Evaluations of alcohol consequences moderate social anxiety risk for problematic drinking.

The link between social anxiety (SA) and problematic drinking is complex; this seems predominantly true among young adults. Individuals high on SA are thought to be particularly sensitive to the negative effects of alcohol, which should deter them from drinking. Yet, some evidence suggests that those high on SA continue to drink despite experiencing negative alcohol-related consequences (NACs) (Morris, Stewart, & Ham, 2005). Although traditionally, researchers assume NACs are perceived as averse, emerging evidence suggests these are not categorically viewed as negative by undergraduates. The study goal was to test whether evaluations of NACs moderate the effect of SA on problematic drinking. It was hypothesized that high SA would predict elevated alcohol use and number of NACs experienced, but only for those who evaluate NACs as less negative. Undergraduate drinkers (N=130, 80 women) completed self-reports of social anxiety, NAC evaluations (ratings of how 'bad' experiencing each alcohol-related consequence would be), alcohol use, and NACs experienced. Regression analyses revealed that NAC evaluations moderated the effect of SA on number of NACs experienced, but not the effect of SA on weekly alcohol use. Simple slopes analyses showed that high SA was associated with elevated NACs experienced for those with weak negative NAC evaluations, controlling for alcohol use. These findings help explain the mixed SA-problematic drinking literature by identifying perceptions of NACs as an important moderator of SA risk for experiencing NACs. Moreover, clinical interventions aimed at reducing SA risk for undergraduate problematic drinking may benefit from targeting NAC evaluations.

Impulsivity increases risk for coping-motivated drinking in undergraduates with elevated social anxiety.

According to theory, those high in social anxiety (SA) are at risk for drinking alcohol for coping and conformity motives, which in turn lead to alcohol use and related problems. Empirical tests of this risk pathway in non-clinical samples have produced mixed results. Although those high on SA may drink to cope with anxiety and to reduce the likelihood of social rejection, they may also avoid drinking for fear of embarrassing themselves when intoxicated. Central to alcohol use by those high in SA is a temporary disregard of alcohol's potentially negative consequences. Accordingly, we hypothesized that SA would positively predict alcohol use and problems, but only at high levels of impulsivity (IMP). We expected these interactive effects to be mediated by coping and conformity motives. Undergraduates (N = 461) completed self-reports. Partially supporting hypotheses, IMP moderated the association between SA and alcohol-related problems (but not use), such that SA predicted problems only at high IMP. This interactive effect was mediated by coping (but not conformity) motives, such that SA positively predicted coping motives (especially at high IMP), which in turn predicted problems. Results suggest that IMP and coping motives clarify SA-related drinking. Clinical interventions may consider targeting IMP.

Factors associated with disability and depressive symptoms among individuals with diabetes: a community study in Quebec.

BACKGROUND: The prevalence of diabetes in Canada is increasing. Multiple factors have been identified in the development of disability in diabetic patients, but the interaction of those risk factors is not clear. OBJECTIVE: The purpose of this paper was to assess the association between diabetes severity, health behavior, socioeconomic status, social support, depression, and disability simultaneously in a population-based study of individuals with diabetes in Quebec, Canada. METHOD: Random digit dialing was used to select a sample of 2,003 adults with self-reported diabetes in Quebec. Health status was assessed by the World Health Organization Disability Assessment Schedule II and the CDC Healthy Days Measures. The Patient Health Questionnaire (PHQ-9) was used to assess depression. Potential risk factors included diabetes severity, social support, socioeconomic status, and health behavior factors. Structural equation models were used to identify risk factors that contributed to both depressive symptoms and disability. RESULTS: The prevalence of major and minor depression was 8.7% and 10.9%, respectively, while the prevalence of severe disability was 6.7%. Diabetes severity and health behavior factors were associated with both depression and disability. Social support was associated with depression for women but not for men. DISCUSSION: Our results suggest a complex interaction between health behavior factors, diabetes severity, social support, depression, and disability. Behavioral factors and diabetes-specific factors might have a direct effect on both depression and physical functioning.

Epidemiology of antidepressant medication use in the Canadian diabetes population.

BACKGROUND: Depression has been shown to be a common co-morbidity in diabetes. From a public health point of view, there is a lack of population-based studies regarding the use of antidepressant medication in non-clinical samples of people with diabetes. The objective of the present study was to provide demographic and clinical information about the use of antidepressant medication in a representative community sample of people with diabetes. METHOD: The Canadian Community Health Survey 1.2 (CCHS 1.2) is a cross-sectional survey that collects information related to health status, health-care utilization and health determinants of the Canadian general population. Diabetes presence was ascertained by self-report of physician diagnosis. Depression and anxiety were assessed using a modified version of the World Mental Health Composite International Diagnostic Interview. Antidepressant use was determined through self-report. RESULTS: The population prevalence of self-reported antidepressant use in the past 12 months was 8.4% (SE = 0.95) among people with diabetes (n = 1,662). People who took antidepressants had higher average body mass index (M = 32.6, SD = 6.5) than those not taking antidepressants (M = 29.2, SD = 5.7). The use of antidepressants was associated with poorer health status and higher number of co-morbid chronic conditions. Half of diabetes subjects who used antidepressant medication in the last year did not have a lifetime history of major depression. CONCLUSIONS: In a community sample of people with diabetes, the prevalence of antidepressant use exceeded the prevalence of major depression. Anxiety disorders and other somatic chronic conditions were associated with the prescription of antidepressant medication in people with diabetes, but without a history of major depression.

Association between neighborhood-level deprivation and disability in a community sample of people with diabetes.

OBJECTIVE: The objective of the present study was to analyze the association between neighborhood deprivation and self-reported disability in a community sample of people with type 2 diabetes. RESEARCH DESIGN AND METHODS: Random digit dialing was used to select a sample of adults with self-reported diabetes aged 18-80 years in Quebec, Canada. Health status was assessed by the World Health Organization Disability Assessment Schedule II. Material and social deprivation was measured using the Pampalon index, which is based on the Canadian Census. Potential risk factors for disability included sociodemographic characteristics, socioeconomic status, social support, lifestyle-related factors (smoking, physical activity, and BMI), health care-related problems, duration of diabetes, insulin use, and diabetes-specific complications. RESULTS: There was a strong association between disability and material and social deprivation in our sample (n = 1,439): participants living in advantaged neighborhoods had lower levels of disability than participants living in disadvantaged neighborhoods. The means +/- SD disability scores for men were 7.8 +/- 11.8, 12.0 +/- 11.8, and 18.1 +/- 19.4 for low, medium, and high deprivation areas, respectively (P < 0.001). The disability scores for women were 13.4 +/- 12.4, 14.8 +/- 15.9, and 18.9 +/- 16.2 for low, medium, and high deprivation areas, respectively (P < 0.01). Neighborhood deprivation was associated with disability even after controlling for education, household income, sociodemographic characteristics, race, lifestyle-related behaviors, social support, diabetes-related variables, and health care access problems. CONCLUSIONS: The inclusion of neighborhood characteristics might be an important step in the identification and interpretation of risk factors for disability in diabetes.