This table depicts that number of people who are distressed for various reason individually as measured in GHQ and also in combination amounts to 27 (90%). Thus, a statistically significant number of patients were graded as distressed (p=0.00002), even though Depression was not found at statistically significant levels.

TABLE 4: PSYCHOTICISM STATUS ON EPQ IN PATIENTS

YATES CHI2 =4.033; DF =1; P= 0.04 SIGNIFICANT

The number patients scoring high on Psychoticism are 21 (70%) and low are 9 (30%). This attained statistical significance (p=0.04)

TABLE 5: NEUROTICISM STATUS ON EPQ IN PATIENTS

YATES CHI2 =5.633; DF =1; P= 0.01 SIGNIFICANT

The majority of people in this sample score High in Neuroticism 22 (73.83%) and people scoring low are 8 (26.66%). This too attained statistical significance, p=0.01

TABLE 6: EXTRAVERSION STATUS ON EPQ IN PATIENTS

Table 7: GHQ and Depression

PEARSON CORRELATION = - 0.272; P=0.146; NOT SIGNIFICANT

Patients who are found to be depressed are also found to be Distressed on GHQ- 12 (40%) and the patients who are not distressed are not depressed 3 (10%). There is no statistically significant correlation between distress on the GHQ and Depression. P=0.146.

TABLE 8: PSYCHOTICISM ON EPQ AND DEPRESSION

PEARSON CORRELATION = - 0.208; P=0.270; NOT SIGNIFICANT

This table shows most of patients with high psychoticism are not depressed and patients scoring low on psychoticism are depressed. There is no statistically significant correlation between psychoticism on EPQ and depression, p=0.270

TABLE 9: NEUROTICISM ON EPQ AND DEPRESSION

This shows that nearly half of patients scoring High on neuroticism are depressed and most of patients scoring low on neuroticism are not depressed. But neuroticism on EPQ and depression are not correlated significantly on statistical analysis, p=0.329.

Table 10: Reason for Consultation at Psychiatric OPD

YATES CHI2 =4.475; DF =2; P= 0.1 NOT SIGNIFICANT

The most reason for consultation to psychiatric OPD for the patients in the study was seen as Suicide attempt 16(53.3%) followed by Withdrawal symptoms 8 (26.6%), then medical/physical health 6 (20%). Even tough over half the patients presented with a suicide attempt, this does not reach statistical signi ficance (p=0.1).

The present study aimed to assess the psychological profiles of patients presenting with alcohol-related disorders at a tertiary care hospital. The findings reveal important insights into the prevalence of psychiatric comorbidities and personality traits in this population.

Depression and Distress

While 40% of patients met criteria for depression based on HAM-D scores, this did not reach statistical significance. However, a striking 90% of patients were classified as distressed according to GHQ-28 scores, which was highly significant (p=0.00002). This discrepancy suggests that while many patients with alcohol use disorders experience psychological distress, it may not always manifest as clinical depression. The high prevalence of distress highlights the need for comprehensive psychological assessment and support for this population.

Personality Traits

Analysis of personality traits using the EPQ revealed significantly high levels of psychoticism (70%, p=0.04) and neuroticism (73.83%, p=0.01) among patients. These findings align with previous research indicating a strong association between certain personality traits and alcohol use disorders. A meta-analysis by Kotov et al. (2020)⁷ found that high neuroticism and low conscientiousness were consistently linked to substance use disorders, including alcohol dependence.

Reasons for Consultation

The most common reason for psychiatric consultation was suicide attempt (53.3%), followed by withdrawal symptoms (26.6%) and medical/physical health concerns (20%). Although the high rate of suicide attempts did not reach statistical significance, it underscores the elevated suicide risk in this population. This aligns with a recent systematic review by Conner et al. (2019)⁸ that found alcohol use disorders to be associated with increased risk of suicidal ideation, attempts, and completed suicide.

Clinical Implications

The high prevalence of psychological distress, maladaptive personality traits, and suicide risk in this population emphasizes the need for integrated treatment approaches. Screening for psychiatric comorbidities and personality factors should be routinely conducted in patients presenting with alcohol-related disorders. Tailored interventions addressing both alcohol use and underlying psychological factors may improve treatment outcomes.

Limitations and Future Directions

The small sample size and cross-sectional design limit the generalizability of findings. Longitudinal studies with larger samples are needed to elucidate the temporal relationships between alcohol use, psychiatric symptoms, and personality traits. Additionally, future research should explore protective factors and resilience in this population to inform strength-based interventions.

This study highlights the complex interplay between alcohol use disorders, psychiatric comorbidities, and personality traits in patients presenting to tertiary care. The high prevalence of psychological distress and maladaptive personality traits underscores the need for comprehensive assessment and integrated treatment approaches. Clinicians should be vigilant for suicide risk and underlying psychiatric issues in this vulnerable population. Future research should focus on developing and evaluating targeted interventions that address both alcohol use and co-occurring psychological factors to improve outcomes for individuals with alcohol-related disorders.

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