Toward integrated care: How brief screening tools can help identify and address alcohol use and depression comorbidity

The co-occurrence of problematic alcohol use and depression among the primary patient population in the United States is well-documented. However, meta analytic studies identify few instances of comorbidity research using screening instruments. Identifying the existence of such a comorbidity is important because the disorders may causally interact and prevent patient improvement. This study explored the use of standardized screening tools (AUDIT and PHQ-9) to identify and address comorbidities between problematic alcohol use and depression by examining a sample of 10,268 primary care patients at five community health centers. Each patient was prescreened for alcohol use and depression, and “positive” patients completed the appropriate full screening instrument(s). We used one-way ANOVA analyses and Tukey's post-hoc test to compare patients who prescreened negative for alcohol and those scoring in each of the AUDIT's four diagnostic zones in order to assess differences in the prevalence and severity of depression by patients' level of alcohol use. We observed significantly higher levels of depression among patients who scored in any zone on the AUDIT than among those who prescreened negative for alcohol. We also found that the severity of depression was higher among patients scoring in zone IV on the AUDIT than among those scoring in zone I. Screening for alcohol use and depression effectively can identify comorbidities, and may be beneficial to implement in primary care sites where care coordination is possible, especially those implementing screening, brief intervention, and referral to treatment (SBIRT). Further research on patient outcomes in this area is warranted.