Changes in alcohol consumption reported on routine healthcare screenings are associated with changes in depression symptoms

Abstract Background The Alcohol Use Disorders Identification Test‐Consumption version (AUDIT‐C) has been robustly validated as a point‐in‐time screen for unhealthy alcohol use, but less is known about the significance of changes in AUDIT‐C scores from routine screenings over time. Unhealthy alcohol use and depression commonly co‐occur, and changes in drinking often co‐occur with changes in depression symptoms. We assess the associations between changes in AUDIT‐C scores and changes in depression symptoms reported on brief screens completed in routine care. Methods The study sample included 198,335 primary care patients who completed two AUDIT‐C screens 11 to 24 months apart and the Patient Health Questionnaire‐2 (PHQ‐2) depression screen on the same day as each AUDIT‐C. Both screening measures were completed as part of routine care within a large health system in Washington state. AUDIT‐C scores were categorized to reflect five drinking levels at both time points, resulting in 25 subgroups with different change patterns. For each of the 25 subgroups, within‐group changes in the prevalence of positive PHQ‐2 depression screens were characterized using risk ratios (RRs) and McNemar's tests. Results Patient subgroups with increases in AUDIT‐C risk categories generally experienced increases in the prevalence of positive depression screens (RRs ranging from 0.95 to 2.00). Patient subgroups with decreases in AUDIT‐C risk categories generally experienced decreases in the prevalence of positive depression screens (RRs ranging from 0.52 to 1.01). Patient subgroups that did not have changes in AUDIT‐C risk categories experienced little or no change in the prevalence of positive depression screens (RRs ranging from 0.98 to 1.15). Conclusions As hypothesized, changes in alcohol consumption reported on AUDIT‐C screens completed in routine care were associated with changes in depression screening results. Results support the validity and clinical utility of monitoring changes in AUDIT‐C scores over time as a meaningful measure of changes in drinking.