Skip to main content

ORIGINAL RESEARCH article

Front. Psychiatry, 22 June 2022
Sec. Addictive Disorders

Alcohol Use and Misuse Among Chinese Psychiatrists During the Early COVID-19 Pandemic

\nDaming Mo,,Daming Mo1,2,3Kaiyuan MinKaiyuan Min4Rachel GluckRachel Gluck5Feng Jiang,Feng Jiang6,7Rui TaoRui Tao3Feng GengFeng Geng8Lei Xia,Lei Xia1,2Tingfang LiuTingfang Liu9Yuanli LiuYuanli Liu9Huanzhong Liu,
Huanzhong Liu1,2*Yi-lang Tang,
Yi-lang Tang5,10*
  • 1Department of Psychiatry, Chao Hu Hospital of Anhui Medical University, Hefei, China
  • 2Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
  • 3Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, China
  • 4State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  • 5Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
  • 6School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
  • 7Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
  • 8Department of Psychiatry, Second Affiliated Hospital of Anhui Medical University, Hefei, China
  • 9School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  • 10Atlanta Veterans Affairs Medical Center, Decatur, GA, United States

Aim: Survey alcohol use and misuse among Chinese psychiatrists during the Coronavirus diseases 2019 (COVID-19) pandemic.

Methods: We conducted a large-scale, nationwide online survey of psychiatrists regarding their alcohol use during the pandemic. The Alcohol Use Disorder Identification Test-Concise (AUDIT-C) was used to assess alcohol use and misuse.

Results: Of 3,815 psychiatrists who completed the survey, alcohol use and misus were 47.5% and 8.2%, respectively, and both were significantly higher in males. The majority (59%) reported no change in alcohol use during the pandemic, one-third (34.5%) reported a decrease, and 6.5% reported an increase. Alcohol misuse was associated with middle-age (OR = 1.418), male sex (OR = 5.089), Northeast China (OR = 1.507), cigarette-smoking (OR = 2.335), insomnia (OR = 1.660), and regular exercise (OR = 1.488). A master's degree (OR = 0.714) and confidence in clinical work (OR = 0.610) were associated with less alcohol misuse. Those who reported a decrease in alcohol use during the pandemic were more likely to be male (OR = 2.011), located in Northeast China (OR = 1.994), and feel confident in their clinical work (OR = 1.624). Increased alcohol use was significantly associated with insomnia (OR = 3.139).

Conclusions: During the COVID-19 pandemic, alcohol use and misuse among Chinese psychiatrists declined. While males were more likely to misuse alcohol, they were also more likely to have reduced their intake. Age, location, and lifestyle factors also predicted alcohol use and misuse. Further examination of specific factors that reduced alcohol use and misuse may help guide public health efforts to sustain the lower rates beyond the pandemic.

Introduction

Alcohol use disorder (AUD) is prevalent in the general population and is estimated at 3.4% in Europe (1). Recent reports indicate that China's per capita alcohol consumption increased by 80% between 2005 and 2018 (2), faster than anywhere else in the world (3). Physicians play an essential role in preventing, screening, and managing AUD (4). However, physicians are also at risk of hazardous alcohol consumption, yet data describing physicians' alcohol use are scarce. Recent international studies show alcohol misuse among physicians varies considerably, with 12.6% misuse found in French physicians and 32% in Spanish primary health care (57). One self-report survey conducted in 1,418 physicians (1,447 contacted) in east China's Jiangsu province in 2008 showed an alcohol misuse incidence of 14.0% (40.4% for men and 2.6% for women) (8). A 2019 survey of Chinese mental health workers showed an overall alcohol consumption rate of 41.8% (53.9% of psychiatrists, 36.2% of nurses, and 40.5% of clinical psychologists) (9). Alcohol use and misuse were relatively common among mental health professionals in China, which may negatively impact their physical and psychological wellbeing as well as impair patient care. Our previous study recommended interventions to promote healthier use of alcohol in this professional group, especially among at-risk subgroups (9).

The Coronavirus disease 2019 (COVID-19) is a viral respiratory infection that reached pandemic levels in March 2020 (10), immediately following the collection of these data from Chinese mental health workers. COVID-19 had a significant impact on the physical health and mental well-being of the global population. As social distancing and quarantine guidelines came into effect, people worldwide were exposed to many psychosocial stressors, from decreased opportunities to socialize to job loss (11). Healthcare workers in particular were significantly affected by the pandemic, as they were pressed to work longer hours with very sick patients. A systematic review found that healthcare workers were at increased risk of mental health difficulties during the pandemic, including anxiety and depressive symptoms (1214). Research has shown that many use alcohol or other substances to cope with negative mood states and stress (15, 16), and those with pre-existing AUD tend to increase their alcohol in response to increases in stress (17).

A longitudinal study in China during the SARS outbreak showed that hospital staff used alcohol as a coping method (18). Some respondents who began using alcohol during the SARS pandemic indicated continued use once the pandemic was over (18). Whether or not alcohol consumption has similarly increased during the COVID-19 pandemic has been a topic of debate (19). A growing literature has investigated the effects of the COVID-19 pandemic on alcohol use among different populations, including college students, community adults, and older adults, and the findings are mixed (1925). Some studies have found that most individuals continued to use alcohol at the same rate as before the COVID-19 pandemic (2123, 26). Other studies have shown that the general population's alcohol consumption increased significantly (24, 27). By contrast, studies conducted in the general population in China found decreased alcohol consumption during the pandemic (28). Alcohol consumption may be one of the ways people respond to the remarkable changes associated with the COVID-19 pandemic, and understanding alcohol use among psychiatrists is of importance, as their knowledge, perceptions, and attitudes often affect their interactions with patients. Furthermore, investigating alcohol use may shed light on overall mental health and coping behaviors of this professional population.

There are several possible explanations for the differences in study findings including variations in sample makeup, settings, cultures, and the exact timing of the study with respect to the pandemic (such as during the lockdown, acute phase, or chronic phase). In addition to inconsistent findings, little is known about the specific factors associated with changes in alcohol use during the pandemic. Given prior data about alcohol use to cope with stress, changes in use during increases in stress, and evidence of increased use in healthcare workers in China during the prior SARS pandemic, we hypothesized that healthcare workers would be at increased risk of alcohol use and misuse during the COVID-19 pandemic. Therefore, this study's main objective is to explore the changes in alcohol use among Chinese psychiatrists during the COVID-19 pandemic based on a large, nationally representative sample.

Methods

Study Design, Setting, and Participants

The study was a large-scale, nationwide online survey of Chinese healthcare professionals conducted in January 2021. In total, 21,858 healthcare professionals (including psychiatrists, psychiatric nurses, and psychotherapists) from 41 major psychiatric tertiary hospitals in 29 provinces in China were approached to participate in the survey. A total of 18,713 people completed the survey, including 3,815 psychiatrists. The survey was conducted anonymously through WeChat, an online social media application widely used in China. To avoid double registration each WeChat account could only submit one questionnaire. We collected socio-demographic data, alcohol use, and information about other health-related behavior (exercise, sleep, and cigarette smoking). The Alcohol Use Disorder Identification Test (AUDIT-C) was used to examine patterns of alcohol use.

Questionnaire Design

We developed the online questionnaire based on the existing literature and expert opinion. Before the survey was made available to all participants, a pilot study was conducted in a small sample (N = 332, including nurses, doctors, and psychologists) to assess the readability of the questions. AUDIT-C is a concise version of the AUDIT, and it has been demonstrated to have similar accuracy to the full AUDIT (2931). The total AUDIT-C score ranges from 0 to 12, with a higher score indicating more severe alcohol use. The Chinese version of the AUDIT has been validated (32) and used in different settings (9, 33, 34), the details in AUDIT-C scoring can be found elsewhere (9, 33, 34). Using the AUDIT-C scores, participants were categorized as no alcohol users (the total score = 0) and alcohol users (the total score ≥1). The alcohol use group was further divided into low-risk users of alcohol [the total score of <3 (women) and <4 (men)] and probable alcohol misuse (hazardous, harmful, or dependent) [the total score of ≥3 (women) and ≥4 (men)] (25).

Socio-demographic and occupational characteristics such as age (years), sex (male/female), marital status (married, single, divorced, or widowed), region (East, Central, West, or Northeast China), and education (degree) were collected. We referred to the World Health Organization criteria to designate age groups (20–34, 35–49, ≥50 years). The health-related behaviors included physical exercise, sleep, and cigarette smoking. In this study, we defined “regular exercise” as exercising at least three times per week in the past month according to the recommendations of the National Fitness Guideline. “Frequent insomnia” was defined as having sleep disturbances (difficulty falling asleep, difficulty maintaining sleep, or waking up early) at least three times per week in the past month. Participants were considered to have a “smoking habit” if they had a cumulative history of smoking more than 100 cigarettes in their lifetime (35). We also collected information on whether psychiatrists had been on the “frontline” of COVID-19 (treating COVID-19 patients) and their overall attitude and confidence about being a healthcare professional going forward (negative, neutral, positive).

Statistical Analysis

The sample distribution was conducted by frequency calculated for categorical variables. For the statistical analysis, the one-sample K-S test was utilized to assess the normality of numeric variables. The Chi-square test was used for univariate analysis. Multiple logistic regression was used to calculate OR value and 95% confidence interval, and multivariate analysis was performed. All statistical analyses used IBM. Statistical Package of Social Sciences (SPSS version 22.0) with two-tailed p values of 0.05 for statistical significance.

Results

Demographic Characteristics of Participants

As shown in Table 1, 60% of the participants were female, more than four-fifths (85.3%) were younger than 50 and 80% were married. We found that 1,811 subjects (47.5%) self-identified as current alcohol users. Significant differences were found between those with and without alcohol use with respect to the demographic (age group, sex, education, marital status, region) and lifestyle (smoking habit, frequent insomnia) factors, and experience of working in the frontline of COVID-19, perceived confidence in clinical work (all p < 0.05) (Table 1).

TABLE 1
www.frontiersin.org

Table 1. Basic features of 3,815 psychiatrists, and subgroup comparisons between those endorsed alcohol use, alcohol misuse and those who did not.

Alcohol Misuse and Related Factors Among Psychiatrists

The overall prevalence of alcohol misuse among the participants sampled was 8.2% during the COVID-19 pandemic and varied significantly between male and female psychiatrists (16.6% prevalence in males and 2.8% in females). Rates of alcohol use increased with age, from 5.1% for low-age (20–34 years group) to 9.1% (35–49 years group) and 12.1% (≥50 years group) for middle and high-age. Compared to those with college/medical degrees (10.0%), those with Master's (5.1%) or doctoral degrees (5.2%) had significantly lower rates of alcohol misuse (p < 0.01). The rate of alcohol misuse among psychiatrists in northeast China was significantly higher than that in east regions (11.8 vs. 6.3%, p < 0.01). The smoking rate among alcohol misusers was more than 4 times higher than that of non-alcohol misusers (27.2 vs. 6.1%, p < 0.01). Alcohol misuse was significantly more common in people with frequent insomnia than those without insomnia (13.0 vs. 7.3%, p < 0.01). Those who reported regular exercise had higher rates of alcohol misuse than non-exercisers (13.7 vs. 7.8%, p < 0.01). Alcohol misuse was higher among psychiatrists who participated in the frontline work of COVID-19 than those with no such experience (10.1 vs. 7.7%, p < 0.01) (Table 1).

Factors Associated With Alcohol Misuse in a Multiple Logistic Regression

We used AUDIT-C cut-off scores to divide the sample (N = 3,815) into two groups, those with probable alcohol misuse (N = 316) and those without (N = 3,499). We used multiple logistic regression to examine the association between probable alcohol misuse and demographic variables (Table 2). The references of the categorical variables were defined as shown in Table 2. During the COVID-19 pandemic, a higher risk of alcohol misuse was associated with the 35–50 year group (OR = 1.418; 95%CI = 1.012–1.988), male sex (OR = 5.089; 95% CI = 3.719–6.965), working in Northeast China (OR =1.507; 95%CI = 1.011–2.246), smoking habit (OR = 2.335; 95%CI = 1.742–3.131), frequent insomnia (OR = 1.660; 95% CI = 1.244–2.213) and regular exercise (OR = 1.488; 95%CI = 1.022–2.165). An add-on Master's degree and positive confidence in medical work were significantly associated with a lower risk of alcohol misuse among alcohol users (OR = 0.714; 95%CI = 0.514–0.927 and OR = 0.610; 95%CI = 0.377–0.987, respectively).

TABLE 2
www.frontiersin.org

Table 2. Multiple logistic regression examining individual characteristics associated with alcohol misuse in psychiatrists in China.

Reported Changes in Alcohol Use During the COVID-19

Among all participants, 1,035 (59.0%) reported no change in alcohol use during the COVID-19 pandemic, 605 (34.5%) reported a decrease, and 114 (6.5%) reported an increase. We examined the differences in alcohol use across subgroups by demographic features, health-related behaviors, and direct experience working with COVID-19 patients. With respect to sex effects, significantly more males were classified as either increased or decreased alcohol use than females (39.5 vs. 26.5%; 7.6 vs. 4.8%, both p < 0.01). For those who reported a decrease in alcohol use, significantly higher rates were found in those with a college/medical degree (37.5%) than those with an add-on master's degree (27.7%) (p < 0.01). Nearly half (46.4%) of those who reported a decrease in alcohol use were working in Northeast China. The rate of psychiatrists reporting an increase in alcohol was significantly higher (14.2%) than those without insomnia (4.9%) (p < 0.01). The rate of reported decrease was significantly higher (44.9%) in those who reported less frequent or no exercise, compared to those with regular exercise (33.4%, p < 0.01). Those who reported feeling confident in their medical work were more likely to report a decrease in alcohol use (51.4%), compared to both those with neutral (36.6%) or negative attitudes toward their medical work (30.8%) (both p < 0.01). There were no significant differences in change in alcohol use during the pandemic concerning age, marital status, frontline experience with COVID-19, or smoking habit (Table 3).

TABLE 3
www.frontiersin.org

Table 3. Difference between the studied variables and alcohol use changing during the COVID-19 among 1,754 psychiatrists in China.

Factors Associated With Changes in Alcohol Use in a Multiple Logistic Regression

We also performed multiple logistic regression analysis to examine the associations between reported changes in alcohol use and other variables. During the COVID-19 pandemic, compared to the unchanged group, those who reported a decrease in alcohol use were more likely to be male (OR = 2.011; CI = 1.585–2.552), working in Northeast China (OR = 1.994; CI = 1.432–2.777), and feeling confident in clinical work (OR = 1.624; CI = 1.141–2.363) (Table 4). On the other hand, compared to those who reported no changes in alcohol use, those who reported an increase in alcohol use were more likely to be male (OR = 1.974; CI = 1.235–3.157), and with reported frequent insomnia (OR = 3.139; CI = 2.043–4.825) (Table 4).

TABLE 4
www.frontiersin.org

Table 4. Multiple logistic regression examining individual characteristics associated with alcohol use changed.

Discussion

This was the first study to examine alcohol use and misuse in psychiatrists during the COVID-19 pandemic in China. We found that alcohol use and misuse were relatively common among Chinese psychiatrists, with 47.5% reporting alcohol use and 8.2% for probable alcohol misuse. The survey found that alcohol misuse was significantly associated with younger age, male sex, region (Northeast China), education (Master's degree), cigarette use, frequent insomnia, regular exercise, and working experience on the COVID-19 front lines. Changes in alcohol use during the pandemic were significantly associated with male sex, education (Master's degree), region (Northeast China), frequent insomnia, regular exercise, and perceived confidence in clinical work. Specific risk factors for psychiatrists' alcohol misuse during the pandemic were male sex, working in Northeast China, lower levels of education, cigarette use, and regular exercise. Confidence in one's ability to provide adequate care was a protective factor. Compared with those who reported no change in alcohol use, those who reported an increase in alcohol use were more likely to be male, and/or with confidence in clinical work. In contrast, those who reported increased alcohol use were more likely to have frequent insomnia.

Alcohol Use/Misuse and Smoking Among Chinese Psychiatrists

In 2019, before the pandemic started, our group conducted a similar national survey among mental health professionals (9) using the same screening tool (AUDIT-C) and cutoffs. The current study included a few additional questions: for example, we asked the participants to rate the change in their alcohol consumption compared to before the pandemic. Compared with the findings of the 2019 study, we found that the rates of both alcohol use and alcohol misuse were significantly lower (9) (47.5 vs. 53.9%, p < 0.01; 8.2 vs. 10.2%, p < 0.01). Among all participants, the majority (59%) reported no change in alcohol use during the pandemic, but more than one-third (34%) reported a decrease in alcohol use, and only 6.5% reported an increase. These findings are overall consistent with the results from another study in China, which surveyed 2,229 participants who were predominantly employed (>90%) and college-educated (>85%), which also showed alcohol use slightly decreased during COVID-19 compared with before (28). However, our findings are different from most studies during the pandemic era from other parts of the world. A meta-analysis of 45 articles on alcohol and other substance use during the COVID-19 pandemic showed an overall increase in alcohol consumption compared to pre-pandemic drinking levels (36).

The unique findings of our study are intriguing. While there are several possible explanations for the overall decrease in alcohol use in this population, two plausible explanations are related to the Chinese government's response to the epidemic and cultural practices in China. For example, the lockdown and social restrictions imposed by the Chinese government were probably among the most-strict worldwide. One report indicated a 90% reduction in open restaurants during the pandemic (37). Social gatherings, including drinking in social settings, were also dramatically reduced and were almost non-existent (37). In China, drinking in the social environment plays a significant role in alcohol use and misuse (3), especially among those with higher socioeconomic status, such as physicians. Before the pandemic, physicians often attended work-related social dinners where alcohol intake was culturally expected. The restrictions during the pandemic likely contributed to the overall alcohol use decrease by reducing social gatherings where alcohol would be used as well as the gifting of alcohol to physicians in thanks. Similar findings were reported in Spain during the pandemic. Rodrigues et al. interviewed 179 Spanish and 179 British participants about drinking behavior before and during the COVID-19 lockdown. They found interesting cultural differences: during the lockdown, Spanish participants reported a decrease in alcohol use while British participants reported no change in their consumption habits. The authors suggested that the decrease in alcohol consumption in Spanish participants may be related to the absence of a social context that culturally condones alcohol use, while British culture may allow for alcohol use outside of social gatherings (38).

While “social” opportunities for alcohol use decreased during COVID-19, another study suggested emotional coping motivated those who increased their alcohol use (39). In fact, coping motives were the strongest predictors of increased alcohol use during the lockdown (40). During the pandemic, healthcare workers may have more medical knowledge and resources to cope with stress, and they may demonstrate a lower burden of mental distress than the general population (41).

Compared with the 2019 study, we also observed a decline in cigarette smoking among psychiatrists (9). Similar to the findings of the 2019 study, we again confirmed that cigarette smoking was significantly associated with alcohol misuse (OR = 2.3). The link between alcohol use and cigarette smoking has been well-documented (42). Our finding of the association between smoking and alcohol misuse among psychiatrists was consistent with other studies conducted in China (43) and other countries (44).

Demographics and Alcohol Misuse

We found that the rates of alcohol use and misuse were significantly higher in males than females, and male sex was a significant risk factor for alcohol misuse. This gender association has been repeatedly reported in different populations and different cultures (4547), but the sex gap in our sample is much greater than in most studies in western countries (47). Many studies showed that male doctors had a higher rate of alcohol misuse (4850). A recent survey of healthcare professionals in a hospital in China also found that male medical workers reported a strikingly high rate of alcohol use than their female colleagues (40.4% for males and 2.6% for females) (8). Gender differences were expressed in different patterns of alcohol consumption and related behaviors, including alcohol use disorders (51). The factors contributing to the differences are multiple and often involve biological (e.g., neurotransmitters, hormones, genetics), psychological (e.g., personality traits, coping mechanisms), and social (role expectation, cultural norms, etc.) factors (47). The traditional Chinese culture and gender stereotyping likely contribute to the striking gender differences in alcohol (and cigarette) use, as Chinese culture is generally disapproving of and often discriminatory against women who drink or smoke.

We found that the middle age group (35–49 years group) was a risk factor for alcohol misuse, consistent with another recent study (9). Middle age is in the career development period who have frequent social activities and experience higher social and career pressures. Since it usually takes 5–10 years or longer to develop alcohol dependence (52), attention needs to be directed to the younger group to provide early intervention.

The 2019 survey from our group found that being divorced or widowed was significantly associated with alcohol misuse (9). The current study also found that the rate of alcohol use among divorced or widowed people was significantly higher than that of married people, however, we did not find a significant association between marital status and alcohol misuse. The previous hypothesis was that marriage's psychological and social aspects, particularly health-monitoring spousal interactions, may protect against the development of alcohol use disorder (53). During the COVID-19 pandemic, many single and divorced individuals returned to their families of origin, which may have decreased their drinking behavior.

Consistent with prior studies, our survey found that an add-on master's degree was a protective factor for alcohol misuse. A recent study of 329 people ages 18–65 in China who consume alcohol found that those with lower education levels drink more heavily than those with higher education levels (54). However, patterns of alcohol use across a lifetime may vary by education as well, as one study in Denmark involving 7,019 men seeking outpatient AUD treatment showed that patients with higher educational levels were likely to have a later onset and treatment of AUD (55).

Lifestyle and Alcohol Misuse

We found that alcohol misuse was associated with lifestyle behaviors such as exercise and insomnia. Specifically, those with frequent insomnia were more likely to report increased alcohol use during the pandemic. One meta-analysis showed that healthcare professionals fighting COVID-19 are often affected by psychiatric disorders such as depression, anxiety, distress, and insomnia (13). Alcohol is often a coping mechanism to deal with negative mood states and insomnia (17, 56). A study of frontline health workers in Australia during the pandemic found that over a quarter of healthcare workers reported increased alcohol use associated with a history of poor mental health and worse personal relationships (57). In the current study, we found that Chinese psychiatrists' alcohol use and misuse have declined, and more than 93%of them reported no change or decrease in alcohol use. Perceived confidence in clinical work was a protective factor for alcohol misuse, and working on the frontline of COVID-19 did not seem to contribute significantly to alcohol use or misuse.

Limitations

Some limitations of this study need to be acknowledged. First, we used a screening instrument to assess alcohol use, and we did not have data on the actual diagnosis. The cut-off scores for “alcohol misuse” were based on other studies. Therefore, the actual rates need to be taken with some caution. Second, we only targeted psychiatrists in the top-tier psychiatric hospitals in the capital cities of each province, and we did not include hospitals in smaller towns or rural areas. Third, as most data, such as alcohol use, and the change in alcohol use during the pandemic, were merely based on self-report, this may introduce bias into the findings with participants intentionally or unintentionally underestimating their consumption. Furthermore, as with all online surveys, self-selection bias cannot be ruled out. Fourth, the time frames for different variables were different: it was the past year for alcohol, a lifetime for smoking, and the last month for exercise and insomnia, and this may affect our findings. Fifth, the severity of the pandemic and the restrictiveness of infection prevention standards in different regions were different. The situations were often rapidly evolving, confounding the drinking behavior. Furthermore, we did not data on the individual experience of, and exposure to the COVID-19 and the associated restrictive measures, which were likely to affect some of the findings. Finally, other studies referenced in the above comparisons may have used different instruments or definitions (cut-off scores), thus limiting the true comparability.

Conclusion

Contrary to our prediction, alcohol use and misuse among Chinese psychiatrists actually decreased during the COVID-19 pandemic. Though males were more likely to misuse alcohol, they were also more likely to have reduced their intake during the pandemic. Psychiatrists who were younger, practiced in Northeast China, smoked cigarettes, and/or experience frequent insomnia were also more likely to misuse alcohol. This survey identified essential factors associated with alcohol use and misuse, which may guide the development of alcohol misuse detection and intervention practices for this professional group. However, more research is needed to explore specific factors underlying drinking behavior among mental health professionals, both during and after the pandemic.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

Before this study was initiated, ethical approval was obtained from the Ethical Committee (IRB) at the Chao hu Hospital of Anhui Medical University (202002-kyxm-02). The survey was anonymous. Participants' consent was obtained when they accessed the online questionnaire.

Author Contributions

J, HL, and Y-lT: study design. DM, TL, YL, KM, RT, FG, LX, and Y-lT: collection, analyses, and interpretation of data. DM: drafting the first version of the manuscript. RG and Y-lT: critical revision of the manuscript. All authors: approval of the final version for publication.

Funding

This study was supported by the National Clinical Key Specialty Project Foundation (CN) and the Beijing Medical and Health Foundation (Grant No. MH180924).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

1. Rehm J, Anderson P, Barry J, Dimitrov P, Elekes Z, Feijao F, et al. Prevalence of and potential influencing factors for alcohol dependence in Europe. Eur Addict Res. (2015) 21:6–18. doi: 10.1159/000365284

PubMed Abstract | CrossRef Full Text | Google Scholar

2. Choi NG, DiNitto DM. Adverse childhood experience and lifetime mental and substance use disoeders among older adults. Innov Aging. (2017) 1:1148. doi: 10.1093/geroni/igx004.4192

CrossRef Full Text | Google Scholar

3. Tang YL, Xiang XJ, Wang XY, Cubells JF, Babor TF, Hao W. Alcohol and alcohol-related harm in China: policy changes needed. Bull World Health Organ. (2013) 91:270–6. doi: 10.2471/BLT.12.107318

PubMed Abstract | CrossRef Full Text | Google Scholar

4. Rizer C, Lusk M. Screening and initial management of alcohol misuse in primary care. J Nurse Pract. (2017) 13:660–6.e1. doi: 10.1016/j.nurpra.2017.08.011

CrossRef Full Text | Google Scholar

5. Joos L, Glazemakers I, Dom G. Alcohol use and hazardous drinking among medical specialists. Eur Addict Res. (2013) 19:89–97. doi: 10.1159/000341993

PubMed Abstract | CrossRef Full Text | Google Scholar

6. Romero-Rodríguez E, Pérula de Torres LÁ, Fernández García JÁ, Parras Rejano JM, Roldán Villalobos A, Camarelles Guillén F, et al. Alcohol consumption in Spanish primary health care providers: a national, cross-sectional study. BMJ Open. (2019) 9:e024211. doi: 10.1136/bmjopen-2018-024211

PubMed Abstract | CrossRef Full Text | Google Scholar

7. Thiebaud PC, Martin C, Naouri D, Le Joncour A, Truchot J, Yordanov Y. Alcohol consumption among French physicians: a cross-sectional study. Drug Alcohol Depend. (2021) 218:108356. doi: 10.1016/j.drugalcdep.2020.108356

PubMed Abstract | CrossRef Full Text | Google Scholar

8. Qin ZU, Zhu QL, Zhu XY, Shen H, Yu RB. Investigation of the relationship between smoking, drinking and mental health status of medical staff in comprehensive hospitals. Acta Univ Med Nanjing. (2008) 28:1214–7.

9. Tao R, Jiang F, Min KY, Liu TF, Liu YL, Xia L, et al. Alcohol use among mental health professionals in China: a nationwide cross-sectional survey. Alcohol Alcohol. (2021) 56:351–9. doi: 10.1093/alcalc/agaa065

PubMed Abstract | CrossRef Full Text | Google Scholar

10. World Health Organization. Coronavirus disease (2019). (COVID-19): situation report, 101. World Health Organization. (2020, April 30).

11. Bauerle A, Teufel M, Musche V, Weismuller B, Kohler H, Hetkamp M, et al. Increased generalized anxiety, depression and distress during the COVID-19 pandemic: a cross-sectional study in Germany. J Public Health. (2020) 42:672–8. doi: 10.1093/pubmed/fdaa106

PubMed Abstract | CrossRef Full Text | Google Scholar

12. Serrano-Ripoll MJ, Meneses-Echavez JF, Ricci-Cabello I, Fraile-Navarro D, Fiol-deRoque MA, Pastor-Moreno G, et al. Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis. J Affect Disord. (2020) 277:347–57. doi: 10.1016/j.jad.2020.08.034

PubMed Abstract | CrossRef Full Text | Google Scholar

13. Silva FC, Neto ML. Psychiatric symptomatology associated with depression, anxiety, distress, and insomnia in health professionals working in patients affected by COVID-19: a systematic review with meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. (2021) 104:110057. doi: 10.1016/j.pnpbp.2020.110057

PubMed Abstract | CrossRef Full Text | Google Scholar

14. Chalhub RA, Menezes MS, Aguiar CV, Santos-Lins LS, Netto EM, Brites C, et al. Anxiety, health-related quality of life, and symptoms of burnout in frontline physicians during the COVID-19 pandemic. Braz J Infect Dis. (2021) 25:101618. doi: 10.1016/j.bjid.2021.101618

PubMed Abstract | CrossRef Full Text | Google Scholar

15. Clay JM, Parker MO. Alcohol use and misuse during the COVID-19 pandemic: a potential public health crisis? Lancet Public Health. (2020) 5:e259. doi: 10.1016/S2468-2667(20)30088-8

PubMed Abstract | CrossRef Full Text | Google Scholar

16. Keyes KM, Hatzenbuehler ML, Hasin DS. Stressful life experiences, alcohol consumption, and alcohol use disorders: the epidemiologic evidence for four main types of stressors. Psychopharmacology. (2011) 218:1–17. doi: 10.1007/s00213-011-2236-1

PubMed Abstract | CrossRef Full Text | Google Scholar

17. Keyes KM, Hatzenbuehler ML, Grant BF, Hasin DS. Stress and alcohol epidemiologic evidence. Alcohol Res. (2012) 34:391–400.

18. Wu P, Liu XH, Fang YY, Fan B, Fuller CJ, Guan ZQ, et al. Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol Alcohol. (2008) 43:706–12. doi: 10.1093/alcalc/agn073

PubMed Abstract | CrossRef Full Text | Google Scholar

19. Rehm J, Kilian C, Ferreira-Borges C, Jernigan D, Monteiro M, Parry C, et al. Alcohol use in times of the COVID 19: implications for monitoring and policy. Drug Alcohol Rev. (2020) 39:301–4. doi: 10.1111/dar.13074

PubMed Abstract | CrossRef Full Text | Google Scholar

20. Martinez-Cao C, de La Fuente-Tomas L, Menendez-Miranda I, Velasco A, Zurron-Madera P, Garcia-Alvarez L, et al. Factors associated with alcohol and tobacco consumption as a coping strategy to deal with the coronavirus disease (COVID-19) pandemic and lockdown in Spain. Addict Behav. (2021) 121:107003. doi: 10.1016/j.addbeh.2021.107003

PubMed Abstract | CrossRef Full Text | Google Scholar

21. Garnett C, Jackson S, Oldham M, Brown J, Steptoe A, Fancourt D. Factors associated with drinking behaviour during COVID-19 social distancing and lockdown among adults in the UK. Drug Alcohol Depend. (2021) 219:108461. doi: 10.1016/j.drugalcdep.2020.108461

PubMed Abstract | CrossRef Full Text | Google Scholar

22. Pollard MS, Tucker JS, Green HD. Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US. JAMA Netw Open. (2020) 3:e2022942. doi: 10.1001/jamanetworkopen.2020.22942

PubMed Abstract | CrossRef Full Text | Google Scholar

23. Gritsenko V, Skugarevsky O, Konstantinov V, Khamenka N, Marinova T, Reznik A, et al. COVID 19 fear, stress, anxiety, and substance use among Russian and Belarusian university students. Int J Ment Health Addict. (2021) 19:2362–8. doi: 10.1007/s11469-020-00330-z

PubMed Abstract | CrossRef Full Text | Google Scholar

24. Jacob L, Smith L, Armstrong NC, Yakkundi A, Barnett Y, Butler L, et al. Alcohol use and mental health during COVID-19 lockdown: a cross-sectional study in a sample of UK adults. Drug Alcohol Depend. (2021) 219:108488. doi: 10.1016/j.drugalcdep.2020.108488

PubMed Abstract | CrossRef Full Text | Google Scholar

25. Rodriguez LM, Litt DM, Stewart SH. Drinking to cope with the pandemic: the unique associations of COVID-19-related perceived threat and psychological distress to drinking behaviors in American men and women. Addict Behav. (2020) 110:106532. doi: 10.1016/j.addbeh.2020.106532

PubMed Abstract | CrossRef Full Text | Google Scholar

26. Sidor A, Rzymski P. Dietary choices and habits during COVID-19 lockdown: experience from Poland. Nutrients. (2020) 12:1657. doi: 10.3390/nu12061657

PubMed Abstract | CrossRef Full Text | Google Scholar

27. Ammar A, Brach M, Trabelsi K, Chtourou H, Boukhris O, Masmoudi L, et al. Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19 international online survey. Nutrients. (2020) 12:1583. doi: 10.3390/nu12061583

PubMed Abstract | CrossRef Full Text | Google Scholar

28. Wang YF, Lu HL, Hu MR, Wu SY, Chen JH, Wang L, et al. Alcohol consumption in China before and during COVID-19: preliminary results from an online retrospective survey. Front Psychiatry. (2020) 11:597826. doi: 10.3389/fpsyt.2020.597826

PubMed Abstract | CrossRef Full Text | Google Scholar

29. Reinert DF, Allen JP. The Alcohol Use Disorders Identification Test (AUDIT): a review of recent research. Alcohol Clin Exp Res. (2022) 26:272–9. doi: 10.1111/j.1530-0277.2002.tb02534.x

PubMed Abstract | CrossRef Full Text | Google Scholar

30. Yip BH, Chung RY, Chung VC, Kim J, Chan I, Wong MC, et al. Is Alcohol Use Disorder Identification Test (AUDIT) or its shorter versions more useful to identify risky drinkers in a Chinese population? A diagnostic study. PloS ONE. (2015) 10:e0117721. doi: 10.1371/journal.pone.0117721

PubMed Abstract | CrossRef Full Text | Google Scholar

31. Khadjesari Z, White IR, McCambridge J, Marston L, Wallace P, Godfrey C, et al. Validation of the AUDIT-C in adults seeking help with their drinking online. Addict Sci Clin Pract. (2017) 12:2. doi: 10.1186/s13722-016-0066-5

PubMed Abstract | CrossRef Full Text | Google Scholar

32. Tsai MC, Tsai YF, Chen CY, Liu CY. Alcohol Use Disorders Identification Test (AUDIT): establishment of cut-off scores in a hospitalized Chinese population. Alcohol Clin Exp Res. (2005) 29:53–5. doi: 10.1097/01.ALC.0000151986.96710.E0

PubMed Abstract | CrossRef Full Text | Google Scholar

33. Wang Y, Cheng XG. Stress and alcohol use in rural Chinese residents: a moderated mediation model examining the roles of resilience and negative emotions - ScienceDirect. Drug Alcohol Depend. (2015) 155:76–82. doi: 10.1016/j.drugalcdep.2015.08.014

PubMed Abstract | CrossRef Full Text | Google Scholar

34. Huang H, Chen HX, Dong HX, Ning K, Zhang RL, Sun W, et al. Prevalence, correlates and treatment status of alcohol use disorders in psychiatric patients in China. Gen Hosp Psychiatry. (2017) 45:70–5. doi: 10.1016/j.genhosppsych.2017.01.002

PubMed Abstract | CrossRef Full Text | Google Scholar

35. Xia L, Jiang F, Rakofsky J, Zhang YL, Zhang K, Liu TF, et al. Cigarette smoking, health-related behaviors, and burnout among mental health professionals in China: a nationwide survey. Front Psychiatry. (2020) 11:706. doi: 10.3389/fpsyt.2020.00706

PubMed Abstract | CrossRef Full Text | Google Scholar

36. Roberts A, Rogers J, Mason R, Siriwardena AN, Hogue T, Whitley GA, et al. Alcohol and other substance use during the COVID-19 pandemic: a systematic review. Drug Alcohol Depend. (2021) 229:109150. doi: 10.1016/j.drugalcdep.2021.109150

PubMed Abstract | CrossRef Full Text | Google Scholar

37. Jiang M. Report on the development status and trends of China's catering industry under COVID-19 was released. Food Ind. (2020) 81:36–7.

38. Rodrigues H, Valentin D, Franco-Luesma E, Rakotosamimanana VR, Gomez-Corona C, Saldaña E, et al. How has COVID-19, lockdown and social distancing changed alcohol drinking patterns? A cross-cultural perspective between britons and spaniards. Food Qual Preference. (2022) 95:104344. doi: 10.1016/j.foodqual.2021.104344

PubMed Abstract | CrossRef Full Text | Google Scholar

39. Graupensperger S, Fleming CB, Jaffe AE, Rhew IC, Patrick ME, Lee CM. Changes in young adults' alcohol and marijuana use, norms, and motives from before to during the COVID-19 pandemic. J Adolesc Health. (2021) 68:658–65. doi: 10.1016/j.jadohealth.2021.01.008

PubMed Abstract | CrossRef Full Text | Google Scholar

40. Carina C, Rubén G, Cryan JF, Dinan TG. Associations between mental health, alcohol consumption and drinking motives during COVID-19 second lockdown in Ireland. Alcohol Alcohol. (2022) 57:211–8. doi: 10.1093/alcalc/agab067

PubMed Abstract | CrossRef Full Text | Google Scholar

41. Morawa E, Schug C, Geiser F, Beschoner P, Jerg-Bretzke L, Albus C, et al. Psychosocial burden and working conditions during the COVID-19 pandemic in Germany: the VOICE survey among 3678 health care workers in hospitals. J Psychosom Res. (2021) 144:110415. doi: 10.1016/j.jpsychores.2021.110415

PubMed Abstract | CrossRef Full Text | Google Scholar

42. Beard E, West R, Michie S, Brown J. Association between smoking and alcohol-related behaviours: a time-series analysis of population trends in England. Addiction. (2017) 112:1832–41. doi: 10.1111/add.13887

PubMed Abstract | CrossRef Full Text | Google Scholar

43. Liu RY, Chen L, Zhang F, Zhu R, Lin XJ, Meng XC, et al. Trends in alcohol intake and the association between socio-demographic factors and volume of alcohol intake amongst adult male drinkers in China. Int J Environ Res Public Health. (2019) 16:573. doi: 10.3390/ijerph16040573

PubMed Abstract | CrossRef Full Text | Google Scholar

44. Getachew S, Lewis S, Britton J, Deressa W, Fogarty AW. Prevalence and risk factors for initiating tobacco and alcohol consumption in adolescents living in urban and rural Ethiopia. Public Health. (2019) 174:118–26. doi: 10.1016/j.puhe.2019.05.029

PubMed Abstract | CrossRef Full Text | Google Scholar

45. Shaikh R, Khan J. Gender and regional pattern of alcohol use and projection of problematic drinking in India, 1998-2016. Alcohol. (2021) 97:23–30. doi: 10.1016/j.alcohol.2021.09.005

PubMed Abstract | CrossRef Full Text | Google Scholar

46. Keyes KM, Platt J, Rutherford C, Patrick ME, Kloska DD, Schulenberg J, et al. Cohort effects on gender differences in alcohol use in the United States: how much is explained by changing attitudes towards women and gendered roles? SSM Popul Health. (2021) 15:100919. doi: 10.1016/j.ssmph.2021.100919

PubMed Abstract | CrossRef Full Text | Google Scholar

47. Erol A, Karpyak VM. Sex and gender-related differences in alcohol use and its consequences: contemporary knowledge and future research considerations. Drug Alcohol Depend. (2015) 156:1–13. doi: 10.1016/j.drugalcdep.2015.08.023

PubMed Abstract | CrossRef Full Text | Google Scholar

48. Rosta J, Aasland OG. Changes in alcohol drinking patterns and their consequences among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples. Alcohol Alcohol. (2013) 48:99–106. doi: 10.1093/alcalc/ags084

PubMed Abstract | CrossRef Full Text | Google Scholar

49. Addo J, Cook S, Galbete C, Agyemang C, Klipstein-Grobusch K, Nicolaou M, et al. Differences in alcohol consumption and drinking patterns in Ghanaians in Europe and Africa: the RODAM study. PloS ONE. (2018) 13:e0206286. doi: 10.1371/journal.pone.0206286

PubMed Abstract | CrossRef Full Text | Google Scholar

50. Subbaraman MS, Kerr WC. Subgroup trends in alcohol and cannabis co-use and related harms during the rollout of recreational cannabis legalization in Washington state. Int J Drug Policy. (2020) 75:102508. doi: 10.1016/j.drugpo.2019.07.003

PubMed Abstract | CrossRef Full Text | Google Scholar

51. Khan S, Okuda M, Hasin DS, Secades-Villa R, Keyes K, Lin KH, et al. Gender differences in lifetime alcohol dependence: results from the national epidemiologic survey on alcohol and related conditions. Alcohol Clin Exp Res. (2013) 37:1696–705. doi: 10.1111/acer.12158

PubMed Abstract | CrossRef Full Text | Google Scholar

52. Veerbeek MA, ten Have M, van Dorsselaer SA, Voshaar RCO, Rhebergen D, Willemse BM. Differences in alcohol use between younger and older people: results from a general population study. Drug Alcohol Depend. (2019) 202:18–23. doi: 10.1016/j.drugalcdep.2019.04.023

PubMed Abstract | CrossRef Full Text | Google Scholar

53. Kendler KS, Lonn SL, Salvatore J, Sundquist J, Sundquist K. Effect of marriage on risk for onset of alcohol use disorder: a longitudinal and co-relative analysis in a Swedish national sample. Am J Psychiatry. (2016) 173:911–8. doi: 10.1176/appi.ajp.2016.15111373

PubMed Abstract | CrossRef Full Text | Google Scholar

54. Dong P, Yi JL, Wu F, Ni ZJ, Zhao KQ, Sun KQ, et al. The related factors of increased drinking desire and alcohol consumption among drinkers during the COVID-19 epidemic. Chin J Drug Depend. (2021) 30:38–44. doi: 10.13936/j.cnki.cjdd1992.2021.01.008

CrossRef Full Text | Google Scholar

55. Christoffersen LA, Mortensen EL, Becker U, Osler M, Sorensen HJ, Flensborg-Madsen T. Age at onset and age at treatment of alcohol use disorders: associations with educational level and intelligence. Alcohol. (2021) 95:7–14. doi: 10.1016/j.alcohol.2021.04.005

PubMed Abstract | CrossRef Full Text | Google Scholar

56. Wang DF, Zhao JB, Zhai SY, Huang SQ, Yang Z, Pan Y, et al. Longitudinal trajectories of insomnia symptoms among college students during the COVID-19 lockdown in China. J Psychosom Res. (2022) 157:110795. doi: 10.1016/j.jpsychores.2022.110795

PubMed Abstract | CrossRef Full Text | Google Scholar

57. Smallwood N, Karimi L, Pascoe A, Bismark M, Putland M, Johnson D, et al. Coping strategies adopted by Australian frontline health workers to address psychological distress during the COVID-19 pandemic. Gen Hosp Psychiatry. (2021) 72:124–30. doi: 10.1016/j.genhosppsych.2021.08.008

PubMed Abstract | CrossRef Full Text | Google Scholar

Keywords: alcohol use, alcohol misuse, psychiatrists, COVID-19 pandemic, alcohol use disorder

Citation: Mo D, Min K, Gluck R, Jiang F, Tao R, Geng F, Xia L, Liu T, Liu Y, Liu H and Tang Y-l (2022) Alcohol Use and Misuse Among Chinese Psychiatrists During the Early COVID-19 Pandemic. Front. Psychiatry 13:933814. doi: 10.3389/fpsyt.2022.933814

Received: 01 May 2022; Accepted: 30 May 2022;
Published: 22 June 2022.

Edited by:

Wei Hao, Central South University, China

Reviewed by:

Dongfang Wang, South China Normal University, China
Xiangdong Wang, Peking University Sixth Hospital, China

Copyright © 2022 Mo, Min, Gluck, Jiang, Tao, Geng, Xia, Liu, Liu, Liu and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Huanzhong Liu, huanzhongliu@ahmu.edu.cn; Yi-lang Tang, ytang5@emory.edu

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.