Co-occurring heavy episodic drinking and psychological symptoms across five life phases

Abstract Background Co-occurring mental health and substance use problems are linked to various life challenges. Understanding the age-specific characteristics of this co-occurrence helps tailor age-sensitive prevention and treatment strategies. This study examined the association and co-occurrence of psychological symptoms (PS) and heavy episodic drinking (HED) from adolescence to midlife, and their associations with individual and contextual factors. Methods Participants from the Finnish TAM Cohort (N = 2194) provided information on HED, PS, health (e.g. self-perceived health), psychosocial (e.g. self-esteem), social relations (e.g. contact with parents), and socioeconomic factors (e.g. education) at ages 16, 22, 32, 42, and 52. Co-occurrence was categorised into 1) neither, 2) symptoms only, 3) HED only, 4) symptoms + HED. Analyses used generalized mixed models. Results Through the follow-up, the proportion of those with both HED and high PS ranged between 3.4% - 6.9% in women and between 4.5% - 8.7% in men. The overall association between high PS and HED was OR 1.89 (1.51-2.37) in women and OR 2.30 (1.78-2.95) in men. In women, age did not play a role in the association between symptoms and HED, while in men, the associations were stronger at ages 16, 22, 32, and 42 compared to age 52. In the multivariate model, in both women and men, poor self-perceived health, smoking, self-esteem, and meaningfulness were associated with co-occurrence. In women, associations were also found regarding overweight, poor relationship with father, and lower education. These associations did not vary by age, except for overweight and meaningfulness in women and smoking in men. Conclusions The strength of the association between psychological symptoms and HED is stable in women from adolescence to midlife but weakens in men. Individual and contextual risk factors for co-occurrence remain relevant across different age phases, suggesting that interventions remain pertinent through the lifespan. Key messages • The strength of the association between heavy episodic drinking and psychological symptoms is stable from adolescence to adulthood, although it starts to decline in men in midlife. • Co-occurring alcohol and mental health problems are associated with health and psychosocial factors generally throughout life, suggesting these targets for interventions remain pertinent through life.