Gender-based examination of the association between individual symptoms of alcohol use disorder, major depressive disorder, and suicidal behaviors: a network analysis of data from the Korean Epidemiologic Catchment Area Study

Background: We aimed to investigate the gender differences in the associations between the individual symptoms of AUD and MDD and SB using a network analysis. Methods: Data from the 2011 and 2016 Korean Epidemiologic Catchment Area Study were analyzed. Variables were assessed using the Korean version of Composite International Diagnostic Interview. Of 11,124 total participants, 907 endorsing screening questions for AUD and MDD were included. The undirected and directed network structures of AUD, MDD, and SB were estimated and centrality and bridge centrality indices were examined. Results: The overall undirected network structure and global strength did not differ between genders. While three AUD symptoms had high strength indices in network structure for both genders, depressed mood for men and worthlessness/guilt for women were the bridge symptoms linking other MDD symptoms and AUD symptoms to SB and had the strongest influence on SB. Directed network indicated that for men, AUD symptoms were related to SB via MDD symptoms with tolerance being a dominant item. For women, none of the AUD symptoms were related to MDD symptoms and SB, and insomnia/hypersomnia was a dominant item. Worthlessness/guilt was the directly linked to SB in the directed network analysis for both genders. Limitations: Cross-sectional design and the use of combined dataset with different time points. Conclusions: Some differential associations at the level of individual symptoms of AUD and MDD with SB were observed between men and women. Targeting to the central and bridging symptoms may improve the outcomes of SB interventions implemented among patients with AUD or MDD.