Unmet Treatment Needs for Co-Occurring Depression and Alcohol Use Disorders Among Young Adults in the U.S

Background: Major depression and alcohol use disorders (AUD) often co-occur among young adults and are each associated with severe health and social consequences. Ideally, individuals with co-occurring depression and AUD should receive treatment for both; yet, little is known about trends and patterns in treatment use among young adults with both conditions. This study aimed to 1) examine temporal trends in the prevalence and treatment of co-occurring major depression and alcohol use disorders and 2) identify disparities in unmet treatment needs among young adults with both conditions.

Methods: Publicly available data for young adults ages 18 to 25 (N = 207,895) from the National Survey on Drug Use and Health (NSDUH) for 2011-2019 were analyzed. Bivariate logistic regression analyses were conducted to assess trends in the prevalence and treatment of 12-month major depressive episode (MDE), AUD, and their co-occurrence. Subsequently, a series of multivariate logistic regression models were used to identify sociodemographic differences in the prevalence and treatment of MDE, AUD and co-occurring conditions. All analyses adjusted for the complex survey design, nonresponse bias, and non-coverage bias by using sampling weights.

Results: From 2011 to 2019, the prevalence of 12-month MDE increased steadily from 8.0% to 13.0% (OR=1.07, P<0.001) in young adults. In contrast, the prevalence of AUD decreased annually from 12.2% to 8.8% (OR=0.95, P<0.001). Overall, the annual prevalence of co-occurring MDE and AUD remained relatively stable between 2.5% and 3.4%. In 2011, 44.6% of participants with both conditions received treatment for MDE, and the prevalence increased significantly to 52.3% in 2019 (OR=1.04, P<0.05). Meanwhile, the prevalence of treatment use for AUD remained largely stable between 9.5% and 11.7% (OR=0.98, P=0.56). Treatment use for co-occurring conditions also remained stable at less than 9% across the survey years (OR=0.99, P=0.81). Among participants with co-occurring conditions, females were more likely than males to use treatment for MDE (AOR=1.83, P<0.001) but less likely to use treatment for AUD (AOR=0.62, P<0.01), or both conditions (AOR=0.61, P<0.01). Consistently, higher prevalence of treatment use was found for MDE (AOR=1.39, P<0.001), AUD (AOR=2.05, P<0.001), and both conditions (AOR=2.52, P<0.001) among participants aged 22-25 than those aged 18-21. Having insurance significantly increased the odds that participants used treatment for MDE (AOR=1.39, P<0.05), but not for AUD or co-occurring conditions. Compared to participants with annual household income below $20,000, those with a household income of $20,000-$49,999 and above $75,000 were less likely to use treatment for AUD and co-occurring conditions. Lastly, having MDE-related severe impairment significantly increased the odds that participants received treatment for MDE (AOR=2.51, P<0.001), AUD (AOR=2.07, P<0.001), and co-occurring conditions (AOR=2.49, P<0.001).

Discussion: Findings highlight widening disparities in treatment for co-occurring depression and AUD in young adults. Expanded service provision and enhanced service coordination between mental health and addiction treatment systems by social workers are essential priorities for this population.