‘ I drink , you suffer ’ : impact of partner ’ s alcohol consumption on spouse

Alcohol abuse by the husband contributes to poor physical and mental health in the spouse. The aim of the study was to identify the correlation between alcohol consumption in husbands and depression and suicidal ideation, in their wives. Thirty patients who were wives of persons dependent on alcohol were assessed using PHQ-9 for depression and MSSI for suicidal ideation. The husband’s alcohol consumption was graded using the AUDIT scale. We found significant positive correlation between alcohol consumption in husbands and depressive symptoms and suicidal ideation in their wives.


Introduction
Alcohol is an important risk factors of ill-health and disability.The WHO estimates that one-fourth to one-third of the male population in South East Asian countries drink alcohol (1).In India, the estimated number of alcohol users in 2005 was 62.5 million and 17.4% (10.6 million) were dependent on alcohol (2).Of the hospital admissions, 20-30% were due to alcoholrelated problems (3).Continuous alcohol abuse not only affects the individual but also family members, especially the spouse who faces many emotional problems and stressful life events.Many studies and anecdotal reports suggest that individuals who are married to persons dependent on alcohol have poor overall physical and mental health (4)(5)(6).One study found that substance use disorders among husbands is strongly associated with psychiatric illness such as depressive disorders and anxiety disorders among their wives (7).
A literature search revealed that there is little data from India on alcohol consumption and its impact on the wives.In India the socio-cultural conditions, social values, amount of social support and types of stressors are different from that in the Western world.Therefore we conducted this study with the primary objective of identifying the correlation between alcohol consumption in the husband and the depressive features in the spouse.Secondarily, we aimed to assess whether the alcohol dependence in husband and depression in wives was related to suicidal ideation.

Methods
The 30 subjects recruited in this cross-sectional study were the wives of alcohol dependent men admitted to the de-addiction ward of a hospital in Jaipur, India.These wives had been living with their husbands since marriage.Wives with a history of substance abuse or dependence, lifetime history or family history of any psychiatric or medical disorder and those who were unable to read or understand the questionnaires were excluded.After taking informed consent, their socio-demographic profile was recorded and they were assessed using the Patient Health Questionnaire (PHQ-9 Hindi version) for screening of depression and Modified Scale for Suicidal Ideation (MSSI) to rate suicidal ideation.Alcohol Use Disorders Identification Test (AUDIT) was used to grade severity of alcohol dependence in the husbands.We included only the female spouse in our study due to the male-predominant drinking pattern in our country.Statistical analysis was done using SPSS 17.

Results
The mean age of the sample was 30.67 years (SD 8.125).Majority of the sample were housewives (66.7%), of the Hindu religion (83.3%), had received at least primary education and were living in a nuclear family (53.3%).Mean duration of alcohol consumption in the husbands was 9.60 years (SD 2.79).Among the alcohol users the mean AUDIT score was 11.47 ± 4.05.The mean PHQ-9 score among the wives was 4.87 ± 5.49.The correlation between variables measuring alcohol intake and PHQ-9 and MSSI scores is shown in table 1. Depressive symptomatology in the wife was significantly and positively correlated with the AUDIT scores.There was strong correlation between AUDIT scores and suicidal ideation in wives measured by the MSSI.Those with suicidal ideation stated that concerns about their children's upbringing and their future, were the main reasons which prevented them from killing themselves.

Discussion
We found that depressive symptomatology in the wife was significantly and positively correlated with the severity of alcohol use in the husband, as measured by the AUDIT score.A longitudinal study also reported similar results (8).There is evidence that women are more susceptible to depression when their husbands are Brief report alcoholic (9).Among community samples too there is evidence that alcohol use disorders are associated with depression in the partner (10).Although, some believe this to be a spurious relationship related to assortative mating, others propose that common life experiences and shared stress in couples may influence drinking in one partner and a negative psychological effect on the other (9).The result of our study found that heavy drinking is associated with depression in the partner.It may be speculated that husbands' alcohol use creates a context in which the depressive symptoms emerge in the wives and that women experience emotional distress due to living in an environment with problems caused by alcohol consumption by the husband.
Another significant finding was the direct strong correlation between the drinking pattern in husbands and suicidal ideation in the wives.A study has reported that the wives of alcoholic males might have more depressive features than wives of non alcoholic males (11).It also reports that wives of alcoholics have strong unhappy feelings, frequent suicidal thoughts, strong desire to die and self-harm.Similar to findings from our study, concerns about their children play an important role in preventing them from killing themselves.There were several limitations in our study.We did not distinguish between alcohol use and alcohol-related problems.We used a self-reported screening instrument for assessing depression, the sample size was small and the study design was cross-sectional.
Our findings show that alcohol use results in consequences which extend beyond the alcohol drinker.The association between alcohol problems and partner's depression highlights the need to include in the management plan not only the individuals suffering from alcohol use disorders, but also the spouses who are at high risk of psychological distress.

Table 1 .
Correlation between severity of alcohol use and outcomes -Alok Tyagi, Professor Shubham Mehta, Resident Doctor Department of Psychiatry, Sawai Man Singh Medical College, Jaipur (Rajasthan) India.Corresponding author: Shubham Mehta mail:drshubhammehta@gmail.com