Visontay, Rachel, Louise Mewton, Tim Slade, Izzuddin M. Aris, and Matthew Sunderland. 2021. “Moderate Alcohol Consumption and Depressive Symptoms: A Marginal Structural Model Approach Promoting Causal Inference.” OSF Preprints. November 19. doi:10.31219/osf.io/e2gcm
Abstract
Importance: Prevention of depressive symptoms and disorders is a key public health priority but requires an improved understanding of modifiable risk and protective factors. A salient unanswered question in this context is whether the apparent protective effect of alcohol against depression may be causal.
Objective: To compare the effects of consistent abstinence, occasional, moderate, and heavy alcohol consumption throughout early-to-middle adulthood on depressive symptoms at age 50.
Design: This secondary analysis of the National Longitudinal Survey of Youth (NLSY79) cohort employed a marginal structural model approach in assessing the relationship between alcohol consumption in early-to-middle adulthood (29-37 through 41-49) and depressive symptoms at age 50. Alcohol consumption was based on measurements at 1994, 2002, and 2006, covariates at 1992, 1994, and age 40 (1998-2006), and outcome at age 50 (2008-2016).
Setting: The NLSY79 is a nationally representative, population-based cohort study.
Participants: 5,667 eligible participants at baseline provided valid data on alcohol consumption, depressive symptoms, and covariates of interest.
Exposure: Alcohol consumption was categorised as either abstinence, occasional, moderate, or heavy drinking in 1994, 2002, and 2006.
Main Outcome and Measure: Depressive symptoms at age 50 as measured by the Centre for Epidemiological Studies-Depression Scale short form (CES-D-SF).
Results: Of the 5,667 eligible participants at baseline, 2,862 [50.50%] were female and the mean age was 30.81 [2.24], with 3,593 participants providing valid outcome data for analysis. Results of linear contrasts from marginal structural models were consistent with a J-shaped relationship, where both consistent occasional (b=-0.84, CI= -1.47, -.11) and consistent moderate (b=-1.08, CI=-1.88, -.20) drinkers had significantly reduced predicted CES-D-SF scores at age 50 compared to consistent abstainers. Consistent heavy drinkers were predicted to have increased depressive symptoms, but this was not statistically significant (b=0.34, CI=-0.62, 1.25). In sex-stratified analyses, results were similar for females and males.
Conclusions and Relevance: In this secondary analysis of longitudinal data accounting for time-varying exposure and confounding, consistent low-to-moderate alcohol consumption in early-to-middle adulthood predicted lower depressive symptoms at age 50, compared with those abstaining from alcohol. This work offers preliminary evidence that such protective effects may be causal.