title: The Socioeconomic Patterning of Alcohol Use and Mental Health Comorbidity
Creators: name: Puddephatt, Jo-Anne
Publisher: name: University of Liverpool Repository
Year: 2022

description: Some individuals with a mental health problem are more likely to drink at harmful levels and report using alcohol to cope with declines in their mental health whilst others no longer use alcohol due to declines in their mental health. Individuals of lower socioeconomic status (SES) are disproportionately more likely to experience alcohol harms and poorer mental health, respectively, compared to those of higher SES. It is also suggested that other factors, such as neighbourhood disadvantage and social support, play a role in these co-occurrences. This thesis aims to understand the prevalence of alcohol use across a range of mental health problems in the general population, examine the role of SES and other factors on this co-occurrence, and explore experiences of alcohol use and how it is used over time among individuals with a mental health problem living in the general population. Using a multi-methods approach, this thesis conducts a systematic review and meta-analysis to establish the prevalence of alcohol use among individuals with and without common mental disorders (CMD). A secondary data analysis using a large, representative survey in England, 2014 Adult Psychiatric Morbidity Survey, is then used to establish the prevalence of alcohol use (including non-drinking) across a range of mental health problems. This thesis then focusses on individuals who meet criteria for a mental health problem to establish how i) individuals are clustered based upon different indicators of SES, ii) SES is associated with alcohol use and, iii) the indirect effect of social support and neighbourhood disadvantage on this co-occurrence. Finally, qualitative interviews explore changes in drinking based upon the mental health symptoms individuals experience and how these differ among drinkers and non-drinkers who have a severe mental illness (SMI). Findings from the thesis show that individuals with a CMD are twice as likely to report an alcohol use disorder compared to those without. Secondary data show that those meeting criteria for a range of mental health problems are more likely to be non-, hazardous or harmful/probable dependent drinkers, compared to low-risk drinkers. This data also shows that, among those with a mental health problem, lower SES groups are more likely to be non-drinkers, compared to those of higher SES. Qualitative findings show that alcohol is used to cope specifically with trauma, mental health symptoms or stress among individuals with a SMI. Non-drinkers change their drinking habits before or during getting formal support and after experiencing significant declines in their mental health. Whereas drinkers change their drinking habits either during or after getting formal support and now currently drink alcohol for enjoyment and in a controlled way. The evidence lends support for the self-medication and drinking motives models and highlights that the co-occurrence of alcohol and mental health problems are complex. Findings have important implications for how drinking habits may change over time and the role of mental health, previous trauma and appropriate and timely support.