Abstract
Alcohol misuse and depression are highly comorbid. Self-medication theory posits that depressed individuals use alcohol to reduce negative emotions. Research suggests that the co-pattern of depression and alcohol misuse is not uniform, and that emerging adults transitioning out of university can be differentiated into subgroups based on their co-patterns. We aimed to replicate and extend this study with emerging adults during university by examining whether baseline individual differences predicted subgroup membership. Undergraduates (N = 300) completed four waves of self-reports at 6-month intervals over 18-months. Parallel process latent class growth modeling supported three classes: Class 1, the “high-risk comorbid” group, had high stable depression and high stable alcohol misuse (n = 28). Class 2, the “moderate-risk depression-only group” had high stable depression but low decreasing alcohol misuse (n = 87). Class 3, the “low-risk normative” group, had low stable depression and low decreasing alcohol misuse (n = 185). Multinomial regressions showed that male sex, higher hopelessness, impulsivity, and anxiety sensitivity, and higher coping-with-depression and enhancement drinking motives, differentiated Class 1 from Class 3. Higher impulsivity and lower hopelessness, and higher enhancement motives, differentiated Class 1 from Class 2. Higher hopelessness, and higher coping-with-depression and conformity motives, differentiated Class 2 from Class 3. We utilized a subclinical sample and a short follow-up period. Emerging adults display differing co-patterns of depression and alcohol misuse over time during university, including both high-, moderate-, and low-risk subgroups. Our results provide novel evidence subgroups that can be distinguished based on sex, drinking motives, and personality.
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References
Adams, T., Rapinda, K., Frohlich, J., O’Connor, R., & Keough, M. (2019). Impulsivity moderates the effect of social anxiety on in-lab alcohol craving. Addictive Behaviors, 97, 70–76. https://doi.org/10.1016/j.addbeh.2019.05.025.
Adlaf, E. M., Demers, A., & Gliksman, L. (2005). Canadian campus survey. Toronto: Centre for Addiction and Mental Health.
Arnett, J. J. (2005). The developmental context of substance use in emerging adulthood. Journal of Drug Issues, 35(2), 235–254. https://doi.org/10.1177/002204260503500202.
Balodis, I. M., Potenza, M. N., & Olmstead, M. C. (2009). Binge drinking in undergraduates: relationships with gender, drinking behaviors, impulsivity and the perceived effects of alcohol. Behavioral Pharmacology, 20(5–6), 518–526. https://doi.org/10.1097/FBP.0b013e328330c779.
Battista, S. R., Pencer, A., McGonnell, M., Durdle, H., & Stewart, S. H. (2013). Relations of personality to substance use problems and mental health disorder symptoms in adolescents. International Journal of Mental Health and Addiction, 11, 1–12. https://doi.org/10.1007/s11469-012-9395-0.
Boschloo, L., Vogelzangs, N., Smit, J., van Den Brink, W., Veltman, D., Beekman, A., & Penninx, B. (2011). Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders. Journal of Affective Disorders, 131(1–3), 233–242. https://doi.org/10.1016/j.jad.2010.12.014.
Brooks Holliday, S., Pedersen, E., & Leventhal, A. (2016). Depression, posttraumatic stress, and alcohol misuse in young adult veterans: the transdiagnostic role of distress tolerance. Drug and Alcohol Dependence, 161, 348–355. https://doi.org/10.1016/j.drugalcdep.2016.02.030.
Brown, R. A., Evans, D. M., Miller, I. W., Burgess, E. S., & Mueller, T. I. (1997). Cognitive-behavioral treatment for depression in alcoholism. Journal of Consulting and Clinical Psychology, 65(5), 715–726 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1885208/.
Collins, J. L., Thompson, K., Sherry, S. B., Glowacka, M., & Stewart, S. H. (2018). Drinking to cope with depression mediates the relationship between social avoidance and alcohol problems: a 3-wave, 18-month longitudinal study. Addictive Behaviors, 76, 182–187. https://doi.org/10.1016/j.addbeh.2017.08.020.
Conrod, P. (2016). Personality-targeted interventions for substance use and misuse. Current Addiction Reports, 3(4), 426–436. https://doi.org/10.1007/s40429-016-0127-6.
Conrod, P., & Nikolaou, K. (2016). Annual research review: on the developmental neuropsychology of substance use disorders. Journal of Child Psychology and Psychiatry, 57(3), 371–394. https://doi.org/10.1111/jcpp.12516.
Cooper, M. L. (1994). Motivations for alcohol use among adolescents: development and validation of a four-factor model. Psychological Assessment, 6(2), 117–128. https://doi.org/10.1037/1040-3590.6.2.117.
DeVido, J. J., & Weiss, R. D. (2012). Treatment of the depressed alcohol patient. Current Psychiatry Reports, 14(6), 610–618. https://doi.org/10.1007/s11920-012-0314-7.
Dick, D., Aliev, F., Viken, R., Kaprio, J., & Rose, R. (2011). Rutgers alcohol problem index scores at age 18 predict alcohol dependence diagnoses 7 years later. Alcoholism, Clinical and Experimental Research, 35(5), 1011–1014. https://doi.org/10.1111/j.1530-0277.2010.01432.x.
Enders, C. K. (2010). Applied missing data analysis. New York: Guilford.
Fergusson, D., Boden, J., & Horwood, L. (2009). Tests of causal links between alcohol abuse or dependence and major depression. Archives of General Psychiatry, 66(3), 260–266. https://doi.org/10.1001/archgenpsychiatry.2008.543.
Frohlich J. R., Rapinda, K. K., O’Connor, R. M., & Keough, M. T. (2018). Examining co-patterns of depression and alcohol misuse in emerging adults following university graduation. Addictive Behaviors Reports, 8, 40–45. https://doi.org/10.1016/j.abrep.2018.06.002.
Gonzalez, V., Reynolds, B., & Skewes, M. (2011). Role of impulsivity in the relationship between depression and alcohol problems among emerging adult college drinkers. Experimental and Clinical Psychopharmacology, 19(4), 303–313. https://doi.org/10.1037/a0022720.
Grant, B., Goldstein, R., Saha, T., Chou, S., Jung, J., Zhang, H., et al. (2015). Epidemiology of DSM-5 alcohol use disorder: results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry, 72(8), 757–766.
Grant, V. V., Stewart S. H., & Mohr, C. D. (2009). Coping-anxiety and coping-depression motives predict different daily mood-drinking relationships. Psychology of Addictive Behaviors, 23(2), 226–237. https://doi.org/10.1037/a001.5006.
Grant, V. V., Stewart, S. H., O’Connor, R. M., Blackwell, E., & Conrod, P. J. (2007). Psychometric evaluation of the five-factor Modified Drinking Motives Questionnaire – revised in undergraduates. Addictive Behaviors, 32, 2611–2632. https://doi.org/10.1016/j.addbeh.2007.07.004.
Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Dufour, M. C., Compton, W., Pickering, R. P., & Kaplan, K. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 61(8), 807–816. https://doi.org/10.1001/archpsyc.61.8.807.
Hasin, D., Sarvet, A., Meyers, J., Saha, T., Ruan, W., Stohl, M., & Grant, B. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75(4), 336–346. https://doi.org/10.1001/jamapsychiatry.2017.4602.
Ibrahim, A. K., Kelly, S. J., Adams, C. E., & Glazebrook, C. (2013). A systematic review of studies of depression prevalence in university students. Journal of Psychiatric Research, 47(3), 391–400 https://doi.org/10.1016/j.jpsychires.2012.11.015.
Jennison, K. M. (2004). The short-term effects and unintended long-term consequences of binge drinking in college: a 10-year follow-up study. American Journal of Drug and Alcohol Abuse, 30(3), 659–684.
Joiner, T. (2000). A test of the hopelessness theory of depression in youth psychiatric inpatients. Journal of Clinical Child Psychology, 29(2), 167–176. https://doi.org/10.1207/S15374424jccp2902_3.
Jung, T., & Wickrama, K. A. S. (2008). An introduction to latent class growth analysis and growth mixture modeling. Social and Personality Psychology Compass, 2(1), 302–317 https://doi.org/10.1111/j.1751-9004.2007.00054.x.
Karpyak, V. M., Biernacka, J. M., Geske, J. R., Abulseoud, O. A., Brunner, M. D., Chauhan, M., et al. (2016). Gender-specific effects of comorbid depression and anxiety on the propensity to drink in negative emotional states. Addiction, 111(8), 1366–1375. https://doi.org/10.1111/add.13386.
Kendall, A. D., Zinbarg, R. E., Bobova, L., Mineka, S., Revelle, W., Prenoveau, J. M., & Craske, M. G. (2016). Measuring positive emotion with the mood and anxiety symptom questionnaire: psychometric properties of the Anhedonic Depression Scale. Assessment, 23(1), 86–95. https://doi.org/10.1177/1073191115569528.
Kenney, S., Anderson, B., & Stein, M. (2018). Drinking to cope mediates the relationship between depression and alcohol risk: different pathways for college and non-college young adults. Addictive Behaviors, 80, 116–123. https://doi.org/10.1016/j.addbeh.2018.01.023.
Keough, M. T., Badawi, G., Nitka, D., O'Connor, R. M., & Stewart, S. H. (2016). Impulsivity increases risk for coping-motivated drinking in undergraduates with elevated social anxiety. Personality and Individual Differences, 88, 45–50. https://doi.org/10.1016/j.paid.2015.08.036.
Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231–244. https://doi.org/10.3109/10673229709030550.
Khantzian, E. J. (2012). Reflections on treating addictive disorders: a psychodynamic perspective. The American Journal on Addictions, 21, 274–279. https://doi.org/10.1111/j.1521-0391.2012.00234.x.
Krank, M., Stewart, S. H., O’Connor, R., Woicik, P. B., Wall, A.-M., & Conrod, P. J. (2011). Structural, concurrent, and predictive validity of the substance use risk profile scale in early adolescence. Addictive Behaviors, 36, 37–46. https://doi.org/10.1016/j.addbeh.2010.08.010.
Kuntsche, E., Knibbe, R., Gmel, G., & Engels, R. (2005). Why do young people drink? A review of drinking motives. Clinical Psychology Review, 25, 841–861. https://doi.org/10.1016/j.cpr.2005.06.002.
Lai, H. M. X., Cleary, M., Sitharthan, T., & Hunt, G. E. (2015). Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990–2014: a systematic review and meta-analysis. Drug and Alcohol Dependence, 154, 1–13. https://doi.org/10.1016/j.drugalcdep.2015.05.031.
Lamis, D., Ballard, E., May, A., & Dvorak, R. (2016). Depressive symptoms and suicidal ideation in college students: the mediating and moderating roles of hopelessness, alcohol problems, and social support. Journal of Clinical Psychology, 72(9), 919–932. https://doi.org/10.1002/jclp.22295.
Lubman, D. I., Allen, N. B., Rogers, N., Cementon, E., & Bonomo, Y. (2007). The impact of co-occurring mood and anxiety disorders among substance-abusing youth. Journal of Affective Disorders, 103, 105–112. https://doi.org/10.1016/j.jad.2007.01.011.
Marmorstein, N. (2009). Longitudinal associations between alcohol problems and depressive symptoms: early adolescence through early adulthood. Alcoholism: Clinical and Experimental Research, 33(1), 49–59. https://doi.org/10.1111/j.1530-0277.2008.00810.x.
Mushquash, A. R., Stewart, S. H., Sherry S. B., Sherry, D. L., Mushquash, C. J., & MacKinnon, A. L. (2013). Depressive symptoms are a vulnerability factor for heavy episodic drinking: a short-term, four-wave longitudinal study of undergraduate women. Addictive Behaviors, 8, 2180–2186. https://doi.org/10.1016/j.addbeh.2012.11.008.
Muthen, B., & Muthen, L. K. (2000). Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes. Alcoholism, Clinical and Experimental Research, 24(6), 882–891 https://www.ncbi.nlm.nih.gov/pubmed/10888079.
Pedrelli, P., Shapero, B., Archibald, A., & Dale, C. (2016). Alcohol use and depression during adolescence and young adulthood: a summary and interpretation of mixed findings. Current Addiction Reports, 3(1), 91–97. https://doi.org/10.1007/s40429-016-0084-0.
Polak, K., Haug, N., Drachenberg, A., & Svikis, H. (2015). Gender considerations in addiction: implications for treatment. Current Treatment Options in Psychiatry, 2(3), 326–338. https://doi.org/10.1007/s40501-015-0054-5.
Shaienks, D., Gluszynski, T., & Bayard, J. (2008). Postsecondary education – participation and dropping out: differences across university, college and other types of postsecondary institutions. Ottawa: Statistics Canada.
Shrout, P., & Rodgers, J. (2018). Psychology, science, and knowledge construction: broadening perspectives from the replication crisis. Annual Review of Psychology, 69, 487–510. https://doi.org/10.1146/annurev-psych-122216-011845.
Smith, J. M., Alloy, L. B., & Abramson, L. Y. (2006). Cognitive vulnerability to depression, rumination, hopelessness, and suicidal ideation: multiple pathways to self-injurious thinking. Suicide and Life-threatening Behavior, 36, 443–454. https://doi.org/10.1521/suli.2006.36.4.443.
Smith, D., Dumas, T. M., & Davis, J. P. (2018). Emerging adult development and substance use disorders. In D. C. Smith (Ed.), Emerging adults and substance use disorder treatment: developmental considerations and innovative approaches (pp. 16–37). New York, NY: Oxford University Press.
Stone, A., Becker, L., Huber, A., & Catalano, R. (2012). Review of risk and protective factors of substance use and problem use in emerging adulthood. Addictive Behaviors, 37(7), 747–775. https://doi.org/10.1016/j.addbeh.2012.02.014.
Swendsen, J., & Merikangas, K. (2000). The comorbidity of depression and substance use disorders. Clinical Psychology Review, 20(2), 173–189. https://doi.org/10.1016/S0272-7358(99)00026-4.
Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics. Boston: Pearson.
Taylor, S., Koch, W., Woody, S., & Mclean, P. (1996). Anxiety sensitivity and depression: how are they related? Journal of Abnormal Psychology, 105(3), 474–479. https://doi.org/10.1037/0021-843X.105.3.474.
Twenge, J., Cooper, A., Joiner, T., Duffy, M., & Binau, S. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005–2017. Journal of Abnormal Psychology, 128(3), 185–199. https://doi.org/10.1037/abn0000410.
Villarosa, M., Messer, M., Madson, M., & Zeigler-Hill, V. (2018). Depressive symptoms and drinking outcomes: the mediating role of drinking motives and protective behavioral strategies among college students. Substance Use & Misuse, 53(1), 143–153. https://doi.org/10.1080/10826084.2017.1327974.
Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., et al. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet, 382, 1575–1586. https://doi.org/10.1596/978-1-4648-0426-7_ch2.
Wickrama, K. A. S., Lee, T. K., O’Neal, C. W., & Lorenz, F. O. (2016). Higher order growth curves and mixture modeling with Mplus: a practical guide. New York: Routledge.
Woicik, P. A., Stewart, S. H., Pihl, R. O., & Conrod, P. J. (2009). The substance use risk profile scale: a scale measuring traits linked to reinforcement-specific substance use profiles. Addictive Behaviors, 34, 1042–1055. https://doi.org/10.1016/j.addbeh.2009.07.00.
Zhou, H., Polimanti, R., Yang, B., Wang, Q., Han, S., Sherva, R., et al. (2017). Genetic risk variants associated with comorbid alcohol dependence and major depression. JAMA Psychiatry, 74(12), 1234–1241. https://doi.org/10.1001/jamapsychiatry.20.
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This research was supported by a grant from the Social Sciences and Humanities Research Council to Drs. Stewart and Sherry (grant number 410-2009-1043).
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.
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This research was supported by a grant from the Social Sciences and Humanities Research Council to Drs. Stewart and Sherry (grant number 410-2009-1043). The authors declare that they have no conflict of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study. All authors contributed meaningfully to the manuscript. Drs. Stewart and Sherry conceptualized and ran the larger study. Dr. Keough and Ms. Orui and analyzed the data. Ms. Frohlich and Ms. Orui conducted literature searches and wrote the first draft of the manuscript. Drs. Stewart, Sherry, and Keough provided significant feedback on all aspects of the paper. Ms. Frohlich applied said feedback. The final manuscript reflects the combined substantial effort of all co-authors and together we declare that we approve of this submission.
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Orui, K., Frohlich, J.R., Stewart, S.H. et al. Examining Subgroups of Depression and Alcohol Misuse in Emerging Adults During University: a Replication and Extension Study. Int J Ment Health Addiction 19, 2323–2341 (2021). https://doi.org/10.1007/s11469-020-00325-w
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DOI: https://doi.org/10.1007/s11469-020-00325-w