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142
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Alcohol Clin Exp Res. 2024;48:142–152.wileyonlinelibrary.com/journal/acer
Received: 11 May 2023
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Accepted: 27 October 2023
DOI: 10.1111/acer.15221
RESEARCH ARTICLE
A latent profile analysis of social anxiety, depression, and
pregaming motives among heavy-drinking college students
Reagan E. Fitzke1 | Toni Atieh2 | Jordan P. Davis3 | Liv Canning3 | Denise D. Tran1 |
Keegan Buch1 | Justin F. Hummer4 | Eric R. Pedersen1
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction
in any medium, provided the original work is properly cited and is not used for commercial purposes.
© 2024 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.
1Department of Psychiatry and the
Behavioral Sciences, Keck School
of Medicine, University of Southern
California, Los Angeles, California, USA
2University of Southern California, Los
Angeles, California, USA
3Suzanne Dworak-Peck School of Social
Work, Universit y of Southern California,
Los Angeles, California, USA
4RAND Corporation, Santa Monica,
California, USA
Correspondence
Eric R. Pedersen, Department of
Psychiatry and Behavioral Sciences,
University of Southern California Keck
School of Medicine, 2250 Alcazar St.,
Suite 220 0, Los Angeles, C A 90033, USA .
Email: eric.pedersen@med.usc.edu
Funding information
National Institute on Alcohol Abuse
and Alcoholism, Grant /Award Number:
R34AA025968
Abstract
Background: Pregaming is a high-risk drinking behavior that is associated with heavy
drinking and negative alcohol-related consequences. College students may engage in
pregaming for several reasons, including to enhance social experiences or cope with
negative affect. Research shows that asso ciations betwe en dr inking, social anxiety, and
depression are multifaceted. However, our understanding of the complex associations
of mental health symptoms with pregaming motives and behaviors remains limited.
Methods: This study examined heterogeneity in how pregaming motives, social anxi-
ety, and depression associate with past 30-day pregaming variables (quantity, fre-
quency, and negative consequences). We used latent profile analysis (LPA) in a sample
of heavy-drinking university students (N = 479).
Results: LPA results indicated four profiles: mild/moderate social anxiety and depression
symptoms, moderate motives (n = 285), minimal social anxiety and depression symptoms,
low motives (n = 61), subclinical/elevated social anxiety and depression symptoms, high
motives (n = 75), and clinically elevated social anxiety and depression symptoms, moderate
motives (n = 58). The subclinical/elevated symptoms, high motives profile reported the
highest pregaming frequency and consequences, including blackouts. Individuals in
the clinically elevated symptoms, moderate motives profile reported more consequences
than those in the minimal symptoms, low motives and mild/moderate symptoms, moder-
ate motives profiles. Individuals in the minimal symptoms, low motives profile reported
the fewest consequences.
Conclusions: Among these students, social anxiety and pregaming motives were
associated with more frequent pregaming and social anxiety and depression were
associated with greater negative consequences. Interventions that target pregaming-
specific motives among students with mental health symptoms may be warranted to
reduce this risky behavior and associated drinking-related harm.
KEYWORDS
depression, drinking motives, drinking to cope, pregaming, social anxiety, university students
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SOCIAL ANXIETY, DEPRESSION, AND PREGAMING MOTIVES
INTRODUCTION
Pregaming (i.e., prepartying, frontloading, and preloading) is a high-
risk drinking behavior that involves alcohol consumption before
another event or gathering where further drinking often occurs
(Zamboanga et al., 2023). Pregaming is highly prevalent among
college students, with a recent review estimating that over 50%
of college students engage in past 30-day pregaming (Zamboanga
et al., 2023). Heavier drinking tends to occur on pregaming days
compared to nonpregaming days (LaBrie et al., 2016), with heavy ep-
isodic drinking (i.e., 4 or 5+ drinks on one occasion) often occurring
both during and after pregaming (Calhoun & Maggs, 2022). Students
endorse many reasons for pregaming, which are often socially mo-
tivated, and include drinking to make it easier to talk to others and
to meet potential dating/hookup partners (Pedersen et al., 2009).
Further investigation into the mechanisms by which motives impact
pregaming and related consequences is an important direction for
pregaming research.
Pregaming consistently associates with elevated risk for neg-
ative alcohol-related consequences. Among college students,
these can include academic problems, interpersonal problems,
and increased alcohol tolerance (Pedersen & LaBrie, 2007).
Importantly, pregaming also elevates risk of serious negative
consequences, such as injury, physical and sexual assault, driving
while intoxicated, and blacking out (Ahmed et al., 2014; Foster
& Ferguson, 2014; Pedersen & LaBrie, 2007). Blackouts, or pe-
riods of alcohol-induced amnesia (White, 2003), are among the
most serious of negative alcohol-related consequences, being
independently linked to risk for other negative alcohol-related
consequences, injuries, mental health disorder symptomology,
and alcohol use disorder (Hingson et al., 2016; Linden-Carmichael
et al., 2023; Miller et al., 2020; Mundt et al., 2012). Pregaming is a
major risk fac tor for bl ackouts, due to th e high blo od al cohol levels
reached during pregaming and on days when pregaming occurs
(LaBrie et al., 2011; Richards et al., 2023).
However, pregaming is often driven by an individual's perceived
positive outcomes (e.g., feeling sociable, relaxed; experiencing im-
proved mood) (Calhoun & Linden-Carmichael, 2022). Therefore, de-
spite increased risk for negative alcohol-related consequences, college
student s continue to engage in pregaming. LaBrie et al. (2012) posited
four motives for pregaming: interpersonal enhancement (e.g., “It helps
me feel more relaxed when meeting new people once I go out”), inti-
mate pursuit (e.g., “To meet a potential dating partner once I go out”),
barriers to consumption (e.g., “Because alcohol may not be available
at destination or may be hard to get at the destination”), and situa-
tional control (e.g., “So I don't have to worry about whether someone
has tampered with the drinks at a par ty”). Social motivations are es-
pecially integral to why students pregame (Pedersen & LaBrie, 2007;
Walukevich-Dienst et al., 2022). Interpersonal enhancement and inti-
mate pursuit in particular are commonly endorsed social motives for
pregaming among college students (LaBrie et al., 2012).
Given the findings related to social motives of pregaming, of
recent interest is the interplay of social anxiety and pregaming.
Buckner et al. (2021)'s theory of social anxiety and substance use
suggests that individuals may use substances to mitigate symptoms
on biopsychosocial domains, including to increase social facilitation.
Though limited, research on pregaming and social anxiety has re-
ported that social anxiety associates with either (1) lower alcohol
consumption overall, due to not engaging in social situations where
drinking may occur in the first place, or (2) pregaming related to bol-
stering socialization (i.e., to make social situations less anxiety pro-
voking) (Davis et al., 2020; Keough et al., 2016; Walukevich-Dienst
et al., 2022). Keough et al. (2016) found that social anxiety posi-
tively predicted solitary pregaming drinking (i.e., pregaming alone);
however, social anxiety also reduced likelihood of pregaming with
others before a different social event. Similarly, Davis et al. (2020)
reported that social anxiety was associated with lower pregaming
frequency overall, but for those with social anxiety who did pre-
game, impulsivity and co-use with cannabis were more likely, indi-
cating potentially riskier pregaming. In other words, social anxiety is
typically associated with light drinking and few consequences, but it
may also motivate some individuals to use alcohol to mitigate their
symptoms (Schry & White, 2013). Drinking motives may be respon-
sible for many of the nuances in these obser ved alcohol-related con-
sequences. For instance, in the context of general drinking, Merrill
et al. (2014) found that coping motives uniquely predicted multiple
alcohol-related negative consequences, above alcohol consumption
alone. With respect to pregaming, Walukevich-Dienst et al. (2022)
found that those with social anxiety and high pregaming social mo-
tives (intimate pursuit, interpersonal enhancement) consumed more
alcohol, more quickly, and in turn experienced more negative alco-
hol-related consequences during their last pregaming occasion. For
individuals with social anxiety, pregaming could be related to the
self-medication hypothesis of substance use, which posits that indi-
viduals may use substances to cope with negative emotional states
(Khantzian, 1997). Using alcohol with trusted friends (or alone) prior
to unfamiliar social interactions may reduce short-term anxiety re-
lated to social discomfort once they go out to the novel social setting
after pregaming. The buzz or intoxication felt during pregaming may
function as the catalyst to overcome the anxiety that typically keeps
them avoiding social situations.
Khantzian's (1997) self-medication hypothesis is also relevant
for college students when considering other mental health disor-
ders, such as depression. Depression is increasing at exponential
rates among college students (Lipson et al., 2022). Evidence for the
link between alcohol use and depression among young adults is
mixed (Pedrelli, Shapero, et al., 2016), with some studies reporting
that depression is associated with heavy drinking (Pedrelli, Borsari,
et al., 2016) and coping drinking motives (Bravo & Pearson, 2017).
In contrast, other studies have reported associations of lower
depression with heavy drinking (Foster et al., 2014), or no asso-
ciation between depression and alcohol use quantity (Martens
et al., 2008; Schnetzer et al., 2013). Importantly, however, depres-
sion symptoms do consistently associate with greater alcohol-re-
lated problems (Acuff et al., 2018; Bravo et al., 2018; Gawron &
Gerlach, 2022; Kenney et al., 2017). Moreover, research is limited
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FIT ZKE et al.
on depression and pregaming. One recent study reported that
those with depression symptoms were less likely to benefit from
the use of protective strategies while pregaming in mitigating al-
cohol use and consequences (Hummer et al., 2021); explicit associ-
ations between depression and pregaming are otherwise unclear.
Research has consistently indicated that social anxiety and de-
pression symptoms commonly co-occur, extending from adolescence
into adulthood (Adams et al., 2016; Beesdo et al., 2007; Koyuncu
et al., 2019). In a recent study, Kraft et al. (2021) reported that cog-
nitive mechanisms underlying depression were also associated with
social anxiety among college students. Another study reported that
dysfunctional coping strategies, including substance use, were associ-
ated with depression and social anxiety symptoms among college stu-
dents (Dugyala & Poyrazli, 2021). A recent systematic review reported
that individuals with social anxiety and alcohol use disorder most com-
monly reported co-occurring depression symptoms, above that of any
other mental health symptoms assessed (Oliveira et al., 2018). Such
co-occurring mental health symptoms are often associated with risk
for alcohol use disorder and problems (Castillo-Carniglia et al., 2019).
Thus, co-occurring social anxiety and depression may be of interest
when investigating high-risk drinking practices, such as pregaming.
Since there are a variety of factors that may predict pregam-
ing drinking among students, it is important to disentangle group
characteristics that may predict pregaming behaviors and conse-
quences. Haas et al. (2018) identified heterogeneous groups of
pregaming consumption and motives using latent profile analysis
(LPA) to better understand differential groups of students who
pregame. The study found that students reported diverse pat-
terns of pregaming frequency and motives, and those who re-
ported heavier pregaming consumption and intoxication-driven
motives were at particular risk for pregaming-related negative
consequences, including blackouts. Given that social anxiety
and depression have been reported to associate with substance
use problems beyond use frequency and quantity (Bartholomay
et al., 2023), considering such mental health problems in how they
associate with pregaming behaviors may be particularly relevant in
the context of alcohol-related consequences.
Considering the interplay of motives and mental health in pre-
dicting pregaming behaviors and associated consequences remains
understudied. This study expands upon prior work using LPA to
explore how profiles of pregaming motives, social anxiety, and de-
pression associate with pregaming drinking behaviors and related
consequences, including alcohol-related blackouts, within a past 30-
day time frame.
MATERIALS AND METHODS
Procedures and participants
The sample was recruited in Fall 2021 from a large private univer-
sity on the west coast as part of a larger randomized controlled trial
examining pregaming drinking behaviors among college students
(Pedersen et al., 2022, 2023). To be enrolled in the study, partici-
pants were full-time undergraduate students, aged 18–24 years, and
repor ted pre gam ing at lea st once per week in the past mo nth (i.e ., 4+
times). Participants were told they were enrolling in a study of health
and risk behaviors among college students, where they would be as-
signed to one of two mobile phone-based alcohol and health behav-
iors programs to review. Data examined in this study come from the
baseline assessment and prior to randomization. A total of N = 485
students enrolled in the larger trial and completed a baseline survey
with informed written consent. The university's Institutional Review
Board approved all study procedures. Participants provided written
informed consent at baseline. We report sample demographic infor-
mation and general alcohol use descriptive statistics in Table 1.
Measures
Profile indicators
Pregaming motives
The Prepar tying Motivations Inventor y (PMI; LaBrie et al., 2012) is a
16-item scale that assesses four motive subtypes for pregaming: in-
terpersonal enhancement (e.g., “To meet new friends once I go out”;
α = 0.86 in the present sample), intimate pursuit (e.g., “To increase
the likelihood of hooking up”, α = 0.86), situational control (e.g., “So I
have control over what type of alcohol I consume rather than relying
on what's available at the destination”, α = 0.85), and barriers to con-
sumption (e.g., “Because I am underage and cannot purchase alcohol
at the destination venue”, α = 0.79). Participants reported to what
extent they pregame for each reason, and scores for each subscale
were calculated by averaging responses to all items within the sub-
scale, ranging from 0 = Almost never/Never to 5 = Almost always/
Always.
Social anxiety
We measured social anxiety symptoms with the Social Interaction
Anxiety Scale (SIAS; Mattick & Clarke, 1998). Th e SIAS co ntai ns 20
items rated on a scale from 0 = Not at all to 4 = Extremely, which
indicates how true each statement is of the respondent. Example
items include “When mixing socially I am uncomfortable,” and “I
find myself worrying that I won't know what to say in social situa-
tions.” Three positively worded items (e.g., “I find it easy to make
friends of my own age”) were reverse coded. Total (e.g., summed)
scores ranged from 0 to 80, with higher scores indicating higher
levels of social anxiety, and a score of 34+ indicating probable
social anxiety disorder (social phobia); it also helps to differenti-
ate those with social anxiety symptoms from those with solely
general anxiety symptoms (α = 0.88; Brown et al., 1997; Heimberg
et al., 1992).
Depression
We measured depression symptoms using the Patient Health
Questionnaire-8 (PHQ-8; Kroenke et al., 2009), an 8-item
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questionnaire that assesses symptoms of depression in the
past 2 weeks (e.g., feeling down, depressed, and hopeless) on a
scale from not at all (0) to nearly ever y day (3). Total scores on
the PHQ-8 ranged from 0 to 24, with higher scores indicating
higher depression severity and a score of 10+ indicating probable
depression (α = 0.89).
Covariates and auxiliary variables
Demographic covariates
We assessed participant age, sex, gender, and race/ethnicity.
Pregaming behaviors
A picture with standard drink definitions preceded all alcohol ques-
tions. Pregaming was defined for participants as, “the consumption
of alcohol prior to attending an event or activity. For example, drink-
ing before going to a party, bar, concert, sporting event, date, meet-
ing, or any other event or activity at which more alcohol may or may
not be consumed. This can be an event that has a large number of
people or very few people.” Participants reported how many days
in the past 30 days they had pregamed (i.e., pregaming frequency)
and how many drinks they typically had while pregaming (i.e., pre-
gaming quantity). They were also asked over how many hours they
pregamed (in 15-min increments). Hours pregamed, participant sex,
and typical number of drinks consumed during pregaming were
used to generate an estimated pregaming blood alcohol level (BAL).
Consistent with methods from Haas et al. (2018), we also computed
a variable that represented the proportion of pregaming days rela-
tive to overall drinking days in the past 30 days.
Pregaming consequences
We used a modified version of the Brief Young Adult Alcohol
Consequences Questionnaire (B-YAACQ; Kahler et al., 2005,
2008) to assess consequences experienced on pregaming days.
Participants reported whether they experienced any of the 24 al-
cohol-related consequences from the measure, and whether they
experienced each endorsed consequence on pregaming days, non-
pregaming days, or both pregaming and nonpregaming days in the
past 30 days. Pregaming consequences were coded if a participant
reported experiencing that consequence on pregaming days (as op-
posed to never or only on nonpregaming days). Finally, participants
reported how many pregaming days they had blacked out in the past
30 days, which was defined to participants as “a night when you pre-
gamed where you didn't remember all or part of the night after you
started drinking.”
Analytic plan
To understand heterogeneity in social anxiety, depression, and
pregaming motives, we conducted exploratory analyses using LPA
(Nylund-Gibson et al., 2014). LPA identifies heterogeneity within a
sample (or groups) and uses probability to classify individuals based on
means of item or measure endorsement. We fit models ranging from
one to five profiles and examined fit statistics to determine if adding
an additional profile improved model fit. To assess model fit, we used
decreases in the negative 2 log likelihood (−2 LL), Akaike Information
Criteria (AIC), Bayesian Information Criteria (BIC), and the sample
size adjusted Bayesian Information Criteria (aBIC). Further, we
used nonsignificant Vuong-Lo–Mendell–Rubin likelihood ratio test
TAB LE 1 Sample demographics (N = 485).
M (SD)/n (%)
Age 19.98 (1.25)
Sex
Male 159 (32.8%)
Female 326 (67.2%)
Gender
Man 159 (32.8%)
Woman 318 (65.6%)
Nonbinary or gender nonconforming 8 (1.6%)
Race/ethnicity
White 232 (47.8%)
Asian 98 (20.2%)
Hispanic or Latinx 90 (18.6%)
Multiracial 48 (9.9%)
African American or Black 13 (2.7%)
Other race or ethnicity 4 (0.8%)
Class status
First year student/freshman 73 (15.1%)
Sophomore 119 (24.5%)
Junior 125 (25.8%)
Senior 168 (34.6%)
Fraternity/sorority membership 126 (26.0%)
Alcohol use (past 30 days)
Days of any alcohol use 10.14 (4.08)
Mean overall drinks per occasion 4.64 (2.45)
Days of pregaming 3.25 (0.69)
Mean pregaming drinks per occasion 3.65 (2.19)
Proportion of pregaming/overall drinking days 0.37 (0.18)
Pregaming motives
Interpersonal enhancement 3.74 (0.84)
Situational control 3.15 (1.00)
Intimate pursuit 2.10 (1.01)
Barriers to consumption 2.72 (1.13)
Mental health symptoms
Social anxiety 24.72 (12.52)
Depression 6.37 (5.19)
Note: A total of 21.4% of participants had a score of 34 or higher on
the Social Interaction Anxiet y Scale, representing the optimal cutoff
for probable social anxiety disorder (social phobia) among college
students. A total of 21.3% of participants had a score of 10 or higher on
the Patient Health Questionnaire, representing the optimal cutoff for
probable depression.
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(VLRT), the Lo–Mendell–Rubin adjusted likelihood ratio test (LMRT),
and the bootstrapped likelihood ratio test (BLRT) to indicate that a
k–1 profile solution is a better fit to the data. Once the best-fitting
profile was determined, we followed best practice methods outlined
by Nyl und-Gibs on et al. (2014), in which classification errors for each
individual are computed, and the inverse logits are used as weights,
rather than using the modal profile assignment as an imperfect
latent profile indicator. Advantages to this method allow the final
model to be more resistant to profile shifts when including the
emergent latent profiles in further modeling steps (Nylund-Gibson
et al., 2019).
After determining the optimal number of profiles, the logits
of profile membership were set to ensure profiles were not influ-
enced by inclusion of covariates when assessing differences in aux-
iliary variables (e.g., profile membership does not shift or change).
To determine how emergent profiles relate to auxiliary variables,
we used the manual 3-step auxiliary BCH approach (Asparouhov &
Muthén, 2014). This method uses a pseudo-profile Wald chi-square
test to assess mean differences in auxiliary variables between pro-
files. These analytic methods allowed us to determine if there are
associations between emergent profiles and multiple pregaming vari-
ables; no causal inferences could be made due to use of cross-sec-
tional data. All models at the final step controlled for participant age
and sex to account for possible demographic differences between
latent profiles in pregaming behaviors that have been reported in
prior work (Ferris et al., 2019). As these two variables were meant
to be controls only, we did not interpret their effects. Mplus omitted
listwise missing cases (i.e., on all variables; n = 6) for a final analytic
sample of N = 479. Missing data was minimal (0.6%) and was adjusted
for using the maximum likelihood estimator in Mplus.
RESULTS
Descriptive statistics
Participants in the sample reported heavy drinking and pregaming in
the past 30 days. We report overall sample means of general drink-
ing, pregaming drinking, motives, social anxiety symptoms, and de-
pression symptoms in Table 1.
Latent profile analysis
Result s of the profile enumeration process resulted in a 4-prof ile so-
lution (see fit statistics in Table 2). The 4-profile solution had lower
AIC, BIC, and aBIC values than the 1-, 2-, and 3-profile solutions. The
5-profile solution had nonsignificant VLRT and LRT values (p > 0.05)
and one small profile emerged (n = 5; 1% of the analytic sample).
Therefore, we determined the 4-profile solution fit the data best.
Table 3 provides means for social anxiety, depression, and mo-
tives by profile; Figure 1 provides a visual representation of the final
solution. Briefly, 59% (n = 285) of participants were categorized into
the mild/moderate social anxiety and depression symptoms, moderate
motives profile. Just under 13% (n = 61) were categorized as minimal
social anxiety and depression symptoms, low motives. Our results also
revealed a profile who reported subclinical/elevated social anxiety
and depression symptoms, high motives (n = 75; 15.6%). The final pro-
file, labeled clinically elevated social anxiet y and depression symptoms,
moderate motives (n = 58; 12.1%) consisted of individuals exceeding
clinical cutoffs for both social anxiety and depression.
Pregaming auxiliary variables
Table 4 disp lays result s for mean difference comparisons across pro-
files. The subclinical/elevated social anxiety and depression symptoms,
high motives profile reported the highest past month days of pre-
gaming compared to all other profiles. The subclinical/elevated social
anxiety and depression symptoms, high motives profile reported more
average overall drinks than only the minimal social anxiety and de-
pression symptoms, low motives profile. The minimal social anxiety and
depression symptoms , low motives group had the lowest calculated
BAL, with significant differences from all other profiles. No differ-
ences emerged between profiles for past month number of pregam-
ing drinks or proportion of pregaming days.
For pregaming consequences, again, the subclinical/elevated so-
cial anxiety and depression symptoms, high motives profile reported
the highest number of past month consequences, followed by clin-
ically elevated social anxiety and depression symptoms, moderate mo-
tives. The clinically elevated social anxiety and depression symptoms,
moderate motives profile reported greater consequences than the
TAB LE 2 Latent profile analysis model fit indices and final model specification.
Solution −2 LL AIC BIC aBIC Entropy VLRT pLMRT pBLRT p
16015.48 12054.96 12105.02 12066.93 — — — — — — —
25926.86 11891.7 7 11971.03 11910.73 0.81 17 7.19 0.046 173.18 0.049 177.19 <0.001
35862.16 11776. 32 1188 4.78 11802.26 0.75 1 29.45 0.001 126.53 0.002 129. 45 <0.001
45832.91 11731 .8 1 118 69.4 8 1176 4 .74 0.73 58.50 0.032 57. 1 8 0.035 58.50 <0.001
55813.56 11707.11 11873.98 11747.02 0.76 38.70 0.13 37. 8 3 0 .12 38.70 <0.001
Note: Bold indicates the best-fitting final profile solution.
Abbreviations: −2 LL, negative 2 log likelihood; aBIC, sample size-adjusted Bayesian information criteria; AIC, Akaike information criteria; BIC,
Bayesian information criteria; BLRT, Bootstrapped log-likelihood ratio test; LMRT, Lo–Mendell–Rubin test; VLRT, Vuong-Lo–Mendell–Rubin
likelihood ratio test.
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SOCIAL ANXIETY, DEPRESSION, AND PREGAMING MOTIVES
mild/moderate social anxiety and depression symptoms, moderate mo-
tives prof ile. All profiles repo r ted gre ater co nsequ enc es than minimal
social anxiety and depression symptoms, low motives profile. Finally,
the subclinical/elevated social anxiety and depression symptoms , high
motives profile reported the greatest number of blackouts on a pre-
gaming day in the past 30 days compared to all other profiles. No
differences emerged for the proportion of pregaming days relative
to total alcohol use days.
DISCUSSION
This study expands upon existing work by investigating how
heterogeneous profiles of pregaming motives, social anxiety,
and depression relate to pregaming behaviors and associated
consequences, including blackouts on pregaming days. Analyses
elucidated four separate profiles of mental health and pregaming
motives: (1) mild/moderate social anxiety and depression symptoms ,
FIGURE 1 Final 4-profile solution.
TAB LE 3 Final 4-profile solution of pregaming motives, social anxiety, and depression.
Motives Mental health
Interpersonal
enhancement
Situational
control
Intimate
pursuit
Barriers to
consumption
Social
anxiety Depression
M (SD) M (SD) M (SD) M (SD) M (SD) M (SD)
Mild/moderate social anxiety and depression
symptoms, moderate motives
3.83 (0.10) 3.07 (0.07) 1.95 (0.11) 2.67 (0.09) 22.5 (1.11) 4.63 (0.36)
Minimal social anxiety and depression symptoms,
low motives
2.48 (0.20) 2.91 (0.20) 1.38 (0.14) 2.23 (0.27) 15.2 (1.41) 3.75 (0.64)
Subclinical/elevated social anxiet y and depression
symptoms, high motives
4.48 (0.11) 3.77 (0.23) 3.43 (0.17) 3.38 (0.22) 29.7 (2.69) 7.38 (0.71)
Clinically elevated social anxiety and depression
symptoms, moderate motives
3.81 (0.14) 2.93 (0.16) 1.86 (0.16) 2.69 (0.16) 39.1 (2.85) 15.8 (1.42)
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moderate motives, (2) minimal social anxiety and depression symptoms,
low motives, (3) subclinical/elevated social anxiety and depression
symptoms, high motives, and (4) clinically elevated social anxiety and
depression symptoms, moderate motives.
Participants in the subclinical/elevated social anxiety and depres-
sion symptoms, high motives profile reported the highest pregaming
frequency and negative alcohol-related consequences on pregam-
ing days. Descriptively, all four pregaming motives were endorsed at
higher rates for this profile compared to other profiles, but notably so
for interpersonal enhancement and intimate pursuit motives, which are
primarily related to pregaming in order to make social situations more
relaxed and fun (e.g., easier to talk to people and meet dating partners
once out at the destination). These findings are consistent with prior
work that socially anxious individuals who also endorse social motives
to pregame may drink more frequently and experience more conse-
quences (Walukevich-Dienst et al., 2022). These results also suggest
that those with elevated depression and high motives (again, notably
so for interpersonal enhancement and intimate pursuit) may pregame
more frequently and experience negative consequences to overcome
the depressive symptoms; for example, they may be motivated to pre-
game because of the belief that pregaming will make the night more
fun and alleviate their negative affect. This profile reported a mean
of approximately 13 of the 24 consequences in the past 30 days,
which was highest among all profiles. Moreover, heightened risk for
consequences among this profile importantly included frequency of
blackouts, as this profile had a mean of 3.5 blackout days in the past
month—significantly greater than all other profiles, and nearly double
that of the mild/moderate social anxiety and depression symptoms, mod-
erate motives group. Thus, individuals with elevated social anxiety and
depression symptoms and social motives represent an important focus
for interventions targeting pregaming and socially motivated drinking
behaviors to reduce alcohol-related harms among college students.
Despite the clinically-elevated social anxiety and depression symp-
toms, m oderate motives profile reporting similar motives to the sub-
clinical/elevated social anxiety and depression symptoms , high motives
profile and having significantly higher consequences than the mild/
moderate social anxiety and depression symptoms, moderate motives,
and minimal social anxiety and depression symptoms, low motives pro-
files, this profile still pregamed less frequently (by about 2 days) and
experienced about two fewer consequences than the subclinical/
elevated social anxiety and depression symptoms, high motives group.
Thus, there appears to be something unique about elevated/sub-
clinical social anxiety and depression, which is consistent with prior
work that found depression and social anxiety symptoms predicted
alcohol-related problems above that of general drinking quantity/
frequency (Bartholomay et al., 2023). However, once symptoms of
social anxiety and depression become elevated to a clinical level,
pregaming may occur less frequently, and thus, opportunities to
experience consequences on pregaming days may be reduced. This
has been found in studies of general drinking and social anxiety
(Book & Randall, 2002; Buckner & Heimberg, 2010) and depression
(Beck et al., 2008), which suggests that those with clinically elevated
symptoms avoid social situations and are less likely to be in large
social settings where heavy drinking occurs (e.g., crowded bars and
parties).
Findings also support the self-medication hypothesis (i.e.,
drinking to cope; Bravo & Pearson, 2017; Khantzian, 1997; Lewis
et al., 2008) in the context of pregaming, for which limited research
has shown preliminary support (Davis et al., 2020). Indeed, prior
work has found that coping-related motives are predictive of con-
sequences independent of general drinking quantity and frequency
(Merrill et al., 2014). Given that social anxiety does commonly co-oc-
cur with depression (Adams et al., 2016), our results demonstrate
that co-occurring social anxiety and depression is an important
TAB LE 4 Profile correlates with pregaming-related auxiliary variables.
(1) Mild/moderate
social anxiety
and depression
symptoms,
moderate motives
(n = 285; 59.5%)
(2) Minimal
social anxiety
and depression
symptoms, low
motives (2)
(n = 61; 12.7%)
(3) Subclinical/
elevated social
anxiet y and
depression symptoms,
high motives (n = 75;
15.6%)
(4) Clinically elevated
social anxiety
and depression
symptoms, moderate
motives (n = 58;
12.1%)
Sig differences*M (SE) M (SE) M (SE) M (SE)
Pregaming days 6.97 (0.23) 6.48 (0.53) 8.82 (0.64) 6.71 (0.50) 3 > all
Average number of drinks per
pregaming occasion
3.73 (0.16) 3.11 (0.31) 3.86 (0.33) 3.59 (0.33) No sig diff
Estimated pregaming blood
alcohol level (BAL)
0.11 (0.01) 0.09 (0.01) 0.12 (0.01) 0.11 (0.01) All >2
Proportion of pregaming days/
drinking days
0.74 (0.02) 0.70 (0.04) 0.86 (0.08) 0.69 (0.04) No sig diff
Consequences on pregaming
days
8.12 (0.33) 4.85 (0.64) 13.03 (0.74) 10.67 (0.78) 3 > all
4 > 1 and 2
1 > 2
Pregaming day blackouts 1.39 (0.19) 1.94 (0.35) 3.50 (0.58) 2.01 (0.38) 3 > all
Note: All auxiliary variables were assessed within a past 30-day period. Models controlled for age and sex.
*Significant at p < 0.05.
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SOCIAL ANXIETY, DEPRESSION, AND PREGAMING MOTIVES
consideration for targeting pregaming interventions. Though not
fully explicitly assessed in this study, the use of alcohol to cope with
mental health symptoms among college students is well established
(Park & Levenson, 2002). Coping-related drinking is a major risk
factor among individuals with mental health conditions for adverse
outcomes, including increased risk for alcohol-related problems
(Merrill et al., 2014; Walukevich-Dienst et al., 2022). Further, using
alcohol to cope with mental health symptoms also confers higher
risk for alcohol dependence, and thus greater symptomology later
on (Merrill et al., 2014). The findings that the minimal social anxiety
and depression symptoms, low motives profile had the lowest calcu-
lated BAL compared to all others, and reported fewer consequences
on pregaming days compared to all other groups helps to support
this idea; however, this profile still reported reaching BALs during
pregaming that are concerned (i.e., above 0.08) and reported about
five consequences in the past month. This points to the continued
need for interventions targeted toward preventing heavy drinking
during pregaming.
Our results have important clinical implications. Social anxiety
and depression symptoms are notable risk factors for pregaming
consumption and consequences. Interventions that have tradition-
ally focused on the social motives of drinking, such as social norms
interventions, can better target individuals with these symptoms
by incorporating more discussion around helping students get what
they want out of pregaming without needing to rely on it to cope
with their symptoms. For example, interventions might emphasize
that though “practicing” talking to new people is a main exposure
treatment for social anxiety (Horigome et al., 2020), doing so while
intoxicated is contraindicated, and independently seeking care
for social anxiety may help reduce social/coping-related drinking
(Thomas et al., 2007). Interventions may also benefit from target-
ing coping-related drinking among individuals with co-occurring so-
cial anxiety and depression symptoms. However, additional work is
needed in this area, as the measure used in this study to assess pre-
gaming motives was developed with a primarily socially motivated
sample who were likely not representative of those with high lev-
els of social anxiety and depression symptoms. Future work needs
to better assess for coping-related pregaming motives to identify
those at risk for alcohol-related consequences. Elucidating coping
motives further for pregaming may thus inform intervention imple-
mentation, which can include helping individuals who are at-risk for
coping-related pregaming and consequences to identify and em-
ploy alternate coping techniques. Attention to reducing pregaming
motives in general is an important potential intervention target in
reducing negative alcohol-related consequences for individuals
with elevated social anxiety and depression symptoms who report
heavy alcohol consumption. Importantly, our study identified the
group with subclinical yet elevated symptoms of social anxiety and
depression as experiencing the highest level of pregaming-related
negative consequences. Individuals who experience symptoms at
subclinical levels who may not be identified using only clinical cut-
off criteria may thus benefit most from intervention for symptoms
and drinking-related motives. Lastly, we see that despite moderate
motives and no changes in consumption, having more mental health
symptoms overall associates with higher risk for pregaming-related
consequences. Thus, pregaming interventions may improve efficacy
by conc ur rently ta rget ing pote nt ial underly in g social anxiet y and de-
pression symptoms.
Limitations, strengths, and future directions
This study has limitations to consider for directions in future re-
search. First, though we assessed motives for pregaming using a
well-established measure (LaBrie et al., 2012), we did not explicitly
assess mental health coping motives, which may be particularly rel-
evant. Though we draw inferences that social motives are adjacent
to coping for individuals with social anxiety in our sample, future
work may expand upon these findings to elucidate specific mecha-
nisms behind pregaming-related coping related to negative affect
and depression symptoms. We also do not report other high-risk
drinking behaviors that commonly occur in the context of pregam-
ing, such as drinking games or solitary drinking (Keough et al., 2016;
Walukevich-Dienst et al., 2022; Zamboanga et al., 2023). Though
also not explicitly assessed, socially motivated individuals with
social anxiety may be more likely to engage in solitary pregaming
and drinking (Keough et al., 2016). There is evidence that solitary
drinking and coping-related drinking are both associated with in-
creased alcohol dependence and negative consequences (Skrzynski
& Creswell, 2020; Waddell et al., 2022). Future work may untangle
pregaming behaviors further by examining such specific contexts of
pregaming drinking.
Analytically, the sample was limited in being majority White, cis-
gender, and female. Therefore, it is beyond the scope of this study
to assess meaningful demographic differences; this represents an
important direction for future research with more diverse samples.
Finally, data were cross-sectional; as such, we were unable to estab-
lish causality and could only report associations. Though analyses
captured heterogeneity within our sample with a latent variable ap-
proach, future nonintervention-based samples can use longitudinal
data to expand upon findings with latent transition analysis across
time points to determine causal relations between profiles and out-
comes of interest.
This study has a number of strengths that contribute meaning-
fully to the literature on pregaming in college students. We drew
from a heavy-drinking college student sample at high risk for alco-
hol-related consequences; results are thus especially relevant to
high-risk drinking groups, representing an important target group
for future intervention work in this area. We also used an advanced
latent variable modeling approach to establish heterogeneous pro-
files that may otherwise not have been captured by simple path
analysis or regression-based models, which few pregaming-related
studies have used to date (Zamboanga et al., 2023). We expand
upon these studies by combining a focus on mental health sympto-
mology and pregaming motives in associating with alcohol-related
consequences, and namely with blackout frequency, which is one
150
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FIT ZKE et al.
of the most severe consequences related to heavy-drinking behav-
iors (Hingson et al., 2016; Merrill et al., 2019) relevant to pregaming
(LaBrie et al., 2011). Thus, our results add to limited research sup-
porting the complex role of depression, social anxiety, and motives
in associating with pregaming behaviors and negative consequences.
CONCLUSION
This study illuminates heterogeneous profiles of pregaming motives
and mental health symptomology as they relate to pregaming con-
sumption and related negative consequences. Findings contribute to
a growing body of evidence that social anxiety and social motives
confer additional risk for consumption and motives during pregam-
ing drinking, and that mental health symptomology may confer risk
for alcohol-related consequences disparate from alcohol consump-
tion in the context of high-risk drinking behaviors. The interplay of
mental health and motives in relation to pregaming drinking is an
important area for future targeted interventions for heavy-drinking
college students.
ACKNOWLEDGMENTS
This work was funded by a grant from the National Institute on
Alcohol Abuse and Alcoholism (R34 AA025968 “Mobile Application
Intervention Targeting the High Risk Drinking Practice of
Prepartying”) awarded to Eric R. Pedersen.
CONFLICT OF INTEREST STATEMENT
The authors have no conflicts to declare.
DATA AVAIL AB ILI T Y STAT EME N T
The data that support the findings of this study are available from
the corresponding author upon reasonable request.
ORCID
Reagan E. Fitzke https://orcid.org/0000-0001-8815-7536
Jordan P. Davis https://orcid.org/0000-0002-6108-4936
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How to cite this article: Fitzke, R.E., Atieh, T., Davis, J.P.,
Canning, L., Tran, D.D., Buch, K. et al. (2024) A latent profile
analysis of social anxiety, depression, and pregaming motives
among heavy-drinking college students. Alcohol: Clinical and
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doi.org/10.1111/acer.15221
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