Globally, adults are living longer. By 2030, 1 in 6 people will be aged over 60 years worldwide (WHO, 2022). Mid-life and, particularly, late mid-life are under-investigated but important phases of the lifespan characterised by changes in family dynamics, employment, and physical and mental health.

Few research studies have examined changes in alcohol consumption and risk for heavy and harmful drinking in late mid-life adults. However, data from the UK suggest that adults aged 45 and over are more likely to have drank alcohol in the past week, than other age groups and those aged 65 and over are more likely to have drank on five days or more in the past week (ONS, 2022).

One potential underlying risk factor for heavy drinking in middle age is the experience of negative life events such as severe illness or death of a family member or divorce. Evidence suggests that individuals who experience a negative life event are more likely to drink heavily compared to those who have not. However, less is known about the patterns of alcohol consumption in those experiencing negative life events i.e., drinking trajectories within this group.

The present study aimed to identify patterns of alcohol use before and after the experience of a negative life event, as well as to examine sociodemographic, health and behavioural characteristics of individuals within drinking trajectory groups (Agahi et al, 2022).

Methods

Participants

Participants were recruited from a cohort study – The Finnish Retirement and Aging Study (FIREA). Eligible individuals were public sector employees, working in 1 of 27 municipalities in southwest Finland or in 9 selected cities or 5 hospital districts around Finland and with a retirement date between 2014 and 2019.

Participants were individuals who reported a negative life event; divorce (n=264), severe 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 centred around the timing of the first negative life event that occurred, with study waves taking place before (-3, -2, -1) and after (+1, +2, +3) each life event. For control participants, a mock event year was randomly assigned to organise data in a similar manner.

Measures

• Negative life events were self-reported using a 12-item questionnaire over the past 12-months. Two types of negative events were examined (1) severe illness in the family (spouse/child) and/or death in the family (spouse/child), and (2) divorce.
• Alcohol consumption was self-reported as weekly units of alcohol. One unit corresponds to 12g of pure alcohol, or the equivalent of 33cL of beer, 12cL of wine, or 4cL of spirits. Heavy alcohol consumption was defined as weekly consumption exceeding 14 units for both women and men according to current UK guidelines.
• Individual characteristics that have been previously associated with heavy alcohol consumption and/or the experience of negative life events were assessed and included in analyses as covariates. Participants self-reported their date of birth, sex, socioeconomic status (occupational title), neighbourhood socioeconomic disadvantage, marital status, work status (full-time, part-time, retired), anxiety, depression, social network ties, and smoking status. These data were gathered from the last questionnaire prior to the life event of interest.

Analysis

Data were analysed using complete case analysis, with a prevalence of heavy drinking (%) calculated for individuals experiencing negative life events and controls. Changes and differences in heavy drinking before and after life events were analysed using latent trajectory analysis.

Separate analyses were conducted for divorce and severe illness or death. Three drinking trajectory groups were established:

1. No heavy drinking
2. Decreasing heavy drinking – elevated probability of heavy drinking before the event, followed by a decrease surrounding the event and low after
3. Constant heavy drinking – constantly high probability of heavy drinking.

Results

Proportions of heavy drinking

Participants who experienced severe illness or death exhibited a declining trend for heavy drinking after the event. On the contrary, participants who experienced divorce reported showed increasing proportions of heavy drinking after the event. For participants not experiencing an event (control) the proportion of heavy drinking was more stable, with a slight decrease, over the follow-up time.

Trajectories of heavy drinking

• For participants who experienced severe illness or death (82%) and divorce (75%)
  • the largest trajectory group was “no heavy drinking”
• For participants who experienced severe illness or death
  • 7% were in the “decreasing heavy drinking” group
  • 10% in the “constant heavy drinking” group
• Lastly, for those who experienced divorce
  • 12% were in the “decreasing heavy drinking” group
  • 13% in the “constant heavy drinking” group.

Characteristics of individuals belonging to trajectories

• Participants who experienced severe illness or death, who were in the “constant heavy drinking” group were more often men, had a history of depression, high levels of anxiety and were smokers compared with those in the “no heavy drinking” trajectory group.
• The “decreasing heavy drinking” group did not differ significantly from the “no heavy drinking” group, but there was a trend for “decreasing heavy drinking” individuals to be retired or working part-time and to be smokers.
• Participants who experienced divorce, who were in the “decreasing heavy drinking” and “constant heavy drinking” groups were more often men and had a history of depression (statistically significant for only constant group) compared with the “no heavy drinking” group.
• The “constant heavy drinking” group more often had higher occupational status, lived in areas with low neighbourhood deprivation and were more likely to be smokers (not statistically different).

Conclusions

Results suggest that for mid-life adults experiencing negative life events, there is often no change in drinking behaviours.

Men experiencing divorce were over-represented in the “constant heavy drinking” and “decreasing heavy drinking” trajectory. This may reflect a larger proportion of men drinking to cope, or simply heavy drinking in men compared with women.

Individuals in the “constant heavy drinking” group were also more likely to be men, reported more depression and had higher occupation status, potentially reflecting higher alcohol consumption in higher socioeconomic individuals and a co-occurrence between depression and heavy drinking.

Together these findings suggest that males with a history of depression, who experience negative life events may be at greater risk of heavy alcohol use.

Strengths and limitations

The findings of the present study should be considered in light of the following strengths and limitations. Firstly, the large cohort design of the study enabled changes in alcohol consumption to be assessed across several years in a homogenous group of individuals. Studying such a similar group of individuals can also be a disadvantage, where findings from public sector workers, who are still mostly working and from a small age range (60-65 years) may not be generalisable to other groups.

Moreover, the study used the UK guidelines as a measure of heavy drinking. It is not known how familiar Finnish adults were with the concept of an alcohol unit when self-reporting alcohol consumption. Even in the UK where alcohol units are the most used measurement of alcohol consumption, the general public has a poor understanding of them.

Lastly, the experience of negative life events may have prevented some individuals from participating, i.e., the most affected individuals may not have been captured in this study.

Implications for practice

The findings of the study suggest that most heavy drinkers who experience negative life events in late mid-life tend to continue with this pattern of alcohol consumption whilst going through these events. Therefore, mental health practitioners may wish to consider asking about and/or assessing alcohol consumption in individuals reporting mid-life events such as divorce and severe illness or death of a family member. This is especially pertinent given that the “constant heavy drinking” group in the study was also shown to be more vulnerable to depression, suggesting a co-morbidity between alcohol use and mental health problems in this group.

Findings also indicate a gender difference in alcohol use as a potential coping mechanism. Males, with a history of depression who experience negative life events, may be more vulnerable to “constant heavy drinking”. Thus, public health initiatives may wish to focus on reducing heavy and potentially harmful alcohol consumption in this group. Especially as the study’s findings suggest that males using alcohol to cope with divorce, illness and death of family may be reluctant to give up heavy drinking.

Statement of interests

None.

Links

Primary paper

Agahi, N., Morin, L., Virtanen, M., Pentti, J., Fritzell, J., Vahtera, J., & Stenholm, S. (2022). Heavy alcohol consumption before and after negative life events in late mid-life: longitudinal latent trajectory analyses. Journal of Epidemiology and Community Health, 76(4), 360–366.

Other references

World Health Organisation “Ageing and Health” [accessed 21.10.2022]

Office for National Statistics “Adult drinking habits in Great Britain” [accessed 21.10.2022]

Photo credits

• Photo by Sérgio Alves Santos on Unsplash