Life events, drinking patterns and depressive symptomatology; the stress-buffering role of alcohol consumption

Gender difference in the association between alcohol consumption and depressive symptoms among the elderly in rural areas

To determine gender difference in the nature of the association between alcohol consumption and depressive symptoms in the elderly aged 60 and above in a rural community sample. A cross-sectional face-to-face survey conducted for community residents 60 years of age and older (n = 1,819). Alcohol consumption problems were measured by self-report of the Korean version of Alcohol Use Disorders Identification Test (AUDIT-K) scale. Depressive symptom was measured using the Korean Beck Depression Inventory (K-BDI) scale. Potential explanatory variables included MCS, PCS, and health-related behavior, socio-economics status, and democratic variables. Two gender-specific multivariate regression models were applied for the analysis. A U-shaped relationship between alcohol consumption and depressive symptoms was found, and the relationship did not differ by gender. Non-problem drinkers and hazardous and harmful drinkers were related to an increased risk of depressive symptoms for both men and women. Several correlates for the association were found. No gender difference was found in a U-shaped curvilinear relationship between alcohol consumption and depression found among the elderly aged 60 and above in rural communities in South Korea. The findings of this study suggest the need for further investigation of subgroup differences in the association by using samples of various age groups in rural and urban areas, and samples drawn from different cultural contexts than the studies conducted in Western countries.

Disentangling psychopathology, substance use and dependence: a factor analysis

BACKGROUND

The notion that substance use can induce symptoms of depression and anxiety is influential in clinical practice, however questions remain about the empirical support for this hypothesis.

METHODS

We analysed mental health and substance dependence screening records for 280 outpatients in addictions treatment. Item-level data for depression (PHQ-9), anxiety (GAD-7), severity of dependence (SDS) and self-reported weekly substance use were studied using factor analysis and correlations. Symptom-level associations between substance use and psychological distress symptoms were examined after controlling for underlying levels of psychopathology.

RESULTS

We obtained a two-factor solution accounting for approximately 48 % of total variance. Depression and anxiety symptoms loaded onto a single psychopathology factor. Severity of dependence (SDS) and substance use measures loaded onto a distinct but correlated factor. After controlling for latent levels of psychopathology, the only remaining symptom-level associations were impaired concentration linked to cannabis use and irritability linked to alcohol use. Dependence (SDS) was prominently associated with depressive rumination, and negatively correlated with residual anxiety symptoms related to substance use (e.g., craving).

CONCLUSIONS

Overall, this analysis supports a psychological understanding of comorbidity; with dependence, craving, negative reinforcement and rumination as key variables.

College student affect and heavy drinking: Variable associations across days, semesters, and people

This study tested associations between positive and negative affect and heavy drinking in 734 college students who completed daily diaries in 14-day bursts once per semester over 7 semesters (≤98 days per person). Three-level multilevel models tested whether affect and heavy drinking were linked across days, semesters, and persons. Higher daily, between-semester, and between-person positive affect were each associated with greater odds of heavy drinking on weekdays and on weekend days. A significant interaction with semester in college showed that the association between daily positive affect and heavy drinking on weekend days became stronger over time. That is, heavy drinking on a weekend day with higher positive affect was more likely in later years of college (OR = 2.93, Fall of 4th year), compared to earlier in college (OR = 1.80, Fall of 1st year). A similar interaction was found for between-semester positive affect and heavy drinking on weekdays. Higher daily negative affect was associated with a greater odds of heavy drinking on weekdays only for students who first began drinking in 7th grade or earlier (OR = 2.36). Results of this study highlight the importance of varied time spans in studying the etiology, consequences, and prevention of heavy drinking. Harm-reduction strategies that target positive affect-related drinking by encouraging protective behaviors during celebratory events may become increasingly important as students transition to later years of college. (PsycINFO Database Record

Does alcohol consumption exacerbate the mental health consequences of interpersonal violence?

Although studies show that interpersonal violence is associated with poorer mental health, few studies specify the conditions under which victimization can be more or less detrimental to psychological well-being. Building on previous research, the authors test whether the association between interpersonal violence and psychological distress is moderated by alcohol consumption. Our analysis of longitudinal data from the Welfare, Children, and Families project suggests that interpersonal violence is more strongly associated with psychological distress in the context of more frequent intoxication. Programs designed to treat the combination of victimization and heavy alcohol consumption may make unique contributions to the well-being of women.

A literature overview of the relationship between life-events and alcohol use in the general population

AIMS

A critical review of the evidence of effects of stressful life-events on alcohol use in the general population, with a particular focus on study design.

METHODS

A literature search in Medline was conducted, covering the period from 1990 to 2005, to identify articles in which the relationship between life-events and alcohol use in the general population (i.e. non-problem drinking population) was investigated. Samples with a limited age range (e.g. college students) were excluded. Twelve studies with a cross-sectional design, and four articles with a longitudinal design were included in this review.

RESULTS

Four cross-sectional studies found evidence that experiencing life-events is related to higher alcohol use, three other studies, however, found no such association. The relationship between specific life-events and alcohol use in the five remaining cross-sectional studies is less clear-cut. Being a victim of crime was associated with higher alcohol use, but divorce and financial problems were related to both higher and lower alcohol use. Health-related life-events were found to be associated with lower alcohol use. In studies with a longitudinal design, it was found that health-related life-events and financial problems caused a decrease in alcohol use, and life-events related to spouse, friends and relatives, and retiring led to an increase in alcohol use.

CONCLUSIONS

Evidence points towards a relationship between the occurrence of life-events and alcohol use in the general population. The direction of the effect is, however, not unequivocal. When life-events are operationalized or categorized separately they are not only related to an increased alcohol use but also to a decreased alcohol use. Specification of the model to be tested, including buffering factors such as gender, social support, coping resources, as well as baseline consumption, is important for a correct estimation of the effect of negative life-events.

Effectiveness of complementary and self-help treatments for depression

OBJECTIVES

To review the evidence for the effectiveness of complementary and self-help treatments for depression.

DATA SOURCES

Systematic literature search using PubMed, PsycLit, the Cochrane Library and previous review papers.

DATA SYNTHESIS

Thirty-seven treatments were identified and grouped under the categories of medicines, physical treatments, lifestyle, and dietary changes. We give a description of each treatment, the rationale behind the treatment, a review of studies on effectiveness, and the level of evidence for the effectiveness studies.

RESULTS

The treatments with the best evidence of effectiveness are St John's wort, exercise, bibliotherapy involving cognitive behaviour therapy and light therapy (for winter depression). There is some limited evidence to support the effectiveness of acupuncture, light therapy (for non-seasonal depression), massage therapy, negative air ionisation (for winter depression), relaxation therapy, S-adenosylmethionine, folate and yoga breathing exercises.

CONCLUSION

Although none of the treatments reviewed is as well supported by evidence as standard treatments such as antidepressants and cognitive behaviour therapy, many warrant further research.

Effects of depression and social integration on the relationship between alcohol consumption and all-cause mortality

AIMS

This study was designed to assess the potentially confounding influences of social integration and depression on the form of the relationship between alcohol consumption and all-cause mortality. DESIGN, PARTICIPANTS AND MEASUREMENT: Respondents from the 1984 US National Alcohol Survey (N = 5177) were followed by searching the National Death Index (NDI) through 1995; 540 were identified as deceased. Predictor variables in a Cox proportional hazards model included gender, ethnicity, marital status, income, smoking, age and alcohol consumption (volume and patterns). Two social variables and their interactions with alcohol consumption were added, the Center for Epidemiological Studies Depression (CES-D) scale and an eight-item social isolation scale.

FINDINGS

The J-shaped risk curve for all-cause mortality by volume was approximated for men but not significantly for women. In addition heavy drinking occasions independently contributed to mortality in men. Low social integration (bottom 12%) had no significant effects on mortality or on the relationship between alcohol consumption and mortality curve. Inclusion of the interaction between alcohol consumption and depression proved significant for heavy male drinkers (> six drinks on average per day) and for female former drinkers with heavy drinking occasions. In both cases, the respective subgroup, which additionally was depressed, had about four times the risk of a life-time abstainer.

CONCLUSIONS

The relationship of alcohol consumption to 11-year all-cause mortality in a general population indicated little confounding effect of social isolation, but revealed important interactions with depression for heavy male drinkers and heavy female ex-drinkers.

Eating as both coping and stressor in overweight control

AIM

The aim of this study was to test a conceptual model proposing that stress evokes eating as coping, that eating then becomes a stressor in itself, and that a coping repertoire specific for overeating is required to moderate its yield of negative mood states.

BACKGROUND

It is known that stressors may evoke eating as a coping response, and that some persons respond to lapses in their dietary regimen with depression and self-criticism. These two findings are linked within the context of a stress and coping paradigm that has in the past been applied to the study of substance abuse.

METHOD

A survey of 79 women who reported overeating was implemented, including the administration of five instruments and a telephone interview.

FINDINGS

Over 43% of the variance in the dependent variable, negative mood states, was explained by hierarchical regression of the independent variables, entered sequentially as exemplars of: social stressors, coping, degree of required calorie consumption, use of overweight control strategies and the interaction between the degree of required weekly calorie consumption and use of overweight control strategies. Significant contributions were made by variables denoting stressors, coping, and the interaction between degree of required calorie consumption and use of overweight control strategies. Of particular interest was the suggestion that for individuals who frequently use strategies to control overeating and overweight, eating may produce negative mood states. Individuals intensively involved in efforts to control their weight may be vulnerable for dysphoria, may require unique nursing interventions, and thus deserve continued study in this context.

Alcohol and suicidal behavior

Alcohol dependence and alcohol intoxication are important risk factors for suicidal behavior. However, the mechanism for the relationship remains unclear. This review presents a conceptual framework relating alcohol to suicidal behavior. Distal risk factors create a statistical potential for suicide. Alcohol dependence, as well as associated comorbid psychopathology and negative life events, act as distal risk factors for suicidal behavior. Proximal risk factors determine the timing of suicidal behavior by translating the statistical potential of distal risk factors into action. The acute effects of alcohol intoxication act as important proximal risk factors for suicidal behavior among the alcoholic and nonalcoholic alike. Mechanisms responsible for alcohol's ability to increase the proximal risk for suicidal behavior include alcohol's ability to: (1) increase psychological distress, (2) increase aggressiveness, (3) propel suicidal ideation into action through suicide-specific alcohol expectancies, and (4) constrict cognition which impairs the generation and implementation of alternative coping strategies. Moreover, the proximal risk factors associated with acute intoxication are consistent with Baumeister's (1990) escape theory of suicide. Suggestions for additional research are discussed, including the possibility that a nonlinear cusp catastrophe model characterizes the relationship between alcohol intoxication and suicidal behavior.

Exploring psychological benefits associated with moderate alcohol use: a necessary corrective to assessments of drinking outcomes?

The aim of this paper is to identify positive psychological concomitants of moderate alcohol consumption. Current research and public-health perspectives on alcohol emphasize harms disproportionately relative to benefits. The major exception is research establishing beneficial effects of moderate drinking on cardiovascular health and overall mortality. In addition, much observational and experiential data suggest the widespread prevalence of positive drinking experiences. This paper is one of the first attempts since 1985 to codify such benefits in epidemiological terms. Methodological difficulties in accomplishing this include defining moderate drinking, controlling for confounding variables, and establishing causality. Nonetheless, evidence of psychological benefits has been found in experimental, observational, interview, self-report, correlational, and some prospective research. These positive findings are in the areas of subjective health, mood enhancement, stress reduction, sociability, social integration, mental health, long-term cognitive functioning, and work income/disability. Problem drinkers and alcoholics also seek mood and other benefits from alcohol, but are more likely to drink to counteract negative feelings and to support their egos than are social drinkers. It is as yet impossible to determine to what extent moderate alcohol consumption causes positive psychological outcomes and to what extent it is part of a complex pattern of mutually reinforcing variables.

The relationship between alcohol, stress, and depression in Mexican Americans and non-Hispanic whites

The effect of alcohol use on the relationship between stress and depression in US-born Mexican American men, Mexican Americans born in Mexico, and non-Hispanic Whites born in the United States was examined in a sample obtained from the Los Angeles Epidemiological Catchment Area study. Chronic stress, measured by financial strain, and acute stress, measured by negative life events, were included in the analysis. Alcohol use was measured through a combination of frequency, quantity, and binging behavior. Non-Hispanic Whites were found to have a U-shaped relationship in which moderate drinkers, in the presence of stress, had lower levels of depression than did heavy drinkers and abstainers. No such U-shaped relationship for Mexican Americans born in the United States was indicated. Mexican Americans born in Mexico had a more J-shaped relationship, with abstainers through moderate drinkers having lower mean depression scores than did heavy drinkers.

Relationships between depressive symptoms, anxiety, alcohol consumption, and blood pressure: results from the CARDIA Study. Coronary Artery Risk Development in Young Adults Study

OBJECTIVES

We examined cross-sectional relationships among depressive symptoms, anxiety, alcohol intake, and blood pressure. Test hypotheses were that: (1) alcohol intake, depressive symptoms, and anxiety would be positively related to blood pressure; (2) depressive symptoms and anxiety would have a stronger association with alcohol intake in Blacks than in Whites; and (3) adjustment for differences in depressive symptoms, anxiety, and alcohol intake would reduce Black-White blood pressure differences.

METHODS

Study hypotheses were tested in a sample of 4,352 Black and White adults, participating in the CARDIA study. Hypotheses were tested using multiple linear regression.

RESULTS

Alcohol intake was positively related to systolic (p = 0.0001) and diastolic (p = 0.0004) blood pressure in men, but not in women. Depressive symptoms and anxiety were unrelated to blood pressure. The relationship between alcohol intake and depressive symptoms differed by race/ethnicity in men (p = 0.0719) and in women (p = 0.0002). Alcohol intake increased with increasing levels of depressive symptoms, but the increase was greater in Blacks than in Whites. After accounting for alcohol intake, body mass index, and other variables, Black-White blood pressure differences were reduced in men, but not in women; most of the reduction was caused by body mass index.

CONCLUSIONS

Blacks may respond differently than Whites to psychological distress.

Race, religious involvement and depressive symptomatology in a southeastern U.S. community

A growing literature suggests that aspects of religious involvement may hold beneficial implications for mental health, and some also suggest that religion is an especially valuable mental health resource for racial minorities in the United States. These issues are explored empirically using data from a large (N = 2956) community sample drawn in the southeastern U.S. Findings include the following: (1) frequency of church attendance is inversely associated with depressive symptoms among whites, but not among blacks. (2) Absence of denominational affiliation is positively associated with depressive symptoms among blacks, but not among whites. (3) Frequency of private devotional activities (e.g. prayer) is positively associated with depressive symptoms among both racial groups. These results are discussed in terms of the distinctive history of the Black Church in the southern U.S. Several promising directions for further inquiry are outlined.

The effect of moderate alcohol use on the relationship between stress and depression

OBJECTIVES

The purpose of the study was to determine whether moderate alcohol use mediates or buffers the effect of stress on depression in a group of non-Hispanic White men and women.

METHODS

Data are from the Los Angeles Epidemiological Catchment Area cohort. Individuals were assessed at two time periods, 1 year apart. Mean depression scores were analyzed for each level of stress and alcohol use.

RESULTS

In the simultaneous presence of both chronic strain and negative life events, a U-shaped pattern was observed in which abstainers and light and heavy drinkers had higher depression scores at the second time period than did light-moderate and moderate alcohol users. The U-shaped relationship remained when the effects of sex, age, and physical health status were controlled.

CONCLUSIONS

Light-moderate and moderate drinkers had less depression in the presence of stress than persons in other more extreme drinking categories. Moderate alcohol use may serve as a proxy for a spectrum of generally moderate behaviors that either attenuate the effect of stress on depression or suppress the effects of stress.

Anxiety and drinking behavior: moderating effects of tension-reduction alcohol outcome expectancies

We evaluated whether alcohol outcome expectancies moderate the association between measures of anxiety and alcohol use. Student subjects completed questionnaires related to their level of anxiety, recent alcohol-use patterns, and outcome expectancies for alcohol to be tension reducing. Interviews were used to determine the presence or absence of alcohol dependence in subjects and in their first- and second-degree relatives. Consistent with predictions, male subjects with high tension-reduction alcohol outcome expectancies showed a stronger positive correlation between measures of anxiety and drinking behavior than did male subjects with low tension-reduction outcome expectancies. However, this effect was not found for female subjects. We note past studies showing similar gender effects, and relate the overall study findings to the tension-reduction hypothesis of stress-induced drinking.

Happy Hour and Social Lubrication: Evidence on Mood-Setting Rituals of Drinking Time

This study employs a combination of questionnaire and diary data to examine positive emotional changes that a sample of 328 students experienced during routine episodes of social drinking. Quasi-experimental comparisons of participants versus nonparticipants in weekday or weekend evening drinking events reveal two basic patterns of change in drinkers' ratings of situational affect. Participants in weekday drinking events — in contrast to weekend drinkers — show a transitional pattern of reduction in stress from a predrinking baseline period to the subsequent period when they began to drink. Increases in sociable affect emerge within the context of both weekday and weekend drinking events, but this contextual pattern of mood enhancement is especially prominent at certain times among drinkers who score relatively high on a dispositional measure of sociability. These results support theoretical analyses of the cultural regulation and mood-setting functions of social drinking rituals.

Life stressors, drinking patterns, and depressive symptomatology: ethnicity and stress-buffer effects of alcohol

This paper seeks to extend previous research on stress buffer effects of alcohol use using data from a tri-ethnic community sample of 1,784 respondents. Differences in buffer effects between Anglos, Blacks, and Mexican Americans are examined to explore possible racial/ethnic variation in the role or function of alcohol vis-à-vis life stress and depressive symptoms. Both acute life events and chronic financial stress are examined to clarify the conditions under which buffer effects are most and least salient in these groups. The findings indicate that alcohol buffer effects are most pronounced among males with regard to life event stress and depression. Ethnic differences in buffer effects were suggested among males for life events, though statistical controls for demographic factors, fatalism, and religiosity accounted for these differences. The implications of these findings are examined, and the paper generally highlights the need to view alcohol use and alcohol buffer effects in the context of more general coping orientations.

Alcohol use, depressive symptoms, and cultural characteristics in two Mexican-American samples

We modeled associations of quantity and frequency of alcohol use with depressive symptoms (negative affect, lack of positive affect, somatic disturbance, interpersonal problems) in two household surveys of Mexican-Americans (Ns = 1,313 and 3,577). Multivariate analyses controlled cultural (immigration, acculturation) and demographic (age, income, household size, marital status, employment status) characteristics, and assessed interactions of these two classes of predictors. Alcohol use was inconsistently related to depression. In some analyses, cultural characteristics accounted for associations of alcohol use with depression. In others, associations of alcohol use with depression depended on cultural characteristics. Associations of drinking with depression tended not to be robust across samples.

Self-rated depressive symptoms in medical inpatients: age and racial differences

One thousand and eleven men under age forty (n = 161) or over age sixty-four (n = 850) admitted to medical and neurological services of an acute care hospital were screened for depressive symptoms as part of the Durham VA Mental Health Survey. Thirty-three percent of younger and 22 percent of older men scored 11 or higher on the Geriatric Depression Scale. Self-rated symptoms were most prevalent among younger whites (40%) and least common in older blacks (19%). Other exogenous factors such as being retired or unemployment and prior psychiatric history were also related to depressive symptoms, as were poor functional status, impaired cognitive status, and respiratory illness. Coping resources associated with fewer symptoms were social support and moderate alcohol use. In a subgroup of 443 patients, self-rated symptoms were compared with observer-rated symptoms. Agreement was highest among young Whites and lowest in older Blacks. Other correlates also varied depending on whether self-rated or observer-rated symptoms were considered. We conclude that self-rated symptoms are common among medical inpatients, are linked with and confounded by certain health and sociodemographic factors, and may be relatively insensitive as a measure of depression in elderly blacks.

Stress and alcohol interaction: an update of human research

The literature on alcohol and stress in human subjects carried out since 1981 is reviewed. The review covers selected aspects of the interaction of alcohol and stress. (1) Most of the review focuses on the role of stress on alcohol ingestion. Retrospective research based on data from the Health and Nutrition Examination Survey indicated an increase in alcohol consumption with anxiety in certain groups of, as yet not well characterized, individuals. For example, although still insufficiently documented, stress does not appear to play a significant role in alcohol ingestion by women and the elderly. By contrast, stress does appear to play a role in the control of alcohol ingestion by adolescents. Prospective studies employing questionnaire-interview formats generally support an effect of stress on alcohol ingestion. However, studies employing male college aged social drinkers did not find a correlation between levels of stress and ingestion of alcohol. Alcoholics also differ in the reasons for drinking alcohol, but generally ingest alcohol to lessen anxiety/stress. It is clear that the Tension Reduction Hypothesis as originally postulated is no longer adequate. Many new models based on an interaction of alcohol and stress have been proposed to explain the control of alcohol consumption. Considering the multidimensionality of factors that appear to contribute to the control of alcohol ingestion, it is unlikely that a single model could possibly be relevant to alcohol ingestion under all conditions. More likely different models may be relevant to alcohol consumption under specific conditions, or for specific populations. (2) Alcohol has been reported to decrease anxiety in agoraphobics. The self-medication by agoraphobics may contribute significantly to their alcohol abuse. (3) Alcohol has also been reported to decrease tremor of the hands in stressed subjects as well as in patients with essential tremor. (4) Although a number of studies have employed electrodermal activity in studies aimed at the interaction of alcohol and stress, the results have been rather inconsistent. (5) The controversy on the purported beneficial effect of alcohol on the cardiovascular system persists. A number of studies have shown a J- or U-shaped relationship between alcohol ingestion and incidence of coronary heart disease. Alcohol may also influence stress-induced changes in blood pressure. Although a number of studies have demonstrated lower blood pressure in individuals ingesting less than two drinks per day compared with abstainers or heavy alcohol imbibers, the evidence is not conclusive. (6) It is not clear whether the interaction of alcohol and stress involves alterations in plasma catecholamines.(ABSTRACT TRUNCATED AT 250 WORDS)

Familial transmission of alcohol use, III. Impact of imitation/non-imitation of parent alcohol use (1960) on the sensible/problem drinking of their offspring (1977)

Imitation/non-imitation by adult offspring of alcohol-related parent behavior was examined in the context of the 'fall-off effect' and of sensible/problem alcohol use, two processes which tend to constrain drinking. Evidence indicates there is more imitation by adult offspring of abstemious parents (both abstainer and low volume) than of high volume parents. Adult offspring drink significantly less, on the average, than their high volume parents, a phenomenon here termed 'fall-off effect' for both men and women with respect to either their fathers or mothers. This fall-off among social drinkers appears when the mother approaches or the father consumes at or more than a typical daily drinking level (greater than or equal to 1 drink per day). More sensible drinking occurs among adult offspring when (1) the parent has no drinking problem-signs than when the parent has drinking problems (this pattern appears at all levels of offspring consumption), and (2) when parents drink at high volume and have no problems for those offspring who do not imitate parent volume. Drinking 'sensibly' appears to be associated directly with the level of parent alcohol use and offsprings' own drinking levels (considered as imitation or non-imitation of parents), and indirectly with offspring recall of problematic intake by parents. Drinking sensibly is a medical, education and public health issue.

Relationship between psychiatric distress and alcohol use: findings from the Eastern Baltimore Mental Health Survey

This study examined the nature and strength of relationships between levels of alcohol use and concurrent psychiatric distress among adults in the community aged 18-64 years. Data for this project were gathered by standardized interview methods during the 1981-1982 Eastern Baltimore Mental Health Survey. The 2558 survey respondents were initially selected by means of multistage probability sampling of adult household residents in eastern Baltimore, Maryland. This project's findings indicated gender differences in the relationships under study. There was a moderate degree of association between heavy alcohol use and psychiatric distress among women; at moderate levels of alcohol use, a modest association was also noted. In contrast, for males, the results suggested a small positive association between heavy alcohol use and concurrent psychiatric distress, although these findings were not conclusive.

An epidemiologic study of alcohol use as a predictor of psychiatric distress over time

This longitudinal epidemiologic study examined how levels of psychiatric distress over one year may be influenced by both concurrent levels of alcohol use and by prior drinking levels. The study's data were gathered during the 1981-1982 Eastern Baltimore Mental Health Survey (EBMHS), as part of the 5-site National Institute of Mental Health Epidemiologic Catchment Area (NIMH-ECA) Program. The 2091 respondents (18-64 years of age) reinterviewed after one year were initially selected by means of multistage probability sampling of adult household residents in eastern Baltimore, Maryland. The findings for men and women indicated that both high psychiatric distress at baseline interview and concurrent heavy alcohol use were associated with higher levels of psychiatric distress at one-year follow-up. Differences across population subgroups were also noted. Among women, the results further suggested that prior heavy alcohol use was an additional predictor of psychiatric distress levels after one year; this was not found for men.

Impaired Small Town Physicians and Their Spouses

Based on the results of a self-administered questionnaire completed by 107 wives of physicians in a rural central California county, this exploratory study examines dimensions of the physician's work and family life associated with excessive use of alcohol. Avoiding the bias of the use of a treatment population, the study seeks to analyze the factors that are predictive of alcohol impairment in physicians' living and practicing in rural areas where role strain is increased. The stress theory's role in explaining alcohol abuse is explored. Several variables associated with increased probability of impairment are identified, including poor relationships with in-laws, extramarital affairs, the intrusion of business into family life, and excessive drinking by one's spouse. Further studies with larger samples are needed to elaborate on and confirm these initial findings.

Response specificity revisited: stress and health status

Numerous authors have obtained significant, but low correlations between life events and specific health status measures. Even with the inclusion of moderating variables, such as coping, the relationship between life stress and health status measures has rarely exceeded .50. It has been argued that failure to enhance the correlation has occurred because response specificity has not been controlled. A representative community sample of 184 adults from London, Ontario, was surveyed with respect to life stress variables, stress-response specificity, and various illness behaviors. First-order factor analysis of the stress-response specificity measure indicated an emotional/psychological response factor, an eating response factor, a drug/alcohol response factor, and several physical response factors. Second-order factor analysis indicated a psychological response and a physical response factor. Each of the illness behaviors was regressed, in a stepwise procedure, upon the life stress measures and related first- and second-order stress-response specificity factors. As predicted, significant relationships were found between the related stress-response specificity and illness behavior measures. These results support the importance of stress-response specificity as a moderator variable in investigations of the relationship between life stress and illness behavior.

Identification of stress buffers

A large amount of research has been published about the role of intervening variables as buffers for the effects of stress precursors on adverse stress impacts. A review revealed that most of these reports focused on single candidates or a subjectively selected constellation of variables using narrow definitions of both precursors and impacts with a variety of statistical procedures. A set of 22 variables was investigated to determine the relative importance of each as a stress buffer, using broadened measures for precursors and impacts. Discriminant analysis with t-test follow-up of data from 668 normally functioning men and women indicated the existence of 7 strong and 7 moderate buffers and a differential effect by sex. Reanalysis, comparing the results from other statistical procedures, concluded that there were 4 "true" buffers: sense of competence, exercise pattern, sense of purpose, and leisure activity. Eleven of the 22 demonstrated main effects independent of stress. This study discusses the importance of using standard statistical procedures with comprehensive measures in order to further knowledge about the human stress process.

Depression, self-derogation, substance use, and suicide ideation: lack of purpose in life as a mediational factor

A theoretical model of adolescent behavior is examined separately for males and females (N = 722). The model hypothesizes that depression and self-derogation may lead to a lack of purpose in life, which, in turn, may lead to suicide ideation and substance use. Confirmatory factor analyses and structural equation procedures were used to examine the model, using Bentler's (1984) EQS computer program, which is available from BMDP. For both the men and women, the model adequately accounted for the data although there were some important differences between the sexes. In response to psychic discomfort (i.e., Depression and Self-derogation), men are more apt to turn to drugs and alcohol, whereas women consider suicide. Conversely, the situation changes in response to feelings of meaninglessness or a lack of purpose in life. Here, the females appear to turn to substance use, whereas the males react with thoughts of suicide.

The psychological benefits of moderate alcohol consumption: a review of the literature

A review of the literature on the positive psychological benefits of light and moderate alcohol consumption suggests the following: (1) Alcohol in moderate amounts is effective in reducing stress. This has been found in both physiologic and self-report measures. (2) Low and moderate doses of alcohol have been reported to increase overall affective expression, happiness, euphoria, conviviality and pleasant and carefree feelings. Tension, depression and self-consciousness have been reported to decrease with equal doses. (3) Low alcohol doses have been found to improve certain types of cognitive performance. Included here are problem-solving and short-term memory. (4) Heavy drinkers and abstainers have higher rates of clinical depression than do regular moderate drinkers. (5) Alcohol in low and moderate doses has been effective in the treatment of geropsychiatric problems. As indicated in the text, results from many of the studies reviewed suggest that light or moderate drinking may be beneficial to psychological well-being. Liber (N. Engl. J. Med., 310(13) (1984) 846) has commented that the subject of control of alcohol intake evokes strong emotional responses, which can overshadow a logical assessment of whether or not to include 'healthy' drinking in a dietary plan. It is hoped that this review of data from available research can help provide a basis for making such an assessment.

The stress-buffering role of alcohol consumption: the importance of symptom dimension

This paper examines the possibility of the existence of stress-buffering properties of alcohol consumption suggested by a recent study in which life events were related to depressive symptoms for abstainers and heavy drinkers but not for moderate drinkers. Survey data on affective and somatic symptoms from 364 urban and 333 rural Florida residents indicated some support for the buffering argument. Moderate and heavy drinkers manifested significantly lower levels of symptoms than did abstainers only with regard to somatic symptoms. Life event-drinking pattern interactions did not reach statistical significance, although trends consistent with the buffering hypothesis were obtained with the somatic symptom measure. Implications of the data are explored.