Association of solitary binge drinking and suicidal behavior among emerging adult college students

'I've never been so stressed in my life': a qualitative analysis of young adults' lived experience amidst pandemic restrictions in Prince Edward Island, Canada

OBJECTIVES

This qualitative study aimed to explore how young adults experienced the COVID-19 pandemic in relation to extensive lockdowns, social isolation and psychosocial distress. Specifically, this research focused on how the pandemic impacted those who did not contract COVID-19 and lived in a low-risk geographical location. The focus was young adults given they have large social circles (high risk for disease transmission) and have an increased propensity to mental health conditions. These insights can inform planning for future pandemics.

DESIGN

This paper draws on 30 in-depth semistructured interviews. Data were analysed inductively following the principles of a constructivist grounded theory approach.

SETTING AND PARTICIPANTS

30 young adults living in Prince Edward Island during the COVID-19 pandemic, a Canadian province with a low number of COVID-19 cases at the time of data collection.

RESULTS

We developed four themes that describe the experience of young adults during the COVID-19 pandemic: (1) life course disruption, (2) fear and anxiety about the COVID-19 virus, (3) isolation and loss of hope and (4) strategies for managing adversity. Our findings highlight the areas of young adults' lives that were affected by extensive social changes related to the COVID-19 pandemic. We demonstrate that even individuals who had not contracted the virus were considerably impacted.

CONCLUSION

We provide a detailed description of the comprehensive impact of COVID-19 on low-risk young adults not previously infected with the COVID-19 virus. By reflecting on the biographical disruption experienced by young adults, we highlight the need and opportunity to direct healthcare resources towards identifying and addressing the secondary impacts of pandemics. Consequently, these findings can guide decisions relating to future pandemic restrictions to better account for the experiences of individuals living through them.

Individual Differences in Affect Dynamics and Alcohol-Related Outcomes

Background: To examine whether individual differences in intensive longitudinal data-derived affective dynamics (i.e. positive and negative affect variability and inertia and positive affect-negative affect bipolarity) - posited to be indicative of emotion dysregulation - are uniquely related to drinking level and affect-regulation drinking motives after controlling for mean levels of affective states. Method: We used a large sample of college student drinkers (N = 1640, 54% women) who reported on their affective states, drinking levels and drinking motives daily for 30 days using a web-based daily diary. We then calculated from the daily data positive and negative affect variability, inertia, affect bipolarity and mean levels of affect and used these as predictors of average drinking level and affect-regulation drinking motives (assessed using both retrospective and daily reporting methods). Results: Findings from dynamic structural equation models indicated that mean levels of affect were uniquely related to drinking motives, but not drinking level. Few dynamic affect predictors were uniquely related to outcomes in the predicted direction after controlling for mean affect levels. Conclusion: Our results add to the inconsistent literature regarding the associations between affective dynamics and alcohol-related outcomes, suggesting that any effects of these indicators, after controlling for mean affect levels, might be more complex than can be detected with simple linear models.

Solitary-specific drinking to cope motives explain unique variance in solitary drinking behavior but not alcohol problems compared to general drinking to cope motives

OBJECTIVE

Adolescent and young adult solitary drinking is prospectively associated with alcohol problems, and it is thus important to understand why individuals engage in this risky drinking behavior. There is substantial evidence that individuals drink alone to cope with negative affect, but all prior studies have assessed motives for alcohol use without specifying the context of such use. Here, we directly compared solitary-specific drinking to cope motives with general drinking to cope motives in their ability to predict solitary drinking behavior and alcohol problems. We hypothesized that solitary-specific drinking motives would provide additional predictive utility in each case.

METHODS

Current underage drinkers (N = 307; 90% female; ages 18-20) recruited from a TurkPrime panel March-May 2016 completed online surveys querying solitary alcohol use, general and solitary-specific coping motives, and alcohol problems.

RESULTS

Both solitary-specific and general coping motives were positively associated with a greater percentage of total drinking time spent alone in separate models, after controlling for solitary-specific and general enhancement motives, respectively. However, the model with solitary-specific motives accounted for greater variance than the general motives model based on adjusted R2 values (0.8 versus 0.3, respectively). Additionally, both general and solitary-specific coping motives were positively associated with alcohol problems, again controlling for enhancement motives, but the model including general motives accounted for greater variance (0.49) than the solitary-specific motives model (0.40).

CONCLUSION

These findings provide evidence that solitary-specific coping motives explain unique variance in solitary drinking behavior but not alcohol problems. The methodological and clinical implications of these findings are discussed.

Longitudinal predictors of depression, anxiety, and alcohol use following COVID-19-related stress

The COVID-19 pandemic imposed profound effects on health and daily life, with widespread stress exposure and increases in psychiatric symptoms. Despite these challenges, pandemic research provides unique insights into individual differences in emotion and cognition that predict responses to stress, with general implications for understanding stress vulnerability. We examined predictors of responses to COVID-19-related stress in an online sample of 450 emerging adults recruited in May 2020 to complete questionnaires assessing baseline stress and psychiatric symptoms, rumination, cognitive reappraisal use and intolerance of uncertainty. Stress and symptoms were re-assessed 3 months later (N = 200). Greater pandemic-related stressful events were associated with increases in symptoms of depression, anxiety and alcohol use severity. Additionally, individual differences in emotional and cognitive styles emerged as longitudinal predictors of stress responses. Specifically, greater rumination predicted increased depression. Reduced cognitive reappraisal use interacted with stress to predict increases in alcohol use. An unexpected pattern emerged for intolerance of uncertainty, such that stress was associated with increases in depression for those high in intolerance of uncertainty but increases in alcohol use at relatively low levels of intolerance of uncertainty. These results highlight unique vulnerabilities that predict specific outcomes following stress exposure and offer potential prevention targets.

Investigating the nature of depressive experiences in adults who self-medicate low mood with alcohol

OBJECTIVE

This study sought to explore if individuals who self-medicate with alcohol experience higher levels of depression, and if symptom level experiences are affected by the behaviour of self-medication.

DESIGN

Data was from the Wave I (2001-2002) National Epidemiologic Survey on Alcohol and Related Conditions - NESARC. Only participants who experienced either one or both of the two stem questions which highlight the key symptoms of depression were included (n=13,753).

RESULTS

A one factor model of depression was supported. Experiences of suicidality were more likely to be endorsed by people who self-medicated, compared to those with low mood who do not use alcohol in this way. Typically, more common experiences of depression in the form of appetite difficulties, were less likely to be reported by those who self-medicated, compared to those who do not.

CONCLUSIONS

The findings aid understanding of the drinking patterns and other mental health correlates of those who engage in the behaviour of self-medication. Findings indicate that those who self-medicate are at a higher risk for suicidality, given the same level of depression. These findings highlight the importance of identifying these potentially problematic health behaviours as early as possible, due to these risks.

Mediational Role of Drinking to Cope in the Associations of Depression and Suicidal Ideation with Solitary Drinking in Adults Seeking Alcohol Treatment

BACKGROUND

Little research on solitary drinking has focused on clinical samples. Previous research in college students has found that depression, suicidal ideation, and drinking to cope with negative affect are associated with drinking in solitary, but not social, contexts. These associations have not been examined among individuals with alcohol use disorder, despite their high rates of depression and suicidal behavior.

METHOD

To fill this gap in knowledge, the associations of depression and suicidal ideation with solitary and social drinking were examined among 96 individuals seeking alcohol treatment, the majority of whom had alcohol use disorder (97.9%). Multiple mediation models were conducted to examine the mediating effects of two drinking to cope variables (drinking excessively to cope and coping motives) on the associations of depression and suicidal ideation with drinks per month and heavy episodic drinking in social and solitary contexts.

RESULTS

Significant indirect effects were found for depression and suicidal ideation with solitary drinking variables through greater drinking excessively to cope. No significant indirect effects were found for social drinking variables. However, a positive direct association was found between suicidal ideation and greater social drinks per month that was not mediated by drinking to cope.

CONCLUSIONS

These findings suggest that greater depression or suicidal ideation, through their effect on greater drinking to cope, are associated with greater solitary drinking in a treatment seeking sample. Drinking context should perhaps be considered in alcohol interventions, particularly when treating individuals suffering from depression or suicidal ideation.

Associations between solitary drinking and increased alcohol consumption, alcohol problems, and drinking to cope motives in adolescents and young adults: a systematic review and meta-analysis

BACKGROUND AND AIMS

Emerging evidence suggests that solitary drinking may be an important early risk marker for alcohol use disorder. The current paper is the first meta-analysis and systematic review on adolescent and young adult solitary drinking to examine associations between solitary drinking and increased alcohol consumption, alcohol problems, and drinking to cope motives.

METHODS

PsychINFO, PubMed, and Google Scholar were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and a pre-registered International Prospective Register of Systematic Reviews (PROSPERO) protocol (no. CRD42020143449). Data from self-report questionnaires regarding negative correlates of solitary drinking (e.g. alcohol problems) and solitary drinking motives (e.g. drinking to cope) were pooled across studies using random-effects models. Studies included adolescents (aged 12-18 years) and young adults (mean age between 18 and 30 years or samples with the majority of participants aged 30 years or younger).

RESULTS

Meta-analytical results from 21 unique samples including 28,372 participants showed significant effects for the associations between solitary drinking and the following factors: increased alcohol consumption, r = 0.23, 95% confidence interval (CI) = 0.12, 0.33; drinking problems, r = 0.23, 95% CI = 0.13, 0.32; negative affect, r = 0.21, 95% CI = 0.16, 0.26; social discomfort, r = 0.17, 95% CI = 0.06, 0.27; negative reinforcement, r = 0.28, 95% CI = 0.24, 0.31; and positive reinforcement, r = 0.10, 95% CI = 0.03, 0.17. These associations were not moderated by age group (i.e. adolescent versus young adult), study quality, or differing solitary drinking definitions. Accounting for publication bias increased the effect sizes from r = 0.23 to 0.34 for alcohol consumption and from r = 0.23 to 0.30 for drinking problems, and lowered it from r = 0.10 to 0.06 and r = 0.17 to 0.11 for positive reinforcement and social discomfort, respectively.

CONCLUSIONS

Solitary drinking among adolescents and young adults appears to be associated with psychosocial/alcohol problems and drinking to cope motives.

Putting things in context: Longitudinal relations between drinking contexts, drinking motives, and negative alcohol consequences

Recent studies suggest that solitary (but not social) drinking may confer risk for negative alcohol consequences via beliefs about alcohol's ability to reduce tension, and explicit motivations to drink to cope with negative mood states. However, because prior studies are largely cross-sectional, it is unclear if tension reduction expectancies and drinking to cope are antecedents or consequences of solitary drinking. The current study aimed to address this gap in the literature using prospective data (3 waves across 12 months) from a sample of moderate to heavy drinking young adults. Data were drawn from a larger investigation of contextual influences on subjective alcohol response. Participants (N = 448) reported on alcohol use in multiple drinking contexts and tension reduction expectancies at baseline (T1), drinking motives at a 6-month follow-up (T2), and past-month negative alcohol consequences at a 12-month follow-up (T3). We examined potential indirect effects of drinking contexts on negative consequences operating through alcohol expectancies and drinking motives. Solitary drinking was indirectly associated with later negative consequences through stronger coping motives, although tension reduction expectancies did not serve as a significant mediator. Social drinking was not directly or indirectly related to later alcohol consequences. Results suggest that solitary drinking contexts confer risk for negative consequences through coping motives, and that these effects are invariant across sex, race, and ethnicity. These findings have important clinical implications as they suggest that targeting solitary drinkers for skills-based coping interventions may reduce risk for a developmental trajectory toward negative alcohol consequences. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Coping Strategies and Suicidality: A Cross-Sectional Study From China

Background and Objective: Suicide is a leading cause of death in young people. Suicidal thoughts and behaviors can be triggered by life and study stresses; therefore, it is important to understand the role of coping strategies. The current study analyzed the link between different coping strategies and suicidality in university students in China. Methods: A cross-sectional study of 2,074 undergraduate students from China used a stratified-clustered-random sampling method (response rate 94.4%). The Suicidal Behaviors Questionnaire-Revised Scale was used to identify suicidal risks, while the Brief COPE scale was used to measure different coping strategies. Univariate and multivariate logistic regression analyses were utilized to examine coping strategies and suicidality. Results: A negative association of some coping skills (active coping and positive reframing) with suicidality and a positive association of some other coping skills (self-distraction, substance abuse, behavioral disengagement, venting, and self-blame) with suicidality were observed after adjusting for sociodemographic and mental health variables. Conclusions: Training and supporting young people to identify and apply adaptive coping strategies to deal with life stress could help to reduce suicidal ideation and behavior.

A preliminary examination of the association between drinking as a typical coping strategy and level of acute alcohol consumption prior to a suicide attempt

Drinking to cope is associated with suicide ideation and attempts. Event-based research shows drinking, particularly when alcohol is consumed in large quantities, increases the intensity of suicidal thoughts and immediate risk for attempt. Such findings suggest those who typically drink to cope may be especially likely to drink heavily in the hours preceding a suicide attempt. In the first examination of the association between regular use of alcohol as a coping strategy and acute alcohol consumption prior to a suicide attempt, participants included 130 patients hospitalized for a recent attempt. The number of drinks consumed in the acute period preceding the attempt, as well as past-year heavy drinking frequency, typical drinking motives, and depressive symptoms were assessed. The unique impacts of coping motives on odds of consuming any alcohol, and of using specific amounts of alcohol in the acute period, were determined through binary and multinomial logistic regressions. Results demonstrated that commonly drinking for coping motives increased the odds of heavy drinking - but not of using alcohol at low levels - during the acute period. Results held after adjusting for relevant covariates. Clinicians should assess drinking motives and prioritize prevention of drinking to cope to reduce risk of alcohol-related suicide attempts.

Solitary drinking and the risk of depressive symptoms and suicidal ideation in college students: Findings from a nationwide survey in Korea

BACKGROUND

Despite the fact that solitary drinking is becoming more common in Korea, few studies have investigated the association between drinking alone and mental health. This study aimed to investigate the relationship between solitary drinking, depressive symptoms, and suicidal ideation in Korean college students.

METHOD

Primary data on a nationally representative sample of college students were used. Data were collected by Yonsei University and the Korean Center for Disease Control in 2017 to investigate alcohol-related behaviors and health consequences in students. The association between solitary drinking, depressive symptoms, and suicidal ideation were measured using multivariate logistic regression analysis.

RESULTS

A total of 3,935 students were analyzed, in which 11.5% had depressive symptoms and 2.8% suicidal ideation. Compared to non-solitary drinkers, solitary drinkers were more likely to have depressive symptoms [Odds Ratio (OR) 2.28, 95% Confidence Interval (95% CI) 1.72-3.02] and suicidal ideation (OR 2.24, 95% CI 1.32-3.81). Moreover, larger differences were found in individuals with higher alcohol use disorders identification test (AUDIT) scores and with more frequent underage drinking experience.

LIMITATIONS

As this study was cross-sectional in design, causal inferences cannot be made on the association between solitary drinking, depressive symptoms, and suicidal ideation.

CONCLUSION

Solitary drinking is associated with higher likelihoods of depressive symptoms and suicidal ideation in college students. The results suggest the importance of monitoring solitary drinkers as they may be more vulnerable to the negative mental health effects of alcohol.

Factors linking suicidal ideation with drinking to cope and alcohol problems in emerging adult college drinkers

There is a well-established association between suicidal behavior and alcohol misuse. However, few studies have applied relevant theory and research findings in the areas of both alcohol and suicidal behavior to aid in the understanding of why these may be linked. The current study examined whether three variables (problem-solving skills, avoidant coping, and negative urgency) suggested by theory and previous findings in both areas of study help to account for the previously found association of suicidal ideation with drinking to cope and alcohol problems. Participants were 381 college women (60.4%) and men (39.6%) between the ages of 18 and 25 who were current drinkers and had a history of (at a minimum) passive suicidal ideation. Structural equation modeling was used to examine hypothesized associations among problem-solving skills, avoidant coping, drinking to cope (DTC), impulsivity in response to negative affect (i.e., negative urgency), severity of suicidal ideation, heavy alcohol use, and alcohol problems. Model results revealed that problem-solving skills deficits, avoidant coping, and negative urgency were each directly or indirectly associated with greater severity of suicidal ideation, DTC, heavy alcohol use, and alcohol problems. The results suggest that the positive association between suicidal ideation and DTC found in this and other studies may be accounted for by shared associations of these variables with problem-solving skills deficits, avoidant coping, and negative urgency. Increasing at-risk students' use of problem-solving skills may aid in reducing avoidance and negative urgency, which in turn may aid in reducing suicidal ideation, DTC, and alcohol misuse. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Preferences in Information Processing and suicide: Results from a young adult health survey in the United Kingdom

BACKGROUND

Suicide prevention literature currently suffers from inconsistent measurement and incomplete theoretical development.

AIMS

Using a recommended suicide measurement approach for epidemiological studies (i.e. the Suicidal Behaviors Questionnaire-Revised (SBQ-R)), the present investigation assessed United Kingdom young adult suicide prevalence rates. This study also investigated the utility of a Preferences in Information Processing (PIP) model of suicide in identifying those at increased odds for elevated suicide risk, as well as lifetime ideation and attempt.

METHOD

A cross-sectional mental health and well-being survey study ( n = 414) was conducted.

RESULTS

The prevalence rates of elevated risk (49.8%), lifetime ideation only (55.3%) and lifetime attempt (13.5%) were high. Bivariate associations demonstrated that elevated depression, anxiety and Need for Affect (NFA) Avoidance were associated with worsened suicide outcomes, whereas elevated Need for Cognition (NFC) was associated with decreased suicide risk. Logistic regression results identified depression and NFA Avoidance as the strongest predictors of elevated suicide risk. Multinomial logistic regression results established several PIP-based moderation effects for depression and anxiety in which NFA Approach and NFC differentially influenced odds of suicide attempt group membership.

CONCLUSION

The SBQ-R is an appropriate tool for UK young adult suicide research. NFA and NFC demonstrated potential for inclusion in young adult suicide prevention programming. Further research is needed to fully evaluate the PIP model of suicide and effectiveness of proposed theory-based approaches to suicide prevention.

Depressive symptoms, alcohol use and coping drinking motives: Examining various pathways to suicide attempts among young men

BACKGROUND

Research has identified several correlates of suicidal behaviors including depressive symptoms, alcohol use and coping drinking motives. However, their associations and their role as possible causal mechanisms in the prediction of suicide attempt are not well understood. This study examined, both cross-sectionally and longitudinally, the potential pathways from alcohol use, drinking coping motives, and depression to suicide attempts.

METHODS

Participants (N = 4617) were young Swiss men (mean age = 19.95) participating in the Cohort Study on Substance Use Risk Factors. Measures of depressive symptoms, alcohol use (total drinks per week, heavy episode drinking) and coping drinking motives were used from the baseline and/or 15-month follow-up assessments to predict follow-up suicide attempt.

RESULTS

Main findings showed indirect associations through depressive symptoms, such that coping drinking motives were positively associated with depressive symptoms, which were in turn positively related to suicide attempts over time (for total drinks per week models, cross-sectional model: B = 0.130, SE = 0.035, 95% CI = 0.072, 0.207; longitudinal model: B = 0.039, SE = 0.013, 95% CI = 0.019, 0.069). Alcohol use was not significantly related to suicide attempt.

LIMITATIONS

Main limitation includes a low prevalence rate for suicide attempt potentially reducing power effects in the analyses and our focus on distal-yet not proximal, role of alcohol use on suicide attempt.

CONCLUSIONS

Findings of this study suggest that young men with depressive symptoms and/or those who use alcohol to cope with negative affect may benefit from programs targeting suicidal behaviors.

Social discomfort moderates the relationship between drinking in response to negative affect and solitary drinking in underage drinkers

OBJECTIVE

Research shows that solitary drinking is associated with negative reinforcement motives (i.e., relieving negative affect). An untested hypothesis proposes that this association may be especially strong for individuals who experience social discomfort. This study aimed to 1) replicate findings linking solitary drinking to social discomfort (i.e., loneliness, social anxiety, and lack of perceived social support), alcohol problems, and drinking in response to negative affect (i.e., drinking to cope motives and inability to resist alcohol during negative affect), and 2) investigate whether greater social discomfort moderates the relationship between drinking in response to negative affect and solitary drinking in underage drinkers.

METHOD

Current alcohol drinkers ages 18 to 20 (N=664) recruited from a TurkPrime panel reported the percentage of time they drank solitarily and completed measures assessing social discomfort, drinking in response to negative affect, and alcohol involvement. Structural equation modeling was used to test the moderation model.

RESULTS

Results replicated prior literature supporting the first aim. For the second aim, analyses indicated a positive association between solitary drinking and drinking in response to negative affect across all individuals, but contrary to prediction, this relationship was stronger for individuals with lower, rather than higher, social discomfort.

CONCLUSION

Underage drinkers with lower, rather than higher, social discomfort appear to be at greater risk for drinking alone. These findings may inform our understanding of individuals at greatest risk for drinking alone and promote new avenues for intervention.

Suicidal ideation and behavior in institutions of higher learning: A latent class analysis

Suicide is the second leading cause of death among undergraduate students, with an annual rate of 7.5 per 100,000. Suicidal behavior (SB) is complex and heterogeneous, which might be explained by there being multiple etiologies of SB. Data-driven identification of distinct at-risk subgroups among undergraduates would bolster this argument. We conducted a latent class analysis (LCA) on survey data from a large convenience sample of undergraduates to identify subgroups, and validated the resulting latent class model on a sample of graduate students. Data were collected through the Interactive Screening Program deployed by the American Foundation for Suicide Prevention. LCA identified 6 subgroups from the undergraduate sample (N = 5654). In the group with the most students reporting current suicidal thoughts (N = 623, 66% suicidal), 22.5% reported a prior suicide attempt, and 97.6% endorsed moderately severe or worse depressive symptoms. Notably, LCA identified a second at-risk group (N = 662, 27% suicidal), in which only 1.5% of respondents noted moderately severe or worse depressive symptoms. When graduate students (N = 1138) were classified using the model, a similar frequency distribution of groups was found. Finding multiple replicable groups at-risk for suicidal behavior, each with a distinct prevalence of risk factors, including a group of students who would not be classified as high risk with depression-based screening, is consistent with previous studies that identified multiple potential etiologies of SB.

The alexithymia, emotion regulation, emotion regulation difficulties, positive and negative affects, and suicidal risk in alcohol-dependent outpatients

The aim of this study was to evaluate the potential contributing factors such as alexithymia, emotion regulation and difficulties in emotion regulation, positive/negative affects and clinical factors including severity of alcohol dependence and depression connected to high suicidality in alcohol-dependent outpatients. 205 alcohol-dependent outpatients and 100 normal controls completed the demographic questionnaire, the Persian version of the Toronto Alexithymia Scale (FTAS-20), the Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ), the Positive/Negative Affect Scales, the Alcohol Use Disorders Identification Test (AUDIT), and the Beck Depression Inventory-II (BDI-II). The suicidal risk was assessed using the Scale for Suicide Ideation (SSI) and history taking. Alcohol-dependent outpatients showed higher means in alexithymia, difficulties in emotion regulation, suppression subscale, negative affect, and suicide ideation than normal controls. Logistic regression analysis revealed that negative affect, duration of alcohol use, externally-oriented thinking, and severity of alcohol dependence explained lifetime suicide attempts. Depression, impulsivity, severity of alcohol dependence, reappraisal (reversely), externally-oriented thinking, difficulties engaging in goal-directed behaviors, and negative affect significantly predicted the suicidal risk. The findings may constitute useful evidence of the relevancies of alexithymia, emotion regulation, emotion regulation difficulties, and affects to suicidality in alcoholic patients.

Factors associated with suicidal ideation among university students

Objective

to analyze the factors associated with suicidal ideation in a representative sample of university students.

Methods

cross-sectional study, carried out with 637 students of the Federal University of Mato Grosso. The presence of suicidal ideation, demographic and socioeconomic variables, use of alcohol through the Alcohol, Smoking and Substance Involvement Screening Test, and depressive symptoms (Major Depression Inventory) were investigated. Bivariate analysis was performed with the Chi-square test and multivariate analysis using the Poisson regression model.

Results

it was found that 9.9% of the students had suicidal thoughts in the previous 30 days and, in the bivariate analysis, the variables economic class, sexual orientation, religious practice, suicide attempts in the family and among friends, alcohol consumption and depressive symptoms were associated with suicidal ideation. In the multivariate analysis sexual orientation, suicide attempts in the family and the presence of depressive symptoms remained as associated factors.

Conclusion

these findings constitute a situational diagnosis that enables the formulation of academic policies and preventive actions to confront this situation on the university campus.

Management of alcohol misuse in patients with liver diseases

Excessive alcohol use not only causes alcoholic liver disease (ALD) but also increases the risk of liver-related mortality in patients who already have other chronic liver diseases. Screening for alcohol misuse or alcohol use disorder (AUD) among patients with underlying liver disease is essential. This clinical review covers what is known about ALD, the impact of alcohol in patients with underlying liver diseases, current management of alcohol misuse and AUD, and the management of alcohol misuse and AUD specifically in patients with liver diseases. Several treatment options for alcohol misuse and AUD exist such as psychosocial intervention and behavioral and pharmacological therapies. The strategies used in the treatment of alcohol misuse and AUD are still applicable in those who consume alcohol and have underlying liver disease. However, certain medications still need to be carefully used due to potentially worsening already compromised liver function. Screening of ongoing alcohol use in subjects with liver disease is important, and prompt intervention is needed to prevent the associated morbidity and mortality from the detrimental effects of continued alcohol use on underlying liver disease. Considering alcoholism is a complex disease, probably a multidisciplinary approach combining psychotherapy and comprehensive medical care will be the most effective. Future research could focus on identifying additional treatment options for addressing the psychotherapy component since the self-determination and will to quit drinking alcohol can play such a crucial role in promoting abstinence.

Factors Associated with Recurrent Suicidal Ideation among Racially and Ethnically Diverse College Students with a History of Suicide Attempt: The Role of Mindfulness

Although one-third of enrolled U.S. undergraduate college students are non-White, little is known about risk factors for suicidal behavior among racial and ethnic minority students. Thus, we set out to determine psychosocial factors associated with recurrent suicidal ideation among racially and ethnically diverse college students with a history of suicide attempt. From 2012-2013, 1,734 racially and ethnically diverse college students completed an on-line survey of suicidal behavior and associated factors. Depression, hopelessness, rejection sensitivity, and mindfulness, as well as past-year discrimination, ethnic identification, and acculturative stress were measured using well-validated self-report instruments. The Beck Scale for Suicide Ideation was used to assess current suicidal ideation. A subsample of 118 college students who self-reported a past suicide attempt were selected for the current analysis. Logistic regression analysis was used to test associations between risk factors and the presence of suicidal ideation, and linear regression analysis was used to test factors associated with suicidal ideation severity among those who reported current suicidal ideation. Depression was significantly related to both the presence and severity of current suicidal ideation. Mindfulness, and in particular awareness of present moment experience, was also inversely associated with ideation severity. We found depression and mindlessness were associated with suicidal ideation severity among a sample of diverse college students at high risk for suicidal behavior due to a past suicide attempt. Factors unique to the minority experience, such as acculturative stress, were not associated with current suicidal ideation. Implications for suicide prevention are discussed.

The Association of Alcohol Use Disorders with Suicidal Ideation and Suicide Attempts in a Population-Based Sample with Mood Symptoms

Using population-based data, we examined associations between alcohol use disorders (AUD) and suicidality, assessing effect modification by mood disorders, and mediation by drinking level. Suicidality was assessed among current drinkers with 2-weeks of low mood (n = 9,173) in the National Epidemiologic Survey on Alcohol and Related Conditions. Independent of mood disorder, alcohol dependence, was associated with suicidal ideation (adjusted odds ratio [AOR] = 1.64; 95% confidence interval [CI] = 1.25-2.14), and suicide attempts (AOR = 2.02; CI = 1.43-2.85) relative to those without AUD. Findings indicate partial mediation by consumption. Associations between AUD and suicidality among those with low mood are not explained by comorbid mood disorder, but are partially mediated by drinking level. Future studies should evaluate transitions in suicidality with change in consumption.

Male solitary drinking and hazardous alcohol use in nine countries of the former Soviet Union

BACKGROUND

Despite evidence that many people engage in solitary drinking and that it might be associated with negative consequences, to date, little research has focused on this form of drinking behaviour. This study examined the prevalence and factors associated with solitary drinking, and assessed whether it is linked with hazardous alcohol use among males in nine countries of the former Soviet Union (fSU).

METHODS

Data came from a cross-sectional population-based survey undertaken in 2010/11 in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine. Information was obtained on the frequency of solitary drinking among male regular drinkers (i.e., those consuming alcoholic drinks at least once a month), and on problem drinking (CAGE) and heavy episodic drinking (HED). Logistic regression analysis was used to examine associations between the variables.

RESULTS

The prevalence of occasional and frequent solitary drinking ranged from 8.4% (Georgia) to 42.4% (Azerbaijan), and 3.1% (Kazakhstan) to 8.2% (Armenia), respectively. Solitary drinking was associated with being older, divorced/widowed, living alone, having a bad/very bad household financial situation, lower levels of social support, and poor self-rated health. Occasional solitary drinking was linked to problem drinking and HED, while frequent solitary alcohol use was related to problem drinking.

CONCLUSIONS

Solitary drinking is relatively common among male regular drinkers in the fSU and is linked to older age, social and economic disadvantage, and hazardous alcohol use.

Personality, negative affect coping, and drinking alone: a structural equation modeling approach to examine correlates of adolescent solitary drinking

AIMS

This study examined the personality traits of negative emotionality and constraint and the ability to resist drinking during negative affective states as correlates of solitary drinking in adolescence. We hypothesized that higher levels of negative emotionality and lower levels of constraint would predict solitary drinking and that these relationships would be mediated by the ability to resist drinking in response to negative emotions.

DESIGN

Structural equation modeling was used to fit a path model from the personality traits of negative emotionality and constraint to solitary drinking status through intermediate effects on the ability to resist drinking during negative emotions using cross-sectional data.

SETTING

Clinical and community settings in Pennsylvania, USA.

PARTICIPANTS

The sample included 761 adolescent drinkers (mean age = 17.1).

MEASUREMENTS

Adolescents completed the Lifetime Drinking History, the Multidimensional Personality Questionnaire, the Constructive Thinking Inventory and the Situational Confidence Questionnaire.

FINDINGS

The path model provided a good fit to the data. The association between trait negative emotionality and solitary drinking was fully mediated by adolescents' ability to resist drinking during negative affective states (b = 0.05, P = 0.01). In contrast, constraint had a direct effect on solitary drinking (odds ratio (OR) = 0.79, b = -0.23, P<0.01), as well as an indirect effect through the ability to resist drinking during negative affective states (b = -0.03, P = 0.02).

CONCLUSIONS

The ability to resist drinking while experiencing negative feelings or emotions may be an important underlying mechanism linking trait negative emotionality (a tendency toward depression, anxiety and poor reaction to stress) and constraint (lack of impulsiveness) to adolescent solitary drinking.

Suicidal ideation and sex differences in relation to 18 major psychiatric disorders in college and university students: anonymous web-based assessment

College/university students are at high risk for psychiatric disorder and suicide secondary to age, campus stressors, and social pressures. We therefore report frequencies of 18 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision disorders and suicidal ideation (SI) acquired anonymously from a Web site receiving 113,181 visits from more than 1,500 predominantly US colleges/universities. Depression was foremost, followed by social phobia and eating disorders. Substance-related disorders were less frequent than expected. SI occurred in 47.1% of students, with women evidencing somewhat stronger findings than men. SI was more associated with substance, bipolar, and panic disorders than depression. Self-reported emotional volatility exceeded thoughts of self-harm for all disorders. The results support two subtypes of suicide risk: dysphoric premeditators and those primarily angry and/or impulsive. Clinicians and researchers should therefore consider suicide as an independent psychopathological phenomenon that includes emotional volatility as a risk factor and thoroughly evaluate psychiatric disorders potentially conferring greater suicidal propensity than depression.

Context counts: solitary drinking explains the association between depressive symptoms and alcohol-related problems in undergraduates

INTRODUCTION

According to theory, depressed individuals self-medicate their negative affect with alcohol. Due to isolation and interpersonal difficulties, undergraduates with elevated depressive symptoms may do much of their drinking alone and/or in intimate contexts (e.g., with family or romantic partners) rather than at normative social events (e.g., parties). Evidence suggests drinking in these contexts leads to heavy use and alcohol-related problems. Accordingly, context may be an explanatory mechanism linking depressive symptoms to problematic drinking. This pathway remains understudied in the literature. Our study aimed to examine solitary and intimate drinking as distinct mediators of the depression-problematic drinking association. We hypothesized that depressive symptoms would be positively associated with solitary and intimate drinking which in turn would be associated with elevated alcohol use and related problems.

METHODS

Undergraduates (N=295; 72% women) completed online self-reports.

RESULTS

Consistent with hypotheses, path analyses supported depressive symptoms as a positive predictor of solitary drinking, which in turn was a positive predictor of alcohol-related problems, but not of alcohol use. Counter to hypotheses, depressive symptoms were unrelated to intimate drinking. Interestingly, depressive symptoms were negatively associated with drinking at parties, which in turn led to reduced risk for elevated alcohol use and related problems.

CONCLUSIONS

Our results shed new light on the depression pathway to problematic drinking in undergraduates by considering the role of drinking context. Our findings suggest undergraduates with elevated depressive symptoms are at risk for potentially problematic drinking because they are drinking alone. Solitary drinking represents a malleable target for clinical interventions aimed at reducing risky depression-related alcohol use.

Ethnic identity, drinking motives, and alcohol consequences among Alaska Native and non-Native college students

This research involves the examination of drinking motives, alcohol consequences, and ethnic identity in a sample of Native and non-Native college student drinkers in Alaska. Although more Alaska Native students are abstinent from alcohol compared to any other ethnic group, Native students who do drink experience greater alcohol consequences and dependence symptoms. Therefore, we attempted to examine the influence of ethnic identity on alcohol consequences in a diverse sample of Native and non-Native students in Alaska. Findings showed that drinking motives, as measured by the Drinking Motives Questionnaire (social, coping, enhancement, and conformity), significantly predicted alcohol consequences after controlling for frequency of monthly binge drinking. In addition, after controlling for depression, binge drinking, and drinking motives, one aspect of ethnic identity (Affirmation, Belonging, and Commitment) was significantly negatively related to alcohol consequences, whereas another aspect of ethnic identity (Ethnic Identity Search) was not. Taken together, these findings suggest that interventions for college student alcohol misuse that target Native students should be culturally grounded and focused on enhancing the Affirmation, Belonging, and Commitment to one's ethnic heritage and should address drinking motives, especially drinking to cope, as a way to reduce alcohol related harm.

Reduced connexin 43 immunolabeling in the orbitofrontal cortex in alcohol dependence and depression

Reduced density of glial cells and low levels of some astrocyte proteins have been described in the orbitofrontal cortex (OFC) in depression and alcoholism, two disorders often comorbid. These regressive changes may also involve the communication between astrocytes via gap junctions and hemichannels, which play important regulatory roles in neurotransmission. We determined levels and morphological immunostaining parameters of connexin 43 (Cx43), the main protein subunit of astrocyte gap junctions/hemichannels, in the OFC of subjects with depression, alcoholism or comorbid depression/alcoholism as compared to non-psychiatric subjects. Postmortem brain samples from 23 subjects with major depressive disorder (MDD), 16 with alcohol dependence, 13 with comorbid MDD and alcohol dependence, and 20 psychiatrically-normal comparison subjects were processed for western blots to determine Cx43 levels. Area fraction of Cx43 immunoreactivity, and density and average size of immunoreactive puncta were measured in histological sections. There was a significant, larger than 60 percent decrease in Cx43 level in the three psychiatric groups as compared to controls. Area fraction of immunoreactivity and immunoreactive punctum size were reduced in all psychiatric groups, but Cx43-immunoreactive puncta density was reduced only in alcohol-dependent subjects. Among psychiatric subjects, no difference in Cx43 levels or immunostaining was found between suicides and non-suicides. The present data suggest that dysfunction of the OFC is accompanied by reduction in the levels of gap junction protein Cx43 in depression and alcoholism, and reduction in density of Cx43 immunoreactive puncta only in alcoholism, pointing to altered gap junction or hemichannel-based communication in the pathophysiology of those disorders.

Alcohol use, drinking consequences, and sensitivity to social cues among college women

College students who drink vary in the extent to which they experience drinking consequences, prompting a need to identify factors that differentiate higher-risk drinkers from others. The present study investigated whether difficulty in processing subtle social information is related to negative drinking consequences experienced within the past year. Specifically, poor ability to detect subtle non-verbal sarcasm cues was predicted to contribute to drinking consequences. Participants were 39 women, aged 18 to 27 (M=22), who were enrolled in a public, four-year university. Participants completed a video measure of ability to detect sarcastic comments. After controlling for (high school drinking consequences, maximum drinks in the past 3 months, age), poorer performance in the Simple Sarcasm condition (which provided no cues to others' intentions) explained an additional 10.8% of the variance in recent drinking consequences (ΔF (1, 34)=6.15, p=.018). When predicting risky/hazardous alcohol use consequences (e.g., driving intoxicated, fights, unplanned/unprotected sex), Simple Sarcasm again improved prediction by explaining an additional 8.6% of the variance (ΔF (1, 34)=4.75, p=.036). Sarcasm conditions that provided additional cues to others' meanings were unrelated to alcohol consequences. Findings are discussed within the context of neurological (orbito-frontal-subcortical) pathways that are common to social information and alcohol reinforcement processes.

Exploring college students' use of general and alcohol-related social media and their associations with alcohol-related behaviors

OBJECTIVE

Alcohol marketers have increasingly moved their advertising efforts into digital and social media venues. As a result, the purpose of this study is to investigate associations between students' use of social media, their exposure to alcohol marketing messages through social media, and their alcohol-related beliefs and behaviors.

PARTICIPANTS

Public and private university students (N = 637) participated November and December 2011 and April 2012.

METHODS

College students completed online surveys to measure their exposure to social and online media generally, as well as their alcohol-related digital media use and alcohol use.

RESULTS

Use of social media related to alcohol marketing predicted alcohol consumption and engaging in risky behaviors, whereas the use of social media more generally did not.

CONCLUSIONS

Students' use of alcohol-related social media-marketing content associates with their problem drinking. Results have implications for alcohol abuse reduction efforts targeted at college students and suggest the importance of considering social, cultural, and cognitive factors in campaign planning and design.

Solitary Alcohol Use in Teens Is Associated With Drinking in Response to Negative Affect and Predicts Alcohol Problems in Young Adulthood

Adolescent solitary drinking may represent an informative divergence from normative behavior, with important implications for understanding risk for alcohol-use disorders later in life. Within a self-medication framework, we hypothesized that solitary alcohol use would be associated with drinking in response to negative affect and that such a pattern of drinking would predict alcohol problems in young adulthood. We tested these predictions in a longitudinal study in which we examined whether solitary drinking in adolescence (ages 12-18) predicted alcohol-use disorders in young adulthood (age 25) in 466 alcohol-using teens recruited from clinical programs and 243 alcohol-using teens recruited from the community. Findings showed that solitary drinking was associated with drinking in response to negative affect during adolescence and predicted alcohol problems in young adulthood. Results indicate that drinking alone is an important type of alcohol-use behavior that increases risk for the escalation of alcohol use and the development of alcohol problems.

Alcohol use, depressive symptoms, and impulsivity as risk factors for suicide proneness among college students

BACKGROUND

Alcohol use, depression, and suicide are significant public health problems, particularly among college students. Impulsivity is associated with all of these factors. Additionally, impulsivity increases the effects of negative mood and alcohol use on maladaptive behavior.

METHODS

The current cross-sectional study examined the association between the four-factor model of impulsivity (urgency, (lack of) perseverance, (lack of) premeditation, and sensation seeking), depressive symptoms, and alcohol use as predictors of suicide proneness among college students. Participants (n=1100) completed online assessments of demographics, impulsivity, depressive symptoms, and suicide proneness.

RESULTS

All predictors were positively related to suicide proneness. The relation between depressive symptoms and suicide proneness was moderated by (lack of) perseverance, alcohol use, and joint interactions of urgency×alcohol use and sensation seeking×alcohol use. Despite some paradoxical findings regarding the depressive symptoms-suicide proneness relation when only one risk factor was elevated, the average level of suicide proneness increased as risk factors increased.

LIMITATIONS

This cross-sectional self-report data comes from a non-clinical sample of college students from a homogeneous background, limiting generalizability and causal predictions.

CONCLUSIONS

Overall, these findings indicate that the association between depressive symptoms and suicide proneness varies considerably by different facets of impulsivity and alcohol use. The results suggest that clinical risk-assessments should weigh two forms of impulsivity (urgency and sensation seeking) as particularly vital in the presence of heavy alcohol use. These findings highlight the importance of considering and exploring moderators of the mood-suicide relationship.