Binge and At-Risk Drinking Behavior Prevalent in Older Adult Population

Relative to the high prevalence of alcohol use and abuse among young adults, middle-aged adults and the elderly as a population have not been shown to consume alcohol in excess or suffer from alcohol abuse in large numbers. However, studies have shown that alcohol use has increased for this population from past measures, possibly due to beliefs regarding health benefits from alcohol consumption. Binge drinking is of particular concern to primary care physicians (PCPs) and other health professionals who treat this population, as drinking in excess can increase patient risk to injury, high blood pressure, and liver disease, among other health hazards.

Dan G. Blazer, MD, PhD, of Duke University Medical Center in Durham, North Carolina, and colleagues, evaluated the drinking behavior of 10,953 people ≥50 years of age living in the United States to estimate the prevalence of and risk factors for alcohol use in older adults. They also sought to particularly examine binge drinking behavior and compare at-risk alcohol use between men and women.

The authors gathered alcohol consumption data for the study participants from the 2005–2006 National Survey on Drug Use and Health, an annual survey of non-institutionalized US residents ≥12 years of age. Alcohol use was defined as consuming ≥1 alcoholic drinks per day (“low risk”) with consuming ≥2 drinks per day being defined as “at-risk” drinking behavior. Binge drinking was defined as consuming ≥5 drinks on the same occasion at least 1 day within the past 30 days. Blazer and colleagues also evaluated psychological distress using the K6-screening scale questions, and compared the age, gender, ethnicity, marital status, educational level, employment status, and income of the survey respondents for any associations with alcohol use.

Among all those included in the study, 66% of male respondents (N=4,952) and 55% of female respondents (N=6,001) reported some alcohol use in the past year. Among those ≥65 years of age, 13% of men and 8% of women reported at-risk use and >14% of men and >3% of women reported binge drinking. Men showed a higher prevalence of at-risk drinking and binge drinking when compared to women, who were more often shown to have low-risk drinking behavior. Smoking, substance abuse, having attended college, and a higher family income (>$40,000 annually) were associated with increased drinking, while psychological distress was not associated with at-risk of binge drinking.  

The authors concluded that these findings show that alcohol consumption, particularly binge drinking, is a public health concern for the older adult population and may be overlooked by PCPs and other health professionals. They advise that, in addition to screening for alcohol problems, clinicians should inquire about binge drinking due to the negative health consequences. 

Study limitations included the cross-sectional study design; use of a self-report survey in the elderly population, who have been shown to be at increased risk for cognitive impairment and dementia; and the exclusion of those with severe mental and physical health disorders.

Funding for this research was provided by the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center and the National Institute on Drug Abuse. (Am J Psychiatry. In press.) –CP

Abuse of Stimulant Medications by Youths Increases Along With Access

Attention-deficit/hyperactivity disorder (ADHD) prevalence rates for children and adolescents vary widely, from 2% to 18% in community samples. Approximately 4% of adults are affected by ADHD as well. Stimulants are commonly prescribed in youths and adults as a first-line treatment for ADHD, and a new study found that abuse of these drugs is becoming more frequent as the number of prescriptions increase.

Jennifer Setlik, MD, of the Cincinnati Children’s Hospital Medical Center, and colleagues, evaluated stimulant abuse trends, collecting information from the National Poison Data System for incidents related to intentional abuse or misuse of prescription stimulants in youths 13–19 years of age between 1998 and 2005. They compared these data with ADHD medication sales trends, acquired from the IMS Health National Disease and Therapeutic Index database.

The estimated number of ADHD prescriptions for youths rose 133% for amphetamine products, 52% for methylphenidate products, and 80% for both combined over the 8-year period. Calls to the National Poison Center related to ADHD medication abuse rose 76% over the same period, from 330 calls during year 1 to 581 calls during the final year. This increase occurred faster than the number of calls related to both general substance abuse and teen substance abuse.

The study did not include data on whether teens who abused these drugs had received a prescription for them, but according to the researchers, access to them was clearly higher and disproportionately related to amphetamine products.

Funding for the acquisition of the IMS Health National Disease and Therapeutic Index prescription data was provided by the RADARS system, a part of the Denver Health and Hospital Authority. (Pediatrics. 2009. ePub ahead of print.) –LS

Postpartum Depression Shown to Negatively Affect Infant Social and Emotional Development

Postpartum depression has been established in numerous prior studies to have a negative effect on a mother’s ability to provide optimal care for her infant. Conversely, investigators in child development have also sought to better understand the effects of maternal depression on the newborn, as research has also shown that this period is key in the development of coping mechanisms and other skills for the newborn.

Recently, Ruth Feldman, PhD, of the Department of Psychology at Bar-Ilan University in Israel, and colleagues, evaluated 100 mothers—some diagnosed with major depressive disorder (MDD) or anxiety following childbirth—and their infants at 9 months postpartum to examine the effects of maternal depression on three areas of infant development: social engagement, fear regulation, and cortisol reactivity. An additional study objective was to assess the role of maternal sensitivity in moderating the relationship between postpartum depression and infant outcome.      

The 100 mother-infant dyads who participated in the study were selected from 971 mothers who were assessed for depression and anxiety following childbirth. Of those evaluated, 215 mothers who exhibited symptoms of depression and anxiety as well as a selection of mothers who had no symptoms of either disorder were evaluated at 6 months. Lastly, at 9 months, mothers diagnosed with MDD (n=22) or an anxiety disorder (n=19) were matched with healthy control mothers (n=59) for study inclusion and evaluated at home. All mothers in the study were physically healthy, educated, in stable relationships, and had delivered a healthy full-term infant.

Infant social engagement was observed during interactions between the mother and infant at home; emotion regulation was assessed using a fear paradigm; and cortisol levels of the mother and infant were assessed at baseline, during stress reactivity situations, and at recovery. These infant outcomes were selected because research has shown that they are associated with the infant’s ability to manage physiologic stress and regulate negative emotions as well as form the foundations of the social and emotional growth of the infant.

Feldman and colleagues found that infants of mothers with MDD scored poorest on all infant development outcome measures at 9 months. Infants of mothers with MDD showed lowest social engagement, more negative emotionality such as crying and fussiness, less mature regulatory behaviors during situations that introduced novelty, and increased cortisol levels indicating increased stress reactivity. Infants of mothers with anxiety were also shown to have similar stress reactivity to infants of mothers with MDD; however, infants of anxious mothers were not shown to match controls in fear regulation.

Findings for infants of mothers with MDD were moderated by increased maternal sensitivity to the child; more sensitive mothers with MDD had infants with better social engagement. Maternal sensitivity was also shown to positively affect infant physiologic reactivity to stress. The authors concluded that these findings may illustrate particular pathways by which postpartum depression may have a direct association with infant development, and postpartum depression should be evaluated in the context of overall infant development.

Funding for this research was provided by the Israel Science Foundation, the US-Israel Bi-National Science Foundation, and the National Alliance for Research on Schizophrenia and Depression Foundation. (J Am Acad Child Adolesc Psychiatry. 2009;48(9):919-927.). —CP

Psychiatric dispatches is written by Carlos Perkins, Jr., and Lonnie Stoltzfoos.