Globally, adults are living longer. By 2030, 1 in 6 people in the world will be over 60 years old (WHO, 2022). Middle age, and especially late middle age, are understudied but important stages of the life span characterized by changes in family dynamics, employment, and physical and mental health.
Few studies have examined changes in alcohol consumption and the risk of heavy and harmful drinking in middle-aged adults. However, data from the UK shows that adults aged 45 and over are more likely than other age groups to drink alcohol in the past week, and those aged 65 and over are more likely to drink alcohol on five or more days in the past week. (ONS, 2022).
One potential major risk factor for heavy drinking in midlife is the experience of a serious illness or negative life event, such as the death or divorce of a family member. Evidence shows that individuals who have experienced a negative life event drink more than those who have not. However, less is known about the alcohol consumption patterns of those experiencing negative life events, that is, drinking trajectories within this group.
The purpose of the current study was to identify patterns of alcohol use before and after experiencing a negative life event, and to examine sociodemographic, health, and behavioral characteristics of individuals within drinking trajectory groups (Agahi et al, 2022).
Evidence shows that individuals who have experienced a negative life event drink more than those who have not.
Methods
Participants
Participants were recruited from a cohort study – the Finnish Research on Retirement and Aging (FIREA). Eligible individuals were public sector employees working in 1 of 27 municipalities in southwestern Finland or in 9 selected Finnish cities or 5 hospital districts and with a retirement date between 2014 and 2019.
Participants were individuals reporting a negative life event; divorce (n=264), serious illness or death in the family (n=1.129) and control participants who did not experience a negative life event (n=3.354).
Design
Data were centered around the time of the first adverse life event, with study waves occurring before (−3, −2, −1) and after (+1, +2, +3) each life event. A dummy event year was randomly assigned to similarly organize data for control participants.
Events
- Adverse life events during the past 12 months were self-reported using a 12-item questionnaire. Two types of negative events (1) serious illness in the family (spouse/child) and/or death in the family (spouse/child) and (2) divorce were examined.
- Alcohol consumption was self-reported as alcohol units per week. One unit corresponds to 12 g of pure alcohol or the equivalent of 33 cl of beer, 12 cl of wine or 4 cl of spirits. Under current UK guidelines, heavy alcohol consumption is defined as more than 14 units per week for both women and men.
- Individual characteristics associated with prior experience of heavy alcohol consumption and/or negative life events were assessed and included in the analyzes as covariates. Participants were asked about date of birth, gender, socioeconomic status (occupational title), neighborhood socioeconomic disadvantage, marital status, employment status (full-time, part-time, retired), anxiety, depression, social network connections, and smoking status. they reported themselves. . These data were collected from the last survey before the life event of interest.
Analysis
Data were analyzed using complete case analysis with prevalence (%) of heavy drinking calculated for individuals experiencing adverse life events and controls. Changes and differences in heavy drinking before and after life events were analyzed using latent trajectory analysis.
Separate analyzes were conducted for divorce and severe illness or death. Three groups of drinking trajectories were created:
- Do not drink strong drinks
- Reduction in heavy drinking – an increase in the likelihood of binge drinking before the event, followed by an event-related decline, and a subsequent decline
- Constant heavy drinking – constantly high probability of drinking.
Results
Proportions of heavy drinks
Participants who experienced severe illness or death showed a decreased tendency to binge drink after the event. Conversely, participants who experienced a divorce reported increased rates of heavy drinking after the event. For participants who did not experience an event (controls), the rate of heavy drinking was more stable with a slight decrease over the follow-up period.
Trajectories of heavy drinking
- For participants with serious illness or death (82%) and divorce (75%).
- The largest trajectory group was “no heavy drinking.”
- For participants experiencing serious illness or death
- 7% were in the “reduction of heavy alcoholic drinks” group
- 10% in the “regular heavy drinker” group
- Finally, for those going through a divorce
- 12% were in the “reduced binge drinking” group
- 13% in the “regular heavy drinker” group.
Characteristics of individuals related to trajectories
- Participants in the “regular heavy drinking” trajectory group who experienced severe illness or death were more likely to be male, have a history of depression, have high levels of anxiety, and be smokers compared to those in the “no heavy drinking” trajectory group.
- The “heavy drinking reduction” group did not differ significantly from the “non-heavy drinking” group, but the “heavy drinking reduction” group tended to be retired or work part-time and to be smokers.
- Participants in the divorced, “reduced heavy drinking” and “regular heavy drinkers” groups were more likely to be male and had a history of depression (statistically significant only for the regular group) compared to the “non-heavy drinkers” group.
- The ‘regular heavy drinker’ group had more occupational status, lived in areas of lower neighborhood deprivation and were more likely to be smokers (not statistically different).
Participants who experienced severe illness or death showed a decreased tendency to binge drink after the event.
Results
Results show that for middle-aged adults who experience negative life events, there is often no change in drinking behavior.
Divorced men were overrepresented on the “continuous heavy drinking” and “reduced heavy drinking” trajectories. This may reflect a greater proportion of men drinking to cope, or simply that men drink more than women.
Individuals in the “regular heavy drinker” group were also more likely to be male, report more depression, and have higher occupational status, potentially accounting for higher alcohol consumption in higher socioeconomic individuals and the association between depression and heavy drinking. reflects the occurrence.
Together, these findings suggest that men with a history of depression and experiencing negative life events may be at higher risk for heavy alcohol use.
This study suggests that experiencing negative life events in midlife does not alter drinking behaviors.
Strengths and limitations
The findings of the present study should be considered in light of the following strengths and limitations. First, the study’s large cohort design allowed us to assess changes in alcohol consumption over several years in a homogeneous group of individuals. Studying such a similar group of individuals may also be deficient, where the results of public sector workers who are mostly still employed and in the younger age range (60–65 years) may not be generalizable to other groups.
Moreover, the study used UK guidelines for measuring multiple drinks. It is not known how familiar Finnish adults are with the concept of an alcohol unit when self-reporting alcohol consumption. Even in the UK, where units of alcohol are the most commonly used measure of alcohol consumption, they are poorly understood by the public.
Finally, the experience of negative life events may have prevented some individuals from participating, meaning that the most affected individuals were not captured in this study.
Large cohort studies such as this allow the assessment of changes in drinking behaviors over time and enhance our understanding.
Implications for practice
Research results show that most heavy drinkers who experience negative life events in midlife continue this pattern of alcohol consumption as they move through these events. Therefore, mental health professionals may want to ask about and/or assess alcohol consumption in individuals reporting midlife events such as divorce, serious illness, or the death of a family member. This is particularly relevant given that the “regular heavy drinker” group in the study was also more vulnerable to depression and the comorbidity between alcohol use and mental health problems in this group.
Findings also suggest a gender difference in alcohol use as a potential coping mechanism. Men with a history of depression who have experienced negative life events may be more susceptible to “regular heavy drinking.” Thus, public health initiatives may want to focus on reducing heavy and potentially harmful alcohol consumption in this group. In particular, men who use alcohol to cope with divorce, illness and death in the family may be reluctant to give up heavy drinking, the study found.
Clinicians can ask about mental health and alcohol use problems together to assess vulnerability in middle-aged adults experiencing negative events.
Statement of interest
None.
Connections
Primary paper
Agahi, N., Morin, L., Virtanen, M., Pentti, J., Fritzell, J., Vahtera, J., & Stenholm, S. (2022). Heavy alcohol consumption before and after adverse life events in midlife: longitudinal latent trajectory analyses. Journal of Epidemiology and Community Health, 76(4), 360–366.
Other references
World Health Organization “Aging and Health” [accessed 21.10.2022]
Office for National Statistics “Drinking habits of adults in the UK” [accessed 21.10.2022]
