Anxiety, depression and alcohol use are prevalent and, in many cases, difficult to diagnose and treat. In Honduras, alcohol consumption and its association as anxiety and depression in women at the national level has not been studied, there are specific studies in the population of specific communities, so the objective of this study was to determine if anxiety and moderate or major depression were associated with high alcohol consumption in Honduran women (15).
Zavala and et al, in 5 Honduran communities in a sample of 1629 women over 15 years of age, found that the frequency of domestic violence was 45.2%: verbal 52%, physical 20.5% and sexual 19%, in women under 39 years of age, in a free union, with primary schooling, with children; At the time of the violence, the aggressor was under the influence of alcohol or other drugs, transforming the home into a center of violence, of danger to the woman and children (16).
Domestic violence in Honduras occurs in various forms, involves multiple factors: socioeconomic, cultural, religious, in addition to being a serious social problem with serious consequences where women experience violence in a duplicate way as inhabitants and as exposed women, in the community of Porvenir San Nicolas department of Copan, in 153 women over 16 years with partner, It was found that 79.1% had some type of domestic violence; 39.7% presented economic violence; 29.6% were between 31 and 40 years old; 52.9% were married; 53.7% with incomplete primary education; 38.8% housewife; 59.5% without income; Only 9.1% made a complaint, 83.5% did not consume alcohol (17).
In a study in Ecuador, where 663 adolescents between 13 and 20 years of age participated, it was found that adolescents who are at risk associated with alcohol and tobacco consumption have a significant relationship with symptoms of anxiety and depression, there is a greater tendency for women to present symptoms of depression and anxiety than men (18).
There is a strong association between anxiety versus risky alcohol use, Esmaeelzadeh et al, found significant associations between anxiety and alcohol consumption (19), studies show that anxiety disorders are more common among women, while alcohol use disorder (AUD) is more common among men(20), Astudy of Canadian adults through an online survey in May 2020, found that women were more likely to increase alcohol consumption (41%) and anxiety, during the COVID19 pandemic (21). Alcohol use disorder (AUD) and anxiety disorders (AnxD) are prevalent health problems that frequently coexist (AUD-AnxD) and are combined with each other(22), withevidence that for women experiencing intimate partner violence (IPV), psychological therapies likely reduce depression and may reduce anxiety (23).
In Chile, anxiety disorders are reportedly the most prevalent, followed by major depression and alcohol use disorders. Comorbidity occurs in 27% of those with disorders, but only 7% have three or more diagnoses (24). Ramón-Arbués et al, found in 1074 undergraduate students (71% women and 29% men) aged 18 to 42, that being a woman, frequently consuming alcohol was associated with anxiety (25).A 2022 meta-analysis reported that unemployed women have a 3.7 times higher risk of dying from a cause of death attributable to alcohol compared to employed women (26).
No association was found between depression and risky alcohol use, according to the WHO, depression is a common mental disorder, it is estimated worldwide that 5% of adults suffer from depression (27).This study differs from that reported in other studies that have found an association between alcohol consumption and depression, in 3,007 Brazilians aged 14 years and older found in women, alcohol dependence and the presence of one or more problems related to alcohol consumption were associated with increased risks of major/severe depressive symptoms (28), in a meta-analysis by Humphreys of 190 studies in 68,830 individuals, conducted to test whether childhood maltreatment was associated with depression diagnosis and symptom scores in adulthood. This is the largest study examining the association between childhood maltreatment and depression (29).
A large association of such mental pathologies was also found with having a history of violence at home, because of the COVID-19 Pandemic, it is believed that some 243 million women have experienced sexual or physical abuse at the hands of an intimate partner at some point during the last 12 months, these women have been trapped with their abuser. A week after France declared its lockdown, reports of domestic violence had increased by 30% (30). Women may be particularly vulnerable to IPV victimization in the context of intoxication, which may also explain the unique associations between sexual IPV and alcohol problems (31). Violence against women is associated with various difficulties of psychological functioning and emotional well-being, many women need protection from their abuser and initiate contacts with confidential domestic violence shelters (32).
Studies of interpersonal trauma and substance abuse in women have shown a strong association between the two conditions, a history of interpersonal trauma increases the risk of substance abuse, the majority (72%, 336/465) of the sample reported physical or sexual abuse in the past; Of these, 75% had experienced abuse for the first time as children (aged 17 and under), we speculate that the life consequences related to substance use are not mediated only by drug and/or alcohol use (33).
Stubbs' meta-analysis published in 2022, demonstrated that the long-term effects of intimate partner violence (IPV) have negative effects on physical health outcomes for women, drug and alcohol abuse and developing chronic diseases and pain. (34). In Honduras according to ENDESA/MICS 2019, 20% of women aged 15–49 have ever been beaten or physically abused by someone after the age of 15, 23% have experienced physical violence by: their husband/partner ( very often when drunk 42%) and their mother/stepmother 23%; 20% by their ex-husband/partner; 18% of the father/stepfather; 14% the ex-boyfriend, 13% other family member and, by a sibling in 12% (8).
Another important association is that both mental pathologies: anxiety and depression were associated with the fact that in the respondent's family, there has been some diagnosis of a problem in the mental sphere, people with common mental disorders (depression, anxiety, phobia) are twice as likely to report an alcohol use disorder, than people without common mental disorders (35).In Tunisia in a study with 751 participants, where women who had a history of mental illness and who allegedly suffered abuse during lockdown during the COVID-19 pandemic had more severe symptoms of depression, anxiety and stress (36).
A key result is that those who had the three criteria of the SRQ test had higher percentages of depression and anxiety, in severe or very severe degrees, In a study in Honduras that used the Self Reporting Questionnaire (SRQ) in 1,306 participants, anxiety showed the highest prevalence and a prevalence for depression of 13.2%, the symptoms that had the highest frequency were: headaches with 29.4%; feel nervous, tense or bored at 28.1% and easily frightened at 23.9% (9).
Husain N and et al, validated the SRQ 20 self-report questionnaire in Pakistani British and white European population in the UK in 415 men, 517 women concluded that the SRQ can be used as a routine screening questionnaire for depression in English and Urdu speaking populations in the UK, The same for the Chinese community, the SRQ-20 is a reliable and valid measure of mental disorders, although in this study it was used as a screening test and the diagnoses of depression and anxiety were confirmed with the Hamilton scales (37)(38).Among the risk and protective factors for mental health are identified social factors, lifestyle, physical health, body mass index (BMI), diabetes mellitus, genetic and biological factors, which(39) shows the importance of generating screening programs with tools like this, which can help detect pathologies of this type and establish management behaviors of this problem.