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Mental Health Correlates of Alcohol Dependence: A Study of Psychological Distress and Self-esteem in Odisha, India Running Title: Self-Esteem Among Individuals with Alcohol Dependence

This cross-sectional study of 100 patients in Bhubaneswar, India, reveals a high prevalence of psychological distress and low self-esteem among individuals with alcohol dependence, noting a positive correlation between these factors despite a lack of significant association with socio-demographic variables, thereby highlighting the need for integrated psychological interventions in treatment plans.

Original authors: Ritarani Nayak, Puspanjali Mohapatro, Kabita Puhan, Rubi Pradhan, Itishree Pradhan, Krishna Samantaray

Published 2026-07-10

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CC BY 4.0

Original authors: Ritarani Nayak, Puspanjali Mohapatro, Kabita Puhan, Rubi Pradhan, Itishree Pradhan, Krishna Samantaray

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a group of 100 people who have been admitted to a hospital in Bhubaneswar, India, because they are dependent on alcohol. Think of this study as a deep-dive investigation into their emotional backpacks. The researchers wanted to see what kind of heavy luggage these individuals were carrying: specifically, how much psychological distress (that heavy feeling of stress, anxiety, and sadness) and how much low self-esteem (that nagging voice saying "I'm not good enough") they were holding.

Here is what the investigation found, broken down into the story of their emotional lives.

The Heavy Backpacks

The study discovered that for these 100 individuals, the backpacks were indeed heavy. There was a high prevalence of psychological distress and low self-esteem. It's like walking through a fog where everyone feels stressed and unsure of their own worth.

However, here is a twist in the tale: when the researchers tried to tie a string between the "distress" backpack and the "low self-esteem" backpack, the string was very weak. They found a weak positive correlation (a statistical link of just 0.080). In plain English, while both problems were common, having a heavy distress backpack didn't automatically mean you had a heavy low-self-esteem backpack in a predictable way for this specific group. The paper suggests these two issues are prevalent together, but they aren't tightly locked together like a zipper.

What Actually Made the Backpacks Heavier?

The researchers asked: "Does who you are or what you do change how heavy your emotional backpack feels?" They tested many things, like your age, your religion, your job, or how much money your family makes.

The "No Effect" Zone:
Surprisingly, for most of these factors, the answer was no. Whether you were 18 or 60, Hindu or Muslim, married or single, rich or poor, or worked in a government office or a private shop—none of these made a statistically significant difference in how much distress or low self-esteem you felt. The paper rules out these common life details as the main drivers of the emotional weight in this specific group.

The "Yes, It Matters" Zone:
But, a few specific habits and traits did show a connection:

For Psychological Distress: The study found that education level and sleeping patterns were significant. If you didn't sleep well or had a certain level of education, it was linked to higher distress. It's like saying, "If you're running on a broken sleep schedule, your emotional backpack feels heavier."
For Self-Esteem: The study found that gender and how often you drink were significant. Being male (which made up 95% of the group) and drinking more frequently were linked to lower self-esteem. The paper suggests that the frequency of drinking and being male are the keys that seem to turn the dial on self-worth for these patients.

What the Study Does NOT Say

It is important to know what this study didn't prove.

It did not prove that alcohol causes the low self-esteem or the distress. Because this was a "cross-sectional" study (a snapshot in time), it's like taking a photo of a messy room; you can see the mess, but you can't tell if the mess caused the photo or if the photo caused the mess. The paper explicitly states it cannot determine causality.
It did not find that age, religion, or family income were the reasons for the distress. The data ruled those out as significant factors for this group.
It did not claim that the link between distress and self-esteem was strong. The paper measured it and found it was weak.

The Takeaway for the Future

The authors suggest that because these emotional backpacks are so heavy, doctors and nurses shouldn't just treat the physical addiction. They recommend adding mental health assessments and psychological interventions (like talking therapies or cognitive behavioral therapy) to the regular treatment plan.

Think of it this way: If you are fixing a car with a broken engine (the alcohol dependence), you also need to check the dashboard lights (the mental health). The study suggests that fixing the engine without checking the lights might not get the car running smoothly. They propose that adding these psychological tools could help the recovery process, but they frame this as a suggestion based on their findings, not a guaranteed magic bullet.

In short, for the 100 people in this study, the road to recovery might need a map that includes sleep habits, drinking frequency, and gender-specific support, all while acknowledging that their emotional struggles are real, heavy, and need more than just medical treatment to lift.

Technical Summary: Mental Health Correlates of Alcohol Dependence in Odisha, India

Problem Statement

Alcohol Use Disorder (AUD) represents a critical global public health challenge, associated with severe physical, psychological, and social consequences. While the physical impacts are well-documented, the psychological dimensions—specifically psychological distress (encompassing anxiety, depression, and stress) and low self-esteem—are frequently overlooked, particularly within hospital-based settings in low- and middle-income nations like India.

Existing literature suggests a bidirectional relationship where psychological distress and low self-worth can both precipitate and result from alcohol dependence. However, there is a significant gap in research examining the specific interplay between these psychological variables and socio-demographic factors among hospitalized patients with alcohol dependence in the Odisha region of India. This study addresses the need to understand these correlates to facilitate the development of personalized, holistic treatment strategies.

Methodology

Study Design and Setting:
The research employed a descriptive cross-sectional design conducted between May 2025 and July 2025. The setting was the psychiatric wards and rehabilitation units of IMS and SUM Hospital, a tertiary care teaching hospital in Bhubaneswar, Odisha, India.

Participants:

Sample Size: 100 patients diagnosed with Alcohol Dependence Syndrome.
Sampling Technique: Non-probability convenience sampling.
Inclusion Criteria: Patients aged 18+, diagnosed with alcohol dependence, available during data collection, and willing to provide informed consent.
Exclusion Criteria: Critically ill patients, those unable to communicate effectively, or those unwilling to consent.
Demographics: The sample was predominantly male (95%), Hindu (90%), and residing in rural areas (56%).

Instrumentation:
Data were collected via face-to-face interviews using a structured questionnaire comprising three sections:

Socio-demographic Profile: Age, gender, religion, residence, marital status, education, family structure, income, occupation, sleep patterns, physical activity, and drinking frequency.
Psychological Distress: Measured using the Kessler Psychological Distress Scale (K10), a 10-item scale assessing anxiety and depressive symptoms.
Self-Esteem: Measured using the Rosenberg Self-Esteem Scale, a 10-item measure of general self-regard.

Data Analysis:

Descriptive Statistics: Frequency, percentage, mean, and standard deviation were used to summarize variables.
Inferential Statistics: Chi-square tests ( $\chi^2$ ) were utilized to assess associations between psychological variables and socio-demographic characteristics.
Correlation Analysis: Pearson's and Spearman's correlation coefficients were calculated to examine the relationship between psychological distress and self-esteem.
Significance Level: $p < 0.05$ .
Reliability/Validity: Instruments underwent content validation by five experts and reliability testing (Cronbach's alpha) on a pilot group of 20 participants.

Key Results

1. Prevalence of Psychological Issues

The study confirmed a high prevalence of psychological distress and low self-esteem among the admitted patients with alcohol dependence.

2. Association with Socio-Demographic Variables

The analysis revealed distinct patterns of association for psychological distress versus self-esteem:

Psychological Distress (K10):
- Significant Associations: Found with Educational Qualification ( $\chi^2 = 170.197, p = 0.04$ ) and Sleeping Pattern ( $\chi^2 = 109.280, p = 0.03$ ).
- Non-Significant: No significant associations were found with age, gender, religion, place of residence, marital status, family structure, physical activity, occupation, family income, or frequency of drinking.
Self-Esteem (Rosenberg Scale):
- Significant Associations: Found with Gender ( $\chi^2 = 32.83, p = 0.008$ ) and Frequency of Alcohol Consumption ( $\chi^2 = 60.19, p = 0.002$ ).
- Non-Significant: No significant associations were identified with age, religion, residence, marital status, education, family structure, sleep patterns, physical activity, occupation, or income.

3. Correlation Between Distress and Self-Esteem

Contrary to some expectations of a strong negative correlation, the study found no statistically significant correlation between psychological distress and self-esteem in this specific population.

Pearson's Correlation: $r = 0.080, p = 0.429$ (Weak positive, non-significant).
Spearman's Correlation: $r = 0.033, p = 0.746$ (Weak association, non-significant).

Key Contributions and Significance

The paper positions its contributions within the context of under-researched areas in Indian mental health:

Contextual Evidence: It provides empirical data from a hospital-based setting in Odisha, a region where specific literature on the psychological correlates of alcohol dependence is scarce.
Identification of Specific Determinants: The study highlights that while general socio-demographics (like age or income) may not universally predict distress or self-esteem, specific factors such as education and sleep patterns are critical for distress, while gender and drinking frequency are critical for self-esteem.
Clinical Implications: The findings argue for the integration of routine mental health assessments into addiction treatment protocols. The authors suggest that addressing sleep disturbances and providing gender-sensitive psychosocial interventions could enhance recovery outcomes.
Methodological Rigor: The use of standardized, validated tools (K10 and Rosenberg Scale) in a clinical setting adds validity to the assessment of psychological burdens in this demographic.

Limitations and Modest Claims

The authors explicitly acknowledge the study's limitations to temper the generalizability of the findings:

Sampling Bias: The use of non-probability convenience sampling limits the ability to generalize results to the broader population of alcohol-dependent individuals.
External Validity: The study is confined to a single tertiary care hospital, which may not represent patients in other healthcare settings or rural community clinics.
Causality: The cross-sectional design prevents the establishment of causal relationships between the variables (e.g., whether low self-esteem causes drinking or vice versa).
Bias: Potential recall and social desirability biases inherent in self-reported data were noted.

The paper concludes that while psychological distress and low self-esteem are prevalent, their relationship is complex and not uniformly correlated in this specific sample. It advocates for further research into psychosocial determinants and the incorporation of cognitive behavioral therapy and psychosocial support into standard care plans.