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The Relationship Between Depressive Symptomatology and Alcohol
Consumption in the Latin American Population Based on Gender and Age
Relación entre sintomatología depresiva y consumo de alcohol en población
latinoamericana en función del sexo y la edad
Víctor José Villanueva-Blasco1; Catalina Espitia-Cepeda1; Andrea Vázquez-Martínez1;
Salvador Simó-Algado2 and Bárbara González-Amado1*
1 Universidad Internacional de Valencia. España.
2 Universidad de Vic - Universidad Central de Cataluña. España.
*Corresponding author: barbara.gonzaleza@professor.universidadviu.com
https://doi.org/10.26754/ojs_ais/accionesinvestigsoc.20254611059
Received 2024-09-12. Accepted 2024-10-18
Abstract
The comorbidity between depression and alcohol consumption is a public health problem, which can
affect the progression and severity of both issues, self-care, treatment adherence, and effectiveness.
Moreover, alcohol use in Latin America exceeds the world average. The objectives were a) To study
the prevalence of depressive symptomatology and risk alcohol consumption, taking into account
gender and age. b) To analyze the relationship between risk alcohol consumption and non-risk alcohol
consumption with depressive symptomatology, considering gender and age. A total of 4,890 people
aged 18-64 years (mean age = 31.62 years; 62.7% female) from the Dominican Republic, Ecuador,
Mexico, Peru, Colombia and Argentina participated. Information was collected using an online
questionnaire. The AUDIT-C was used to assess alcohol consumption and PHQ-9 to assess depressive
symptoms. Women showed significantly higher risk drinking than men and greater severity of
depressive symptomatology. Younger adults (18-24) reported more depressive symptoms. In terms of
comorbidity, women with risky alcohol consumption reported greater depressive symptomatology
than men; and younger risky alcohol consumers showed greater severity of depressive
symptomatology than the other age groups. It is necessary to know what the potential explanatory
variables are for the differential results between men and women in risky alcohol consumption and
depressive symptomatology, as well as their comorbidity, as this has implications for the design of
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preventive interventions. Implications for the early management of depression are discussed.
Keywords: Alcohol risk use; depressive symptomatology; comorbidity; American Latin; gender; age.
Resumen
La comorbilidad entre sintomatología depresiva y consumo de alcohol es un problema de salud
pública, pudiendo afectar a la progresión y gravedad de ambas problemáticas, al autocuidado, la
adherencia y eficacia del tratamiento. Además, el consumo de alcohol en América Latina sobrepasa el
promedio mundial. Los objetivos fueron a) Estudiar la prevalencia de sintomatología depresiva y
consumo de riesgo de alcohol, considerando el sexo y la edad, b) analizar la relación entre consumo
de riesgo de alcohol y consumo de no riesgo con sintomatología depresiva, considerando el sexo y la
edad. Participaron 4.890 personas de 18-64 años (edad media = 31,62 años; 62,7% mujeres) de
República Dominicana, Ecuador, México, Perú, Colombia y Argentina. La recogida de información fue
mediante cuestionario online. Se utilizó el AUDIT-C para evaluar consumo de alcohol y PHQ-9 para la
sintomatología depresiva. Las mujeres mostraron un consumo de riesgo de alcohol significativamente
mayor que los hombres y mayor gravedad de sintomatología depresiva. Los adultos más jóvenes (18-
24) reportaron más síntomas de depresión. En términos de comorbilidad, las mujeres con consumo
de riesgo de alcohol informaron de mayor sintomatología depresiva que los hombres; y los
consumidores de riesgo de alcohol más jóvenes mostraron mayor gravedad en la sintomatología
depresiva que los otros grupos etarios. Se precisa conocer cuáles son las potenciales variables
explicativas de los resultados diferenciales entre hombres y mujeres en el consumo de alcohol de
riesgo y sintomatología depresiva, así como su comorbilidad, en tanto tiene implicaciones en el diseño
de intervenciones preventivas. Se discuten las implicaciones para el abordaje precoz de la depresión.
Palabras clave: Consumo de riesgo alcohol; sintomatología depresiva; comorbilidad; América Latina; sexo;
edad.
INTRODUCTION
According to the World Health Organization [WHO] (WHO, 2020), depression is a mental disorder
characterized by symptoms such as sadness, anhedonia, guilt or low self-esteem, difficulty
concentrating, and attention deficits, which may be accompanied by sleep or appetite disturbances.
The severity and impact of depressive symptoms vary, leading to its classification as mild, moderate,
or severe (American Psychiatric Association [APA], 2002), where the severity of symptoms correlates
with the extent of psychosocial impairment and functional deterioration in the individual.
Studies on depression in Latin America identify this condition as one of the main mental health issues,
with reported prevalence rates of 17-20% for moderate and severe depression (Mautong et al., 2021;
Paz et al., 2020). Krüger-Malpartida et al. (2020) found prevalence rates of 48.5% for mild depression,
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29.5% for moderate depression, and 10% for severe depression, with higher rates among women aged
20 to 30. In university populations, Sánchez-Carlessi et al. (2021) reported that 45% of university
students presented moderate to severe levels of depression.
Another significant health concern in Latin America and the Caribbean is alcohol consumption, which
exceeds the global average (Pan American Health Organization [PAHO] & WHO, 2020). According to
these organizations, in the Andean subregion, the prevalence of alcohol consumption was 70% in 2019
(77.2% in men and 67.1% in women), dropping to 50.2% (54.6% and 43.9% in men and women,
respectively) during 2020 due to the COVID-19 pandemic containment measures. This decline during
the pandemic has also been observed in other countries. Recent studies in the Spanish population
found differences in the frequency of alcohol consumption by age during the COVID-19 pandemic,
with young adults (aged 18-29) reporting a more significant decrease in alcohol consumption
compared to those aged 30-64, possibly due to fewer social drinking opportunities (Villanueva-Blasco,
Villanueva-Silvestre et al., 2021). Similarly, other studies point to the relationship between alcohol
consumption and depression in young adults (20-24 years) regardless of gender (Caldwell et al., 2002).
In young women (18-34 years), depression has been identified as a predictor of alcohol consumption
(Villanueva-Blasco, Mateu-Mollá et al., 2022).
Beyond the public health considerations of depression and alcohol consumption, there is extensive
evidence on their comorbidity (Petersen et al., 2019; Udo & Grilo, 2019). In fact, comorbidity can affect
the progression and severity of both conditions, as well as self-care, adherence, and treatment
effectiveness (Mäkelä et al., 2015; Oliveira et al., 2018). Some studies suggest an association between
problematic alcohol use and individuals with higher levels of depression (Jacob et al., 2021; Martins &
Gorelick, 2011; Murphy et al., 2013). The evidence also suggests that women are more likely to report
drinking alcohol to cope with stress and negative affect compared to men (i.e., McHugh et al., 2018).
Additionally, Khan et al. (2013) report that women with alcohol use disorder exhibit higher rates of
comorbidity with depression. Therefore, age and gender are relevant variables concerning both issues
and their comorbidity.
The study of comorbidity between alcohol consumption and depression in Latin America, and
understanding whether there is a differential relationship by gender and age, is crucial for the design
of public policies and intervention plans. Consequently, the objectives of the present study were: a)
to establish the prevalence of depressive symptoms and risky alcohol consumption, considering
gender and age; and b) to analyze the relationship between risky and non-risky alcohol consumption
and depressive symptoms, depending on gender and age.
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METHOD
Design
This was a correlational and cross-sectional study with convenience sampling. The online battery of
tests was specifically designed for the research, selecting tests with adequate psychometric
properties.
Participants
The sample comprised N = 4,890 adult participants, of which n = 3,064 were women and n = 1,826
men, from six Latin American countries. The selection criteria were: (a) residence in a Latin American
country; (b) age between 18 and 64 years; (c) explicit consent to participate; and (d) appropriate
completion of the battery of questionnaires.
Instruments
An ad hoc questionnaire was used for sociodemographic data such as age and gender.
To assess depressive symptoms, the Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001) was
used, adapted to Spanish (Cassiani-Miranda et al., 2021). It consists of 9 items measuring depressive
symptoms over the past two weeks, using a Likert scale (0 = "not at all"; 3 = "nearly every day"). The
content was developed based on the diagnostic criteria for major depression from the DSM-IV-TR
(APA, 2002). The total score ranges from 0-27, with higher scores indicating greater severity of
depressive symptoms. Severity cut-off points are 0-4: No depression; 5-9: Mild depression; 10-14:
Moderate depression; 15-19: Moderately severe depression; and 20-27: Severe depression. A score
of 10 or more indicates a high likelihood of a major depression diagnosis (Kroenke et al., 2001). The
internal consistency of this unifactorial test is adequate (α = .83) (Baader et al., 2012), as was the case
in the current sample (α = .85).
For alcohol consumption, the Alcohol Use Disorders Identification Test – Short Version (AUDIT-C) (Bush
et al., 1998) was used, adapted to Spanish (Contel et al., 1999). It consists of three items analyzing
frequency of consumption, daily average consumption, and binge drinking. The scale is a Likert-type
with five anchors (0 = low frequency or low consumption; 4 = high frequency or high consumption).
Risky consumption was defined as 4 points or more for women, and 5 or more for men (García-
Carretero et al., 2016; Rodriguez-Martos & Santamariña, 2007). The reliability of the test was
adequate (α = .75) (García-Carretero et al., 2016) and was α = .67 in the current sample.
Procedure
Data collection took place between April and May 2020, during the COVID-19 pandemic. Due to the
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health restrictions, an online format using self-administered tests was employed. The data were
collected via a survey hosted on a website, disseminated through social networks, emails, and
smartphones. Distribution was carried out by collaborators, key informants, professionals, and
acquaintances of the participating researchers from various Latin American and Caribbean countries.
This process determined the convenience sampling limited to the aforementioned countries, along
with the sample sizes obtained in each country. Data collection complied with Spanish data protection
legislation, as this study was part of a broader investigation that included Spain, the country from
which the research was initiated. Informed consent was provided, detailing the voluntary nature of
participation and compliance with the Organic Law 3/2018 on personal data protection and digital
rights. Age ranges were established based on the criteria from the National Institute of Statistics
(2019), concerning the efficient internet access of the general population. The project was approved
by the ethics committee of the Valencia International University (protocol code CEID2020_02).
Data Analysis
An exploratory data analysis was initially conducted to detect incomplete cases and outliers in the
criterion variables. Although outliers above 1.5 and 3 times the IQR were detected, particularly in the
AUDIT-C variable, they were not removed after reviewing individual cases, as the high frequency
indicated that the data came from the same population, but represented individuals with severe
consumption, which was considered of interest to the study's objectives regarding risky alcohol use.
Given that the F-statistic is robust for small deviations from normality in large samples, parametric
hypothesis tests were applied. Homogeneity of variances was assessed using Levene’s test for one-
way ANOVA.
Univariate analyses were conducted to calculate prevalence (e.g., depressive symptoms, risky alcohol
consumption), both for the total sample and disaggregated by age and gender. Student’s t-test was
used for mean comparisons to determine differences in depressive symptoms based on gender and
risky alcohol consumption. ANOVA was performed to examine differences in depression severity and
risky alcohol consumption levels by age (categorized into ranges). Additionally, contingency tables
were used with cut-off points of 10 and 15 (Kroenke et al., 2001) to determine the percentage of the
sample with a potential diagnosis of major depression. Pearson correlation was used to analyze
relationships between quantitative variables (e.g., association between age and severity of depressive
symptoms).
For relationships between categorical variables, the chi-square nonparametric test was used (e.g.,
relationship between risky consumption and gender). Finally, effect sizes were calculated using
Cohen’s d for mean differences between two groups, η² for comparisons involving more than two
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groups, and Pearson’s φ and r for bivariate correlations. A significance level of p ≤ 0.05 was adopted
for hypothesis testing. Statistical analyses were performed using SPSS version 27.
RESULTS
From the initial sample of 5,717 participants, cases were excluded due to missing values (n = 749),
incoherent response patterns (inconsistent answers, clear response trends, or repetitive patterns) (n
= 22), or being outside the established age range (n = 56). The decision was made by two authors who
reached a consensus after reviewing each case, leading to their exclusion from the statistical analyses.
Thus, the final sample comprised N = 4,890 participants, with a mean age of 31.62 years (SD = 12.18).
Women accounted for 62.7% (n = 3,064) and men for 37.3% (n = 1,826). In terms of age, 39.6% were
between 18-24 years old, 42.5% between 25-44 years old, and 18% between 45-64 years old.
Geographically, 52.8% were from the Dominican Republic, 22.1% from Ecuador, 13.5% from Mexico,
7.1% from Peru, 2.5% from Colombia, and 1.9% from Argentina.
Regarding depressive symptoms, findings indicated that 39.2% of the sample did not exhibit
depressive symptoms; 37.3% had mild depressive symptoms; 15.7% moderate; 5.5% moderately
severe; and 2.3% severe (Table 1).
Table 1
Prevalence for Depression Severity Levels according to Gender and Age
n
ND
% (n)
MD
% (n)
MD
% (n)
MSD
% (n)
SD
% (n)
Total sample
4,890
39.2 (1,915)
37.3 (1,825)
15.7 (769)
5.5 (268)
2.3 (113)
Gender
Women
3,064
34.8 (1,067)
38.5 (1,179)
17.5 (537)
6.4 (73,5)
2.7 (84)
Men
1,826
46.4 (848)
35.4 (646)
12.7 (232)
3.9 (26,5)
1.6 (29)
Age
18-24
1,934
26 (503)
40.3 (780)
21.6 (417)
8.2 (159)
3.9 (75)
25-44
2,072
42.2 (875)
38.7 (801)
13.2 (274)
4.4 (91)
1.5 (31)
45-64
884
60.7 (537)
27.6 (244)
8.8 (78)
2 (18)
0.8 (7)
Note. ND (No depression); MD (Mild depression); MD (Moderate depression); MSD (Moderately severe depression); SD (Severe depression).
When considering gender, men (M = 5.74, SD = 4.82) and women (M = 7.11, SD = 5.13) showed
significant differences in depressive symptoms (t(4028.799) = 9.382; p < .001), with women reporting
greater severity, with a small effect size, d = 0.27 (Table 2). Considering the cut-off point of 10 (Kroenke
et al., 2001) for a probable diagnosis of major depression, nearly a quarter of the sample (23.5%, n =
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818 women and n = 332 men) would likely be diagnosed with major depression. Using a more
conservative cut-off (>15), 6.34% (n = 226 women and n = 84 men) would likely receive such a
diagnosis.
Significant differences in mean depressive symptom scores were observed by age group (F(2,4142.686) =
221.851; p < .001) (Table 2), with a moderate effect size, η2 = 0.08. The 18-24 age group (M = 8.18; SD
= 5.29) reported higher symptom severity compared to the 25-44 age group (M = 6.07; SD = 4.67) and
the 45-64 age group (M = 4.36; SD = 4.26). Differences were also significant between the 25-44 and
45-64 age groups, with younger individuals reporting greater severity. Overall, the relationship
between age and depressive symptom severity was significant and negative (r = -0.287, p < .001), with
a small effect size, indicating that younger individuals reported greater symptom severity.
Table 2
Differences in Severity Levels of Depression according to Gender and Age
n
M (SD)
t/F(gl)
p
d/ η2
Total sample
4,890
6.6 (5.06)
Gender
Women
3,064
7.11 (5.13)
9.382 (4028.79)
<.001
0.27
Men
1,826
5.74 (4.82)
Age
18-24
1,934
8.18 (5.29)
221.851
(2.4142.686)
<.001
0.08
25-44
2,072
6.07 (4.67)
45-64
884
4.36 (4.26)
Note. n: Sample; M(SD): Mean (Standard Deviation); t: t Student; F = F-test; gl: degree of freedom; d: d of Cohen; η2: Eta-square.
Among the global sample, 1,595 individuals reported alcohol consumption in the past 30 days. Of
these, 89.8% reported risky consumption according to the AUDIT-C (Table 3). All women who reported
alcohol use had a higher prevalence of risky consumption (n = 949) compared to 74.8% of men (n =
483). A statistically significant relationship was found (χ²(1) = 263.967, p < .001) between risky alcohol
consumption and gender, with women showing significantly higher risky consumption than men, with
a moderate effect size, φ = -.409. No relationship was found between age groups and risky alcohol
consumption (χ²(2) = 0.949, p = .622). When age was treated as a continuous variable, a significant and
positive relationship was found (r = 0.149, p < .001), with a small effect size, indicating that older age
was associated with higher risky alcohol consumption.
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Table 3
Prevalence of Risk Alcohol Consumption According to Gender and Age
n
non-risky alcohol
consumption
% (n)
Risky alcohol
Consumption% (n)
χ2
p
φ
Total sample
1,595
10.2 (163)
89.8 (1,432)
Gender
Women
949
0 (0)
100 (949)
263.967
<.001
-.409
Men
646
25.2 (163)
74.8 (483)
Age
18-24
620
11.1 (69)
88.9 (551)
25-44
718
9.7 (70)
90.3 (648)
.949
.622
45-64
257
9.3 (24)
90.7 (233)
Note. n: sample; χ2: Chi-square; φ: Phi.
Among alcohol consumers with depressive symptoms (n = 1,090) (Table 4), 8.81% (n = 96) reported
non-risky alcohol consumption and a mean PHQ-9 score of M = 9.14 (SD = 4.09) (Table 5). In contrast,
91.19% (n = 994) reported risky alcohol consumption (Table 4) and a mean PHQ-9 score of M = 9.68
(SD = 4.26) (Table 5). However, differences in depressive symptom severity between risky and non-
risky alcohol consumers were not significant (t(1088) = -1.189; p = .235) (Table 5).
When considering gender, significant differences were found in the mean PHQ-9 score (t(561.367) =
3.181; p = .002) between women (M = 9.93; SD = 4.36) and men (M = 9.02; SD = 3.91) with risky alcohol
consumption (Table 5), with a small effect size, d = 0.22, with women reporting greater severity of
depressive symptoms.
Regarding age (Table 5), no significant differences were found in depressive symptom severity among
non-risky alcohol consumers across age groups (F(2.93) = 2.057; p = .134). However, age was related to
depressive symptom severity in risky alcohol consumers (F(2.619.640) = 44.050; p < .001) with a moderate
effect size, η2 = 0.07. Post hoc analyses showed significant differences in depressive symptoms
between the 18-24 age group (M = 10.88; SD = 4.61) and the 25-44 age group (M = 8.75; SD = 3.66)
and the 45-65 age group (M = 8.13, SD = 3.40). Specifically, the younger group with risky alcohol
consumption showed greater severity of depressive symptoms, falling within the moderate severity
range. In terms of the relationship between variables, younger age was associated with greater
severity of depressive symptoms (r = -0.344, p < .001), with a moderate effect size. Additionally, the
youngest group of risky alcohol consumers had a high probability of being diagnosed with major
depression (cut-off > 10).
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Table 4
Prevalence of Alcohol Consumption for Different Levels of Depression according of Gender and Age
Consumption
n
MD
% (n)
MD
% (n)
MSD
% (n)
SDDG
% (n)
Total sample
Non-risky
consumption
96
66.7 (64)
26 (25)
3.1 (3)
4.2 (4)
Risky consumption
994
61.4 (610)
24.9 (248)
9.7 (96)
4 (40)
Gender
Women
Risky consumption
113
55.8 (63)
30.1 (34)
8.0 (9)
6.2 (7)
Men
Risky consumption
58
77.6 (45)
15.5 (9)
3.4 (2)
3.4 (2)
Age
18-24
Non-risky
consumption
47
68.1 (32)
21.3 (10)
2.1 (1)
8.5 (4)
Risky consumption
463
49.2 (228)
30.2 (140)
14.3 (66)
6.3 (29)
25-44
Non-risky
consumption
44
65.9 (29)
29.5 (13)
4.5 (2)
0 (0)
Risky consumption
421
71 (299)
20.2 (85)
6.9 (29)
1.9 (8)
45-64
Non-risky
consumption
5
60 (3)
40 (2)
0 (0)
0(0)
Risky consumption
110
75.5 (83)
20.9 (23)
0.9 (1)
2.7 (3)
Note. ND (No depression); MD (Moderate depression); MSD (Moderately severe depression); SD (Severe depression).
Table 5
Differences in Depression Severity (PHQ-9) between Non-Risk and Risk Alcohol Users, according to Gender and Age
n
PHQ-9
M(SD)
t/F
p
d/η2
Non-risky consumption
96
9.14 (4,09)
-1.189
.235
Risky consumption
994
9.68 (4,26)
Risky consumption
Women
715
9.93 (4,36)
3.181
.002
0.22
Men
279
9.02 (3,95)
Non-risky consumption
18-24
47
9.87 (4,84)
2.057
.134
25-44
44
8.23 (3,13)
45-64
5
10.20 (2,38)
Risky consumption
18-24
463
10.88 (4,61)
44.050
< .001
0.07
25-44
421
8.75 (3,67)
45-64
110
8.13 (3,40)
Note. t = t Student; p = significance level; F = F-test; η2: Eta-square
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DISCUSSION
This study analyzed the relationship between alcohol consumption and depressive symptoms in a
sample from various Latin American countries. Given the scarcity of studies on the relationship
between these variables in Latin American populations, the findings presented here hold significant
value.
In line with previous studies (Apaza et al., 2020; Goularte et al., 2021; Mautong et al., 2021; Paz et al.,
2020; Villanueva-Blasco, Mateu-Mollá et al., 2022; Villanueva-Blasco, Villanueva-Silvestre et al., 2022),
women reported a higher prevalence of depressive symptoms compared to men. This finding may be
related to social, biological, and hormonal factors specific to women (National Institute of Mental
Health, 2020). Additionally, consistent with research conducted across different countries during the
COVID-19 pandemic (Apaza et al., 2020; Gamboa et al., 2021; Guiroy et al., 2020; Sánchez-Carlessi et
al., 2021; Villanueva-Blasco, Mateu-Mollá et al., 2022; Villanueva-Blasco, Villanueva-Silvestre et al.,
2022), younger populations showed higher levels of depressive symptoms. These findings suggest that
sociodemographic profiles based on gender and age for populations affected by depressive symptoms
are transcultural.
Regarding alcohol consumption during the pandemic, women exhibited a higher prevalence of risky
drinking compared to men, which has been observed in other studies (Villanueva-Blasco, Sellés et al.,
2021; Villanueva-Blasco, Villanueva-Silvestre et al., 2021). This finding corroborates the trend of
diminishing gender differences in alcohol consumption prevalence, highlighting the transcultural
nature of this phenomenon, which also occurs in Latin America. Considering age, it was observed that
older individuals tend to engage in riskier alcohol consumption. However, it is important to note that
data were collected during the COVID-19 pandemic, and this result could be due to the effects of
lockdown measures, which limited social gathering spaces and typical alcohol consumption among
young people (Chodkiewicz et al., 2020). As Villanueva-Blasco, Villanueva-Silvestre et al. (2021) point
out, environmental factors such as regulation and restriction of alcohol availability during the
pandemic acted as protective factors against alcohol consumption in young people.
Regarding the association between alcohol consumption and depressive symptoms in the Latin
American population, the findings of this study corroborate those obtained in previous studies
(Gritsenko et al., 2020; Horigian et al., 2020; Jacob et al., 2021; Lechner et al., 2020; OPS & OMS, 2020;
Villanueva-Blasco, Mateu-Mollá et al., 2022; Weerakoon et al., 2021), indicating the transcultural
nature of this association. This is also reflected in the significant differences found in the relationship
between depressive symptoms and risky alcohol consumption based on gender (Valdivia-Lívano et al.,
2018; Villanueva-Blasco, Mateu-Mollá et al., 2022), showing that women with risky alcohol
consumption experience more severe depressive symptoms. The finding that younger risky alcohol
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consumers had more severe depressive symptoms aligns with findings from other studies (Villanueva-
Blasco, Mateu-Mollá et al., 2022). Evidence supports that depressive symptoms are a key predictor of
risky alcohol consumption, with alcohol consumption serving as an avoidant coping strategy for
negative affect (McHugh et al., 2018; Villanueva-Blasco, Mateu-Mollá et al., 2022). Moreover, it is
well-known that alcohol consumption during depression is associated with a worse course of the
disorder, increased likelihood of relapse, poorer overall social functioning, and a higher risk of suicide
(Sullivan et al., 2005). From a clinical perspective, these findings are important and should be
considered in the treatment plans for both disorders, emphasizing the importance of early detection
and intervention.
An important epidemiological finding regarding depressive symptoms in Latin America is that one in
four participants in this study would surpass the cut-off for a probable diagnosis of major depression.
Consequently, the need to strengthen preventive public policies, complemented by early detection
measures and improved access to treatment, is highlighted. Public health services should provide an
integrated approach to addressing both alcohol consumption and depression, separately and in
combination, as well as other preventable and treatable mental health issues (OPS, 2023).
Regarding the limitations of this study, firstly, convenience sampling was used, which does not allow
for the generalization of the sample results to the Latin American population as a whole. While the
study broadly addresses Latin American countries, specific factors could differentially affect alcohol
consumption and its comorbidity with depression. Future research should analyze whether the results
found in this study could differ based on the specific country of reference in Latin America or the
Caribbean, considering other possible cultural explanatory variables. Secondly, the data were
collected during the COVID-19 pandemic, and some changes may have occurred compared to pre- and
post-pandemic periods. Thirdly, the internal consistency of the AUDIT-C questionnaire was moderate,
so this should be considered in the event of conflicting results in the scientific literature. Fourthly, the
interpretation of results in terms of the probability of a major depression diagnosis should be
approached with caution, as a mental disorder diagnosis cannot be based solely on scores from a
specific questionnaire. Fifthly, it should be noted that this study is part of a broader research project
conducted in several countries. Although the instruments used have been previously applied in other
studies in most of these countries, intercultural differences were not accounted for to make an ad hoc
adaptation for each one, using the indicated validated version. Additionally, some variables could
influence the observed comorbidity in different studied countries. Future studies should explore this
issue further. Finally, since this is a cross-sectional design, the relationship between depression and
risky alcohol consumption should be interpreted as an association, not causality.
Two findings from this study stand out for their social and public health implications. Firstly, it is
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evident that the gender gap in alcohol consumption may be closing in Latin American countries, in line
with what has been observed in other nations. However, this should not justify normalizing high-risk
alcohol consumption. Therefore, preventive efforts should continue, considering the differences
found between men and women, as well as deepening the cultural understanding of the various social
determinants of health in the context of Latin America, as a whole, by regions, and by countries. Future
research should examine potential explanatory variables for these differential results between men
and women in risky alcohol consumption and depressive symptoms, as well as their comorbidity.
Secondly, it is important to follow the recommendations of the OPS (2023) for the Americas in terms
of mental health, highlighting the promotion and protection of mental health throughout life, the
integration of mental health into all policies outside the health sector, and “improving and expanding
mental health services and care at the community level” (p.59).
In conclusion, the findings of this study highlight the social and cultural relevance for Latin America,
emphasizing the importance of early and comprehensive intervention. Specifically, they point to the
need to design culturally sensitive interventions tailored to the characteristics of vulnerable
populations, especially women and young people with risky alcohol consumption, as they exhibit more
severe depressive symptoms. Moreover, public health strategies should address both alcohol
consumption and mental health comorbidities to improve overall treatment outcomes.
DATA AND MATERIAL AVAILABILITY
The data used in this research is available upon justified request to the corresponding author.
DECLARATION OF GENERATIVE AI AND AI-ASSISTED TECHNOLOGIES IN THE WRITING PROCESS
The authors declare that no AI-assisted tools were used during the drafting process of this article.
CONFLICT OF INTEREST
The authors declare that they have no conflict of interest.
FUNDING
The funding organization, the Valencian International University [PII2020_05], did not participate in
any stage of the article's development.
AUTHOR CONTRIBUTIONS
VVB: funding acquisition, design, literature review, data collection, results interpretation, discussion,
conclusions, and supervision; CEC: literature review, data collection, discussion, and conclusions;
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AVM: design, literature review, data collection, and supervision; SSA: literature review, data
collection, discussion, and conclusions; BGA: literature review, data analysis, results interpretation,
discussion, conclusions, and supervision.
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