Giving Up Alcohol Boosts Mental Health
in Women

Norra MacReady

July 08, 2019

For women, quitting drinking may be associated with a significant improvement in mental health, according to a study published online today in the Canadian Medical Association Journal.

The findings come from a comparison of two population-based cohorts, which together comprised more than 40,000 people. In both cohorts, lifetime abstainers reported the highest levels of mental well-being at baseline, but women who started out as moderate drinkers and quit during the 4-year study period experienced the greatest improvements in mental health, such that their well-being ultimately approached that of the abstainers.

Mental health also improved among men who quit drinking, but the results were not statistically significant, note Xiaoxin I. Yao, PhD, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, and colleagues.

The findings add to the growing body of evidence suggesting that moderate drinking may not improve health-related quality of life, said coauthor Michael Y. Ni, MD, MPH, of the University of Hong Kong's School of Public Health and The State Key Laboratory of Brain and Cognitive Sciences, in a news release. "Instead, quitting drinking may be associated with a more favourable change in mental well-being, approaching the level of lifetime abstainers."

The researchers analyzed data from adults participating in the FAMILY Cohort study, which is a territory-wide analysis of factors that contribute to the well-being of citizens in Hong Kong. Yao and colleagues used data from waves 1 and 2 of the cohort, which were conducted from 2009 to 2013.

To account for cultural differences, the authors also analyzed data from the US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which was designed to assess the prevalence of alcohol use disorders and comorbid conditions among adults in the United States. The researchers used data waves 1 and 2, conducted from 2001 to 2005.

From both cohorts, the authors included data on participants aged 18 years or older who could be classified as non-drinkers or moderate drinkers, defined as weekly consumption of 14 drinks (196 g of pure alcohol) or less for men or 7 drinks (98 g pure alcohol) or less for women. "People who reported heavy drinking were excluded because the evidence for adverse impacts of heavy drinking on health-related quality of life is well established," they explain.

All participants competed the 12-item Short Form Health Survey version 2, which consists of physical and mental component summaries. The scores range from 0 to 100, with higher scores indicating better health.

The FAMILY cohort had a sample size of 10,386 people (44.2% men) with a mean age of 49.3 years (standard deviation [SD], 17.4 years), a median follow-up time of 2.3 years, and a total follow-up time of 23,055 person-years. Of those 4592 male participants, 2931 (63.8%) of them were non-drinkers (lifetime abstainers or former drinkers) at baseline, and 1661 (36.2%) were drinkers, of whom 40.3% quit drinking during the study period. Similarly, 5080 (87.7%) of the 5794 women in the FAMILY cohort were non-drinkers at baseline and 714 (12.3%) were drinkers, of whom 62.2% quit drinking during the follow-up period.

The NESARC cohort consisted of 31,079 people (40.6% men) with a mean age of 46.3 years (SD, 17.5 years). The median follow-up time was 3.1 years and the total follow-up time was 94,798 person-years.

At baseline, male and female lifetime abstainers in both cohorts reported the highest levels of mental well-being, after adjusting for a wide range of variables including sociodemographic characteristics, body mass index, smoking status, self-reported physical health, and physical activity.

However, at follow-up, improvement in mental health among women in the FAMILY cohort who had quit drinking during the study period was greater than women who were lifetime abstainers (ß = 1.44; 95% confidence interval [CI] 0.43 - 2.45; mean score change of +2.0 for quitters and +0.02 for lifetime abstainers).

This association among women was validated in the NESARC cohort (ß = 0.83; 95% CI, 0.08 - 1.58; mean score change of -1.1 for quitters and -1.6 for lifetime abstainers). However, the association was not statistically significant among men who quit drinking.

The authors also found that initiation and persistent moderate drinking were not associated with better physical well-being during follow-up.

For people who stop drinking, the benefits may be analogous to those experienced by people who quit smoking, who ultimately have health outcomes similar to those who have never smoked, the authors suggest.

They conclude, "Our findings, that lifetime alcohol abstainers report the highest level of mental well-being and [that] quitting alcohol improves mental well-being among women, suggest caution in recommending that moderate drinking could improve health-related quality of life. Instead, quitting drinking may be associated with a more favourable change in mental well-being, approaching the level of lifetime abstainers."

The authors have disclosed no relevant financial relationships.

CMAJ. Published online July 8, 2019. Full text

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