Content of review 1, reviewed on August 28, 2020

In the present study the authors described the prevalence of different psychiatric diagnoses among Danish men registered in an outpatient alcohol clinic. The prevalence of the different psychiatric diagnoses was compared with a matched control population. Moreover, the authors identified different subpopulations according to the temporality of registration with AUD and another psychiatric disorder diagnosis and compared the prevalence of several psychiatric diagnoses among these subpopulations. The present study evaluated the prevalence of different psychiatric disorders in a large cohort of individuals treated for AUD, with and without a diagnosis of AUD in a psychiatric hospital. This approach is relevant considering that one of the main outcomes of the study is that AUD hospital diagnosis are highly underreported.

  1. The authors focused their study on describing and comparing the prevalence of psychiatric diagnoses among Danish men registered in an outpatient alcohol clinic, and they report “Any life-time psychiatric hospital diagnosis” which also included AUD diagnosis which might artificially increase its prevalence in the study population as compared to the control group. Could the authors also provide the prevalence of life-time psychiatric hospital diagnosis without considering AUD?
  2. In the present study, individuals with different lifespans have been merged, however, an individual who has lived a long life is more likely to have been diagnosed with AUD or other psychiatric conditions over their lifetime as compared to an individual who has died at a young age. Therefore, the lifespan of each category of individuals could represent a major cofounding factor that could potentially modify the outcome of the presented data. Did the diagnosed and non-diagnosed people differ in their lifespan?
  3. The authors should provide more detailed and relevant statistical information beyond the p values (degrees of freedom, chi-square value…).
  4. Some references should be included:
    In the third paragraph of the introduction (p4), the manuscript is read “previous studies were based on general population samples assessing a wide range of psychiatric disorders or individuals receiving inpatient psychiatric treatment”. Could the authors include the references of the previous studies?
    In the discussion section (p14), the manuscript is read “…the present study and none of the previous studies assessed these disorders”. Could the authors include the references of the previous studies?
  5. The authors should discuss in the “temporal order of alcohol…” section, the limitation of their classification. Some of the psychiatric disorders included in the present study are often underreported, hence could pre-exist the dependent conditions. The initiation of Alcohol consumption could even be used as a self-medication strategy to cope with such pre-existing conditions.
  6. The authors should rephrase the Study population section. The section starts with the description of the database used to obtain the populations, then the matching variables, followed by the criteria to be considered a case or control, and back to matching variables.
  7. In the Study population section, could the authors homogenise the numerical information by changing “three men were excluded” for the numerical value? It will help to identify the information.
  8. In the Life-time psychiatric hospital diagnoses section and in the Table 1, the authors should provide the meaning of the ICD abbreviature?
  9. The authors should rephrase the Statistical analysis section. The paragraph describing the different subpopulation identified should be moved to a more convenient section. Moreover, the authors should include all data referring to the statistical analysis in this section.
  10. In the results section (p11), the manuscript reads “Of the 3111 men in the AUD first subpopulation, 2822 (90.7%) had their first AUD diagnosis in an outpatient alcohol clinic”. Could the authors also specify in this section where the rest of the AUD diagnosis occurred?
  11. There is a typo in the discussion section (p14), the manuscript reads “which was also fund in a Daish nationwide study”.
  12. In the Table 2, the authors should include the symbol of the national Danish psychiatric registers.

Source

    © 2020 the Reviewer.

Content of review 2, reviewed on November 18, 2020

I would like to thank the authors for addressing all the concerns raised in the peer-review process. Here are some comments:

In the revised version of the manuscript, the authors have reported the p-value for the difference in the matching variables, however the statistical test used has not been reported. The authors should include in the manuscripts the statistical test used and provide the relevant statistical information beyond the p-values.

Considering that all the matching variables differ significantly between the study sample and the control population, it seems more appropriate to report also the OR adjusted for differences on matching variable.

Source

    © 2020 the Reviewer.

References

    N., C. L. A., L., M. E., Merete, O., J., S. H., Ulrik, B., Trine, F. 2021. Lifetime psychiatric hospital diagnoses among 8,412 Danish men registered in an outpatient alcohol clinic. Brain and Behavior.