The Relationship Between Depression and Alcohol Use Disorder Among Asian Americans

Background/Purpose: Researchers have reported an association between alcohol use disorder (AUD) and major depression (MD). One explanation of their relationship is that alcohol use represents self-medication to relieve psychological symptoms such as depression ones. Another explanation is that alcohol use leads to psychological distress. For example, alcohol use including intoxication and withdrawal may induce symptoms of depression. It is unclear whether alcohol use disorder causes depression or if depression causes alcohol use disorder, or if both depression and alcohol use are caused by other factors. Virtually nothing is known of these associations among Asian Americans.

This current study will test a bi-directional causal relationship of MD and AUD and examine factors related to MD and AUD in a national sample of Asian American adults.

Methods: Data and Sample: This study used secondary analysis of the National Latino and Asian American Study (NLAAS). There were a total of 2,095 Asian-American adults.

Measures: Major depression and alcohol use disorder were assessed based on the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV). Discrimination was measured using a set of nine items to rate the frequency of discriminatory experience (α = .91). The Family Cultural Conflict scale was a 5-item instrument that assessed issues of cultural and intergenerational conflict between the respondents and their families (α = .87). English proficiency scale was measured using three items: speaking, reading, and writing English (α = .93). Social support was measured using two items that include support from friends and family (α = .64).

 Socioeconomic variables included gender, age, marital status, income, educational attainment, religion, employment status, and ethnicity. Ethnicity was categorized: Filipino (1), Vietnamese (2), Chinese (3), and other Asian Americans (4) as a reference group. Structural Equation Model was used to examine the direction of causality between MD and AUD and to explore relationships among the variables. The root mean square error of approximation (RMSEA) and comparative fit index (CFI) goodness-of-fit measures were used to assess the fit of the model to the data.

Results: MD was statistically associated with AUD (β =0.219) and at the same time AUD was statistically associated with depressive disorder (β=.080). A good fit of model was obtained: CFI=1 and RMESA=0.

In relation to AUD, MD (β=0.08), education (β= -.003), being catholic (β=-.033), being “other” religion (β=-.-035), being Chinese (β=-.033), and reporting discrimination (β=.003) were found to be statistically significant.

With respect to MD, AUD (β=.219), marital status (β=-.062) and family cultural conflict (β=.023) were statistically significant. Asian Americans who had AUD and experienced family conflict were more likely to report MD. Asian Americans who were currently married were less likely to have MD.

Conclusions and Implications: Our analyses suggest that MD and AUD are reciprocally related to each other. The association between MD and AUD may be due to stressful acculturation processes, including discrimination and family cultural conflict. In addition, this study found that different factors were associated with MD and AUD, suggesting that different strategies may be needed to address distinct disorders.