Horizon Interdisciplinary Journal (HIJ). ISSN: 2992-7706

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Research Article

Anxiety and Depressive Symptoms Associated

to Alcohol Consumption in Health Care Workers

Edgar Omar Vázquez-Puente

, Karla Selene López-García

, Francisco Rafael

Guzmán-Facundo

, Ramón Valladares-Trujillo

y Adriana Patricia Castillo-Méndez

Universidad Autónoma de Nuevo León. Facultad de Enfermería. Monterrey, Nuevo León,

México.

Instituto Mexicano del Seguro Social/Departamento de Educación e Investigación en

Salud. Monterrey, Nuevo León, México.

*Corresponding author: Karla Selene López-García, Universidad Autónoma de Nuevo

León. Facultad de Enfermería. Monterrey, Nuevo León, México. E-mail:

kslg2001@hotmail.com. ORCID: 0000-0002-9462-7140.

Submitted: 10/03/2023 Accepted: 10/25/2023 Published: 11/12/2023

Abstract. – Alcohol consumption in healthcare personnel is of great importance due to the

impact it causes on the individual's well-being and quality of life, even generating behavioral

problems such as anxiety and depressive symptoms. These situations can lead to the

consumption of alcohol to cope with situations that may arise in the workplace. The

objectives of the study include describing the characteristics of health personnel, identifying

the prevalence of alcohol consumption by sex and age, as well as determining the

relationship between anxiety, depressive symptoms and alcohol consumption in health

personnel. Methods: Descriptive, predictive correlational study that included 420

participants. Sociodemographic information was collected, as well as data on anxiety

through the GAD-7, depressive symptoms measured with the PHQ9 and alcohol

consumption through the AUDIT, in compliance with the ethical aspects of the General

Health Law on Health Research. Results: Seventy percent were women, significant

difference was identified in the prevalence of last month (χ

= 5.393, p= 0.020) and last seven

days (χ

= 4.328, p= 0.037) by sex. The age group between 18 and 33 years indicated higher

consumption in all four prevalences. Positive and significant relationship was shown in

anxiety and depressive symptoms (𝑟

𝑠

= .644, p< 0.001), anxiety and alcohol consumption (𝑟

𝑠

0.216, p< 0.001), depressive symptoms and alcohol consumption (𝑟

𝑠

= 0.210, p<0.001). A

significant negative relationship was identified for age and anxiety (𝑟

𝑠

= -0.218, p< 0.001), age

and depressive symptoms (𝑟

𝑠

= -.261, p< .001), as well as age and alcohol consumption (𝑟

𝑠

= -

0.228, p< 0.001). Conclusion: The present study provides information on the impact of

mental disorder on health personnel through associations between anxiety, depressive

symptoms and alcohol consumption.

Keywords: alcohol consumption, healthcare personnel, mental disorders, anxiety,

depressive symptoms.

Horizon Interdisciplinary Journal (HIJ). ISSN: 2992-7706

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1. Introduction

Alcohol consumption represents a serious

problem for public health since is a

psychoactive substance that generates

social and economic consequences. This

substance is related to more than 200

diseases and injuries, generating three

million deaths annually, causing risk in the

development of mental disorders, liver

cirrhosis, and cardiovascular diseases,

which represents 5.1% of the global burden

of morbidity and injuries attributable to

the consumption of this substance

According to the Report on the World

Alcohol and Health Situation, the Americas

region has some of the highest prevalence

rates of alcohol consumption in the world;

in 2016, adults over 15 years of age drank

25% more alcohol on average than the rest

of the world

. In Mexico, consumption

figures are reported for the general

population between 12 and 65 years of age,

where 71% have drank alcohol at some

time in their lives, with a higher prevalence

in men (80.1%) than in women (62.6%).

During 2016, 49.1% reported having

consumed alcohol in the last year, with

consumption being higher in men (59.8%)

than in women (39.0%). Regarding

consumption in the last month, 35.9%

indicated drinking alcohol, again being

higher in men (48.1%) than in women

(24.4%), respectively

Based on the above, a vulnerability group

for alcohol consumption is healthcare

personnel due to the significant impact it

can have on well-being and quality of life,

thus, generating behavioral problems such

as stress, anxiety, and depressive

symptoms

. These situations can lead to

the consumption of substances such as

alcohol, as a way of coping with the

situations that usually arise on a daily basis

in the workplace

In this regard, healthcare personnel are

responsible for providing collaborative

services to the population of all ages, with

the aim of achieving optimal overall

functioning of the health system

. It has

been documented that working in an

environment with inadequate breaks,

working more than eight hours, rotation of

schedules and scarcity of resources can

negatively affect the health of the

healthcare personnel

7,8

. Although stress,

lack of education and lack of knowledge

about alcohol abuse are some factors that

may influence the ingestion of this

substance

Alcohol consumption has been identified

in healthcare personnel in various

countries

10,11

. For example, in Mexico 41.2%

of all nurses reported drinking alcoholic

beverages

, and in the United States a

prevalence of 79.7% was reported in

nursing personnel

. Likewise, in European

countries such as France, consumption of

alcoholic drink was reported by 35.7% of

physicians

, while in Germany 29.0%

showed this consumption behavior, of

which men (32.0%) had higher prevalences

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of alcohol consumption than women

(13.0%)

The consumption of this substance can be

related to aspects such as increased

workload, physical and mental exhaustion

and vital decision making in patient care,

generating harmful effects on healthcare

personnel which can lead to anxiety

disorders or depressive symptoms

, the

latter two are the most prevalent

disorders worldwide, estimating that one

in ten people are affected

Regarding the first disorder, anxiety is

characterized by an excessive concern in

which healthcare personnel do not have

self-control during some situation,

allowing the development of behaviors

that favor alcohol consumption in an

attempt to self-regulate the symptoms

4,14

While depressive symptoms, these can

have repercussions on thinking and the

performance of activities such as sleeping,

eating, losing up to 20.0% of working time,

in addition to having a greater exposure to

having an accident at work

Recent studies have identified proportions

of anxiety disorders and depressive

symptoms, identifying that health

personnel show anxiety between 49.5%

and 72.1% respectively, being higher in

women (52.5%) than in men (24.2%), while

depressive symptoms are between 13.5%

and 58.8%, being women (62.8%) who

show greater disorder compared to men

(24.2%)

12,15,16

Likewise, recent published literature has

focused on the results of anxiety disorders

and depressive symptoms in research

conducted in the context of the COVID-19

pandemic, identifying an increase in these

disorders. In this respect, addressing this

issue is necessary due to the impact of

complications, which can generate

inadequate service, accidents, high

employee turnover and suicidal thoughts

This paper aims to describe the mental

disorders of anxiety, depressive symptoms

and their relationship with alcohol

consumption in healthcare personnel.

Quantitative results are also shown in the

study population with the purpose of

evidencing possible risk factors that have

an impact on the optimal health of

healthcare personnel.

Objective: For this reason, the aim of this

study was to describe the characteristics

of healthcare personnel, to know the

prevalence of alcohol consumption by sex

and age, and to identify whether anxiety

and depressive symptoms predict alcohol

consumption in healthcare personnel

working in two tertiary care hospital

institutions.

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2. Method

2.1 Study design and participants

The present study is descriptive and

predictive correlational. The study

population consisted of 865 healthcare

personnel of both genders, belonging to

two tertiary care hospital institutions in

the metropolitan area of the state of

Nuevo León, Mexico, from April to July

2023.

The sampling was of the systematic 1 in 3

type, with random start. The sample size

was obtained through the statistical

package n'Query Advisor V4.0

, with a

confidence level of 95%, estimation error

limit of 0.05 and a power of 90%. The total

sample of participants selected was 420.

2.2 Measurement instruments

The Personal Data and Alcohol

Consumption History Card (CDPHCA by

its acronym in Spanish) was used. It

included questions related to

sociodemographic characteristics, as well

as the prevalence of alcohol consumption.

Generalized Anxiety Scale [GAD-7]

assessed generalized anxiety disorder,

where the questionnaire consists of seven

items through a 4-point Likert-type rating

(0= Not at all, 1= Several days, 2= More than

half of the days, 3= Almost every day), with

a minimum score of 0 and a maximum

score of 21 points.

A score between 0 and 4 indicates

“nothing”, i.e. no anxiety symptoms, a

score between 5 and 9 indicates “several

days” and above this score there is the

presence of anxiety symptoms, a score

between 10 and 14 indicates “more than

half of the days” and scores between 15 and

21 indicate “almost every day”. The scale

has been validated in Spanish and has

shown acceptable internal consistency

with a Cronbach's Alpha of 0.92

and for

the present study a value of 0.89 was seen.

Patient Health Questionnaire [PHQ-9]

The presence and severity of depressive

symptoms were evaluated, where the

questionnaire consists of nine items

through a 4-point Likert-type assessment

(0= Not at all, 1= Several days, 2= More than

half of the days, 3= Almost every day), with

a minimum score of 0 and a maximum

score of 27 points.

A score between 0 and 4 indicates no

depressive symptoms; a score between 5

and 9 indicates minimal depression; a

score between 10 and 14 indicates

moderate depression; scores between 15

and 19 indicates moderately severe

depression, and scores between 20 and 27

indicate severe depression. The scale has

been validated in Spanish and has shown

acceptable internal consistency with a

Cronbach's Alpha of 0.88

and for the

present study a value of 0.89 was seen.

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Alcohol Use Disorders Identification

Questionnaire [AUDIT]

. Alcohol

consumption was measured; it is

composed of ten multiple-choice items

corresponding to three dimensions:

frequency and amount of consumption,

possibility of dependence and harmful

alcohol consumption. The scale has a

minimum value of 0 and a maximum of 40

points, allowing to establish cut-off points

for each type of consumption; from 1 to 3

is considered risk consumption, from 4 to

7 points is a dependent consumption and

from 8 to 40 points there is a harmful

consumption. A 4-point Likert-type

assessment is made. The scale has shown

Cronbach's Alpha of 0.92

and for the

study a value of 0.85 was seen.

2.3 Procedure

Approval was requested from the Research

and Research Ethics Committees of an

institution of the Public University of

Nuevo León, through electronic means,

after which approval was received to carry

out the present study by means of

registration FAEN-D-1921. After that, it

was proceeded to ask for authorization

from the two hospital institutions using

letterhead printed documents. A list of the

personnel (medicine and nursing) by area

or department and shift was requested in

order to ask for the participation in the

study and clarify any doubts.

Support personnel were trained in the

collection of data for the study, obtaining

two groups, one for each hospital

institution. The person in charge of

teaching was contacted to request

authorization to carry out the study, after

which the participants were selected

through systematic sampling of 1 in 3 until

the sample size was completed.

An invitation to participate in the study

was sent out, and if the participant agreed

to participate, an appointment was

scheduled for the application of the

Informed Consent, once it had been read

and signed, a copy of it was given to the

participant and a sealed envelope

containing the battery of instruments,

which were answered in pencil and paper

in approximately 50 minutes.

The researcher was aware of doubts in

filling out the instruments, mentioning

that, if a question caused them discomfort,

they could suspend for a while and then

continue answering it, they also had the

freedom to leave the study at any time

they wanted, they were informed that they

would not receive any gratification or

benefit for participating in the study.

At the end of the filling, they were

instructed to put the instruments in the

envelope and place it in a lined container

that was strategically placed, at the end of

the filling of the battery they were thanked

for their participation in the study,

reminding them that the information

provided was private and confidential.

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2.4 Data analysis

Data were registered and analyzed in the

Statistical Package for the Social Sciences

(SPSS®) version 24. Descriptive statics

were used using frequencies and

percentages, in addition to inferential

statistics to respond to the objectives set

out in the study.

The internal consistency of the

instruments was determined using

Cronbach´s Alpha Coefficient. Similarly,

the Kolmogorov-Smirnov normality test

with Lilliefors correction was calculated to

determine the distribution of numerical

and continuous variables to determine the

use of parametric or non-parametric

statistics.

2.5 Ethical considerations

Present research followed the provisions

set forth in the Regulations of the General

Health Law on Research for Health

3. Results

3.1 Sample characteristics

Table 1 shows the sociodemographic

characteristics of the participants, where

it can be noted that more than 70% of the

participants are women, with the group

aged 18 to 33 years presenting the highest

proportion (61.4%). Most of the

participants belong to the nursing

profession (93.1%). Regarding the level of

education, 48.3% have a bachelor's degree

and 35.7% are general nurses.

Table 1. Sample Characteristics.

Results

Sex

Female

296

70.5

Male

124

29.5

Age

18-33 years

258

61.4

34-49 years

136

32.4

50-64 years

6.2

Profession

Nurse

391

93.1

Physician

6.9

Level of education

Technician

19.8

General

20.2

Bachelor´s

Degree

203

48.3

Specialty

8.6

Mastery

3.1

Doctorate

0.0

Category

Nursing Assistant

19.3

General Nursing

150

35.7

Bachelor´s

Degree

128

30.5

Specialist Nursing

8.8

General Physician

4.8

Specialist

Physician

1.0

n: Frequency, %: Percentage

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3.2 Alcohol consumption prevalence

In Table 2 the prevalence of alcohol

consumption by sex was assessed,

showing that men have drank more

alcohol than women at some time in their

lives (90.3% vs. 88.5%) and in the last year

(79.8% vs. 72.6%). Regarding the

prevalence in the last month, a significant

difference was identified in the prevalence

of consumption by sex (χ

= 5.393, p= .020),

with men reporting higher consumption

than women (63.7% vs. 51.4%), in the

prevalence of the last seven days a

statistically significant difference was

found (χ

= 4.328, p= 0.037), showing that

men had a higher proportion of

consumption compared to women (38.7%

vs. 28.4%).

Table 2. Alcohol consumption prevalence by sex.

Prevalences

Sex

Female

Male

Yes

Some time in their lives

88.5

11.5

90.3

9.7

0.293

0.588

Last year

72.6

27.4

79.8

20.2

2.403

0.121

Last month

51.4

48.6

63.7

36.3

5.393

0.020*

Last seven days

28.4

71.6

38.7

61.3

4.328

0.037*

(*) Statistically significant at level 0.05 (bilateral), χ

: Pearson´s chi-square, n: 420

3.3 Alcohol consumption prevalence by

age

Table 3 shows the alcohol consumption

prevalence by age, highlighting the age

group between 18 and 33 years with the

highest proportion of sometime in life

consumption prevalence (89.9%), followed

by the group aged 34 to 49 years (89.7%)

with similar figures; consumption in the

last year was higher in the group aged 18

to 33 years (76.7%), followed by the group

aged 34 to 49 years (74.3%). Similarly, the

group aged 18 to 33 years showed a higher

proportion of consumption in the last

month prevalence (58.1%) and the last

seven days (33.3%). However, there was no

significant difference by age (p>0.05).

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Table 3. Alcohol consumption prevalence by age.

Prevalences

Age

𝛘

𝟐

18-33 years

34-49 years

50-64 years

Yes

Some time in their lives

89.9

10.1

89.7

10.3

76.9

23.1

4.182

0.124

Last year

76.7

23.3

74.3

25.7

57.7

42.3

4.570

0.102

Last month

58.1

41.9

50.7

49.3

46.2

53.8

2.849

0.241

Last seven days

33.3

66.7

30.1

69.9

19.2

80.8

2.333

0.311

: Pearson´s chi-square, n: 420

3.4 Correlation of sociodemographic

variables, anxiety, depressive symptoms

and alcohol consumption

Table 4 shows the correlation coefficients

revealing the associations between

sociodemographic variables, anxiety,

depressive symptoms and alcohol

consumption. Positive and significant

relationships were identified between

anxiety and depressive symptoms (𝑟

𝑠

= .644,

p< 0.001), anxiety and alcohol

consumption (𝑟

𝑠

= 0.216, p< 0.001), as well

as depressive symptoms and alcohol

consumption (𝑟

𝑠

= 0.210, p< 0.001). This

interprets that the greater the anxiety and

depressive symptoms, the greater the

alcohol consumption among healthcare

personnel. There were also significant

negative relationships between age and

anxiety (𝑟

𝑠

= -0.218, p< 0.001), age and

depressive symptoms (𝑟

𝑠

= -0.261, p< 0.001),

as well as age and alcohol consumption (𝑟

𝑠

-0.228, p< 0.001).

Table 4. Correlation of variables.

Variables

1. Age

-0.218**

-0.261**

-0.228**

2. Anxiety

0.644**

0.216**

3. Depressive symptoms

0.210**

4. Alcohol consumption

(**) Statistically significant at level 0.01 (bilateral), n: 420

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3.5 Linear Regression Model for effect of

anxiety, depressive symptoms and

alcohol consumption

Table 6 shows that the Linear Regression

Model indicates that the model as a whole

was significant (F

(419)

= 9.750, df = 2,

p<0.001), showing an explained variance of

4.5%. Anxiety reported a positive and

significant effect with alcohol

consumption (β= 0.033, p= 0.023),

however, depressive symptoms showed

non-significant effect with alcohol

consumption (β= 0.021, p= 0.202). In the

second model the Backward method

(elimination of backward variables) was

applied, in which it can be seen that the

model as a whole was significant (F

(419)

17.836, df = 1, p< 0.001), showing an

explained variance of 4.1%. Anxiety

reported a positive and significant effect

with alcohol consumption (β= 0.046, p<

0.001).

Table 5. Linear Regression Model for effect of anxiety, depressive symptoms and alcohol

consumption.

Regression

424.785

212.392

9.750

0.001

Residue

9084.194

417

21.785

Total

9508.979

419

= 4.5%

Model 1

Coefficients

Constant

3.063

0.347

8.831

0.001

Anxiety

0.033

0.015

2.280

0.023

Depressive

Symptoms

0.021

0.016

1.279

0.202

(419)

= 9.750, df = 2, p<0.001

Regression

389.146

17.836

0.001

Residue

9119.832

418

21.818

Total

9508.979

419

= 4.1%

Model 2

Coefficients

Constant

3.205

0.329

9.742

0.001

Anxiety

0.046

0.011

4.223

0.001

(419)

= 17.836, df = 1, p<.001

: Coefficient of determination, SS: Sum of squares, df: Degrees of freedom, MS: Mean

square, F: Statistic F, β: Beta, p: Observed significance, EE: Standard error, t: Test t statistic,

n: 420.

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4. Discussion

This study made it possible to identify the

prevalence of alcohol consumption by sex

and age, as well as the association between

anxiety, depressive symptoms, and alcohol

consumption in healthcare personnel.

Regarding sociodemographic data, it was

observed that almost three quarters of the

sample are women, having ages between

18 and 33 years, which is similar to that

reported by some reviewed authors

26,27,28

Regarding alcohol consumption by sex,

this study identified higher consumption

in men than in women, which agrees with

some authors

13,29,30

, and differs with

information reported by other authors

27,31

This could be explained because

worldwide men drink alcoholic drinks

more frequently and intensely than

women, presenting less effect at the time

of drinking alcohol, so that a higher

consumption amount is required

However, in the present study, similar

proportions of sometime in life and last

year prevalence of alcohol consumption

were identified. It should be noted that in

recent years there has been an increase in

advertising of alcohol consumption among

women in order to reduce the cultural gap,

normalize consumption and empower

them

. In this sense, the incorporation of

women into the public social space has led

to similar behaviors because the

consumption of this substance has been

positively symbolized for women in

society as it has redefined their identity

with respect to men through alcohol

consumption exerting social pressure

towards people who do not consume it

Prevalences of consumption by age were

similar among participants, highlighting a

higher amount of consumption in

healthcare personnel between 18 and 33

years of age, which is consistent with some

authors

27,35

. These results could support

the fact that those young people who

initiate consumption at an early age

present a higher probability of developing

alcohol use disorders in early adulthood

However, it differs from that reported by

Thiebaud et al. (2021), where they

identified that healthcare personnel over

40 years of age drank higher proportions

of alcoholic drinks.

Since in Mexico alcohol consumption is

legal at 18 years of age, starting at this age

the access to the substance increases,

which is also associated in part with the

large number of points of sale in the

community and the advertising of the

substance through the media and social

networks that influence people to drink

this substance.

Regarding the association between the

variables considered in the study, a

positive and significant relationship was

identified in anxiety with depressive

symptoms and alcoholic drinks

consumption, indicating that the greater

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the presence of anxiety, the greater the

depressive symptoms and alcoholic drinks

consumption by healthcare personnel, this

is consistent with what has been reported

by various authors

36,37,38

. This could be

explained by the fact that the measures

considered since the COVID-19 pandemic

have affected aspects of daily life, from

freedom of movement to the way work is

organized, which has led to a greater

proportion of these disorders, leading to

alcoholic drinks consumption as a coping

strategy

This study was conducted after the

COVID-19 pandemic in tertiary care

hospital institutions, in which there is a

possibility that healthcare personnel were

active during this period, and not having a

mental health support department due to

work overload, among other factors, could

have triggered depressive symptoms and

an alternative coping strategy was the

consumption of alcohol.

Similarly, there was a positive and

significant relationship between

depressive symptoms and alcoholic drinks

consumption, revealing that the greater

the presence of depressive symptoms, the

greater the consumption of alcohol by

healthcare personnel; these results are

similar to those found by other authors

9,40

According to the evidence it is highlighted

that people who present greater

depressive symptoms report greater

probability of alcoholic drinks

consumption

, likewise, there is diverse

literature through which the context of

the pandemic by COVID-19 has been

evidenced as an influencing factor in the

increase in the prevalences of depressive

symptoms and alcoholic drinks

consumption in healthcare personnel.

Some factors that have been attributed are

individual aspects generated as a

consequence of daily work with a high

level of occupational exposure and task

overload

Negative and significant results were seen

for age with anxiety, depressive symptoms

and alcoholic drinks consumption,

showing that the younger the age, the

greater the presence of anxiety,

depressive symptoms and alcoholic drinks

consumption in healthcare personnel,

which is in agreement with Monterrosa-

Castro et al. (2020).

The phenomenon of alcoholic drinks

consumption generates negative health

consequences, including the presence of

mental disorders such as anxiety,

depressive symptoms and mood changes.

In addition, at early ages there is a

transition of metabolic, physical, and

psychological changes, which can lead to

the onset of these conditions if alcohol

consumption takes place.

Likewise, Wijeratne et al. (2021) identified

that healthcare personnel with younger

age showed higher consumption of

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alcoholic drinks. It has been reported that

health personnel who start drinking

alcohol at a younger age are more likely to

abuse or depend on it in adulthood, and

may even cause damage to their health

since drinking alcohol is considered part

of the process of acquiring maturity

However, these results disagree with

Prado et al. (2022) who through their

results found that older health personnel

were more likely to present depressive

symptoms.

5. Conclusion

In conclusion, the study provides

information on the impact on the mental

health of healthcare personnel based on

the findings seen in the research. The

findings suggest that healthcare personnel

belonging to tertiary care institutions

evidence an association between anxiety

and depressive symptoms, as well as with

alcoholic drinks consumption.

Over the years, it has been identified that

alcoholic drinks consumption at some

time in life and in the last year has been

increasing in women, indicating greater

social acceptance of this risk behavior.

Therefore, such consumption is in similar

proportions among adults aged 18 to 49

years in the last month and last seven days,

which indicates a problem of frequent

consumption that, if not treated on time,

can pose serious repercussions in old age.

Anxiety and depressive symptoms are also

identified as related to the consumption of

alcoholic drinks. Through this study, it was

detected that healthcare personnel have

developed these disorders and resort to

the consumption of alcoholic drinks as a

way of coping with them.

Moreover, it has been shown that working

conditions, excessive workload, among

other factors, are triggers for the

occurrence of these disorders. For this

reason, the present study can identify the

extent of the problem that occurs within

hospital institutions among healthcare

personnel, thus, highlighting the need to

implement prevention strategies aimed at

reducing alcoholic drinks consumption in

this population, as well as monitoring

mental health due to the responsibility

they have in providing nursing care and

assistance to the community.

6. Acknowledgments

We gratefully acknowledge the authorities

and health personnel of the tertiary care

institutions that participated in this study,

as well as for the assistance and support

provided in the course of this research.

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Volume 1 (3): e14. October-December. 2023. 
13 
 
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