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Depression Research and Treatment
Volume 2011, Article ID 970169, 11 pages
doi:10.1155/2011/970169
Research Article
Hopelessness and Excessive Drinking among Aboriginal
Adolescents: The Mediating Roles of Depressive Symptoms and
Drinking to Cope
Sherry H. Stewart,1, 2 Simon B. Sherry,1, 2 M. Nancy Comeau,2Christopher J. Mushquash,2
Pamela Collins,2and Hendricus Van Wilgenburg3
1Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, 5909 Veteran’s Memorial Lane,
8th floor Abbie J. Lane Memorial Building, Halifax, NS, Canada B3H 2E2
2Department of Psychology, Life Sciences Centre, Dalhousie University, 1355 Oxford Street, Halifax, NS, Canada B3H 4J1
3School for Resource and Environmental Studies, Dalhousie University, Kenneth C. Rowe Management Building,
6100 University Avenue, Suite 5010, Halifax, NS, Canada B3H 3J5
Correspondence should be addressed to Sherry H. Stewart, sstewart@dal.ca
Received 31 May 2010; Accepted 7 August 2010
Academic Editor: Michael Sawyer
Copyright © 2011 Sherry H. Stewart et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Canadian Aboriginal youth show high rates of excessive drinking, hopelessness, and depressive symptoms. We propose that
Aboriginal adolescents with higher levels of hopelessness are more susceptible to depressive symptoms, which in turn predispose
them to drinking to cope—which ultimately puts them at risk for excessive drinking. Adolescent drinkers (n=551; 52%
boys; mean age =15.9 years) from 10 Canadian schools completed a survey consisting of the substance use risk profile scale
(hopelessness), the brief symptom inventory (depressive symptoms), the drinking motives questionnaire—revised (drinking to
cope), and quantity, frequency, and binge measures of excessive drinking. Structural equation modeling demonstrated the excellent
fit of a model linking hopelessness to excessive drinking indirectly via depressive symptoms and drinking to cope. Bootstrapping
indicated that this indirect effect was significant. Both depressive symptoms and drinking to cope should be intervention targets
to prevent/decrease excessive drinking among Aboriginal youth high in hopelessness.
1. Introduction
Alcohol misuse is a serious problem among many North
American Indigenous communities [1]. In Canada, the
Aboriginal1Peoples Survey [2] showed that 73% of First
Nations respondents reported that alcohol was a problem
in their communities. A recent review concluded that rates
of alcohol misuse are higher among American Indians than
among those in the general U.S. population, and that this is
true for both adults and adolescents [3]. For example, rates
of past month drunkenness are about twice as high among
Native American adolescents as among nonnative American
adolescents [3]. The 2002-03 First Nations Regional Lon-
gitudinal Health Survey [4] suggests this is also true for
Canadian Aboriginal people, for example, the proportion of
Aboriginals who reported weekly heavy drinking (5+ drinks
on a single occasion) was more than double that of those
in the general Canadian population (16.0% versus 7.9%,
resp.), despite the fact that when compared to the general
Canadian population, Aboriginals are less likely to be
current drinkers [5]. Some research suggests that Aboriginal
youth may be particularly susceptible to excessive drinking
[6].
These high rates of excessive drinking have many negative
consequences for Aboriginal communities. For example,
death related to alcohol use disorders is higher for Aboriginal
people than for other ethnic groups [7]. In fact, alcohol has
been identified as a leading case of adolescent morbidity and
mortality consequent to violence, falls, suicide, drowning,
motorvehicle accidents, and risky sexual behavior [8]. For
these reasons excessive drinking among Aboriginal youth
must be considered an important public health concern [9].
2Depression Research and Treatment
In addition to elevated rates of excessive drinking,
other problems faced by Aboriginal youth include high
levels of depressive symptoms (e.g., extreme sadness, loss
of interest, suicidality, and fatigue) and hopelessness (i.e.,
feelings of worthlessness and pessimism about the future).
Profound changes brought upon Aboriginal peoples through
colonialism have been linked to high rates of depressive
symptoms and suicide in many communities [10]. Examples
of such profound changes include geographic dislocation
and disruptions to their connections to the land and to
their traditional patterns of subsistence [1]. Depressive
symptoms and suicide appear to be particular problems for
Aboriginal youth [11]. Discrimination has been associated
with depressive symptoms in both American Indians adults
[12] and adolescents [13]. Abject poverty created by colonial
policies has resulted in a lack of control for Canadian
Aboriginal peoples, which has contributed to feelings of
hopelessness [6,14].
Cognitive theories of depression posit a key role to
hopelessness as an individual differences factor that sets the
stage for the development of depressive symptoms (e.g.,
[15,16]). While it is well established that hopelessness is a
risk factor for depression in nonAboriginal groups (e.g., [17–
19]), there is little data examining the impact of hopelessness
on depressive symptoms among Aboriginal peoples. One
cannot simply assume that hopelessness leads to a given
mental health outcome in the same way in Aboriginal
communities as it does in nonAboriginal groups (e.g., see
[20]).
It is well established in nonAboriginal people, that
depression and alcohol abuse/dependence commonly cooc-
cur (see reviews in [21–23]). American epidemiologic
surveys in the adult general population [24,25] show
significant odds ratios for depression comorbid with alcohol
use disorders indicating that the two disorders cooccur at
rates that far exceed chance. A number of studies have
confirmed a cooccurrence of depression and alcohol misuse
in nonAboriginal adolescents as well (see review in [23]). For
example, it has been shown that depression rates increase
from about 5% in American youth who abstain from alcohol
to about 24% in those who use alcohol at least weekly [26].
In nonAboriginals, hopelessness has been linked to
alcohol use and abuse in both adults and adolescents
(e.g., [18,19]), for example, a cross-sectional study found
that hopelessness in adolescents was significantly positively
related to lifetime alcohol use [27]. It was also shown that
hopelessness was associated longitudinally with alcohol use
and drunkenness over a one-year interval in a group of
Canadian adolescents [28]. In sum, there are clearly estab-
lished relations between hopelessness and depression with
excessive drinking in nonAboriginal youth. Data that directly
examines and tests the relationships between hopelessness,
depressive symptoms, and excessive drinking is lacking,
however, among Aboriginal adolescents.
A number of theoretical models have been proposed
to explain the relation between depression and alcohol
misuse (see reviews in [23,29]). One popular model is
self-medication [30], which posits that depressed individuals
drink to reduce negative emotions, and are thus at risk for
heavier drinking and more alcohol-related problems as a
consequence. Consistent with this theory, elevated depressive
symptoms in adolescence have been shown to predict future
alcohol use disorders (e.g., [31]), alcohol-related problems
(e.g., [32]), and alcohol use levels (e.g., [33]), for example, in
a study of 1545 Finnish twins, it was found that early onset
depressive disorder (at age 14 years) predicted later alcohol
use and recurrent intoxication (at age 17.5 years), even
after the effects of other substance use and other psychiatric
disorders were controlled [34].
Few studies, however, have tested the underlying mecha-
nism posited in self-medication theory—namely, drinking-
to-cope with negative emotions. In two separate groups
of nonAboriginal Canadian adolescents, it was shown that
consistent with self-medication theory predictions, drinking
to cope mediated the relations of both hopelessness and
depressive symptoms with alcohol-related problems [35].
It was concluded that both hopelessness and depressive
symptoms play a role in adolescent motivation for alcohol
use, with both reflecting a desire to diminish negative affect
[35]. However, the study did not test the possibility that
hopelessness might be related to drinking to cope indirectly
via its effects on depressive symptoms.
The purpose of the present study was to examine the
relations among four variables (i.e., hopelessness, depres-
sive symptoms, drinking to cope, and excessive drinking)
assessed cross-sectionally in a large group of Canadian
Aboriginal adolescent drinkers. We propose that Aboriginal
adolescents with higher levels of hopelessness are more sus-
ceptible to depressive symptoms, which in turn predispose
them to drinking to cope—a drinking motivation that puts
them at greater risk for excessive drinking. Thus, we specified
a structural equation model in which we hypothesized
(a) hopelessness would be directly linked to depressive
symptoms, (b) depressive symptoms would be directly linked
to drinking to cope, and (c) drinking to cope would be
directly linked to excessive drinking. We also specified three
meditational hypotheses. We expected (d) hopelessness to
be indirectly related to drinking to cope through depressive
symptoms, (e) depressive symptoms to be indirectly related
to excessive drinking through drinking to cope, and (f)
hopelessness to be indirectly related to excessive drinking
through depressive symptoms and drinking to cope. The
hypothesized structural model is depicted in Figure 1.
2. Materials and Methods
2.1. Participants. Participants were drawn from among 837
student respondents enrolled in any one of 10 participat-
ing schools in the Canadian provinces of Saskatchewan,
Manitoba, and Quebec. All participating schools contained
a large representation of Aboriginal students. Six schools
were from the Canadian province of Saskatchewan, two
from Manitoba, and two from Quebec (one from a Cree
and one from an Inuit community). Both urban (n=2)
and rural (n=8) schools were represented. Of the total 837
students, 286 (34%) indicated that they had not consumed
any alcohol in the last four months, leaving 551 participants
(66%) to be classified as “drinkers” (52% boys; mean age
Depression Research and Treatment 3
Depressive
symptoms
Hopelessness
Drinking
to cope
Excessive
drinking
Quantity
Frequency
Binge
Figure 1: The hypothesized structural model. Rectangles represent manifest variables; ovals represent latent variables. Black arrows represent
hypothesized direct effects; grey arrows represent paths hypothesized to be explained by indirect effects. Quantity =drinking quantity;
Frequency =drinking frequency; Binge =binge drinking.
15.9 yrs., SD =1.3, range =14–18; mean grade =9.4, SD =1.2,
range =7–12). Of the 551 drinkers, 178 (32%) self-identified
as Cree, 91 (16%) as Ojibway, 57 (10%) as Metis, 32 (6%)
as Oji-Cree, and 25 (5%) as Dakota. A further 29 (5%)
were classified as “Other Aboriginal”.2Also included among
the drinkers, due to their attendance at the participating
schools, were 63 (12%) students who self-identified as
Caucasian or Black.3A further 76 (14%) drinkers skipped
the race/ethnicity question altogether.4Of the 551 drinkers,
326 (59%) were from schools in Saskatchewan, 168 (31%)
from schools in Manitoba, and 57 (10%) from schools
in Quebec. Only the data provided by the 551 drinkers
were employed in all subsequent analyses. Abstainers were
excluded from completing the measure of drinking to cope
because the measure used requires that respondents have at
least some relatively recent drinking experience to answer
items enquiring about why they drink. The inclusion of even
infrequent, light drinkers (e.g., those having consumed only
one drink in the last four months) ensured that the results
would be applicable to a wide range of adolescent drinkers
from participating schools (see [36]).
2.2. Measures
2.2.1. Substance Use Risk Profile Scale (SURPS). The SURPS
[19] is a 23-item self-report scale designed to measure four
individual difference factors, including hopelessness, each
of which has been shown to be related to risk for alcohol
use/misuse. Participants are asked to rate the degree to which
they agree with each item on a scale ranging from 1 =strongly
disagree to 4 =strongly agree. A sample hopelessness scale
item is “I feel that I am a failure.” The SURPS hopelessness
score is calculated by summing across all 7 hopelessness items
following reverse scoring of several inverselykeyed items.
The SURPS has been shown to have a stable four factor
structure and the four scales have been found to have good
internal consistency and good construct validity in nonclin-
ical adolescents recruited through Canadian schools [19]. In
particular, the hopelessness scale shows significant bivariate
correlations with depressive symptoms, drinking to cope,
drinking quantity, drinking frequency, binge drinking, and
alcohol-related problems in nonAboriginal Canadian youth
[19]. The SURPS hopelessness scale has also been shown to
correlate significantly with lifetime alcohol involvement in a
group of American adolescents [27]. In the present study, the
internal consistency of the hopelessness scale was acceptable
at α=.78.
2.2.2. Depression Subscale of the Brief Symptom Inventory
(BSI-DEP). The BSI-DEP [37] is a 7-item measure that
assesses depressive symptoms. The full BSI was developed as
a brief version of its longer parent instrument, the 90-item
Symptom Check List—Revised (SCL-90-R; [38]. Each item
is rated on a scale ranging from 0 =not at all to 4 =extremely.
A sample BSI-DEP item is “Feeling no interest in things.”
The BSI-DEP total score was calculated by summing across
all seven depression items. Factor analytic studies of the BSI
suggest good structural validity (e.g., all BSI-DEP items show
salient loading on a single depression factor). Both test-retest
reliability and internal consistency are high for the BSI-DEP
scale and it correlates well with the depression scale from the
original SCL-90-R. Moreover, the BSI-DEP scale shows high
convergence with other established depression scales [37].
While there are many validated measures of depression for
use in adolescents, we chose the BSI-DEP scale mainly for
its brief length (i.e., 7 items) in order to reduce participant
burden. In the present study, the internal consistency of the
BSI-DEP was good at α=.86.
2.2.3. Drinking Motives Questionnaire—Revised (DMQ-R).
The DMQ-R [39] is a 20-item self-report measure that taps
four distinct motivations for alcohol use among adolescents,
including drinking to cope. Respondents indicate their
relative frequency of alcohol use in each of the indicated
circumstances, when they drink. Each subscale consists of
fiveitemswhichareratedonascalerangingfrom1=almost
never/never to 5 =almost always/always. Subscale scores are
computed as the mean of the relative frequency ratings for
each of the five items on each subscale [39–41]. The drinking
to cope scale measures drinking to reduce or avoid a range
of negative affective states and consists of items such as
“Because it helps you when you feel depressed or nervous.”
Prior work shows that the drinking to cope scale is associated
both with excessive drinking and with adverse consequences
of drinking among groups of American, Swiss, and Canadian
adolescents [39,42]. The drinking to cope scale has also
been shown to have good internal consistency and structural
validity among Canadian Aboriginal adolescents [43]. In the
present study, the internal consistency of the drinking to cope
scale was good at α=.81.
4Depression Research and Treatment
2.2.4. Excessive Drinking. Excessive drinking was indexed
with three items assessing degree of alcohol use in the last
four months (see also [19]). First, participants indicated
the number of alcoholic beverages they normally consumed
per drinking day; this index was referred to as drinking
quantity. Participants were informed with visual and verbal
cues that one drink equals one bottle/can of beer, one small
glass of wine, one shot of hard liquor, or one cooler. Next,
participants reported how often they normally consumed
alcohol; this index was referred to as drinking frequency.
Finally, participants indicated how often they normally
consumed 5+ drinks in a single sitting (4+ drinks for girls);
this index was referred to as binge drinking. Each item was
rated on a scale of 1–5, such that high scores on each
of the three measures index higher levels of excessive (i.e.,
more frequent, heavy, or intense) drinking. Response options
for the quantity item were 1 =1or2,2=3or4,3=5or
6, 4 =7to9,and5=10 or more. Response options for
the frequency item were 1=less than monthly, 2 =once per
month, 3 =2 to 3 times per month, 4 =weekly, and 5 =daily
or almost daily. Response options for the binge item were
1=never, 2 =less than monthly, 3 =monthly, 4 =weekly,
and 5 =daily or almost daily. Previous research has found
adequate reliability of self-reported alcohol consumption
measures across a broad range of response formats [44].
Nonetheless, recommended methods were used to enhance
the accuracy of participants’ self-reports [45]. Specifically,
drinking behavior items were embedded within other ques-
tions on demographics to minimize their salience. Moreover,
since extensive evidence supports the validity of self-reported
alcohol use when participants are assured confidentiality
[46], students were verbally assured confidentiality prior
to survey completion. In the present study, this three item
measure showed acceptable internal consistency (α=.79).
2.3. Procedure. This study was part of a larger project on
alcohol abuse prevention in the 10 participating schools.
The project received approval from the Dalhousie Health
Sciences Human Research Ethics Board (protocol no.: 2007-
1628) and Health Canada’s Research Ethics Board (protocol
no.: 2007-0026). Recruitment occurred through the active
process of relationship- and partnership-building with the
communities involved. Policing partners and other com-
munity members (e.g., Elders) approached the investigators
upon learning of our previous alcohol abuse prevention
work in Aboriginal (i.e., Mi’kmaq) communities in Nova
Scotia [47]. Essentially, community partners self-identified
for inclusion in the larger project. Community partners
then identified schools that would be interested in being
involved. This study engaged Aboriginal youth (grades 7–12)
through its grounding in the school system of the Aboriginal
community. Reflecting the deep value of Elders’ knowledge
of the participating communities, the project was arranged to
encourage meaningful participation among school partners,
policing partners, and study investigators.
School administration partners advised as to the
method of distributing information about the study to
parents/guardians of students in grades 7–12 in partici-
pating schools, prior to administration of the survey. An
information sheet describing the study was sent in a mail-
out directly to parents/guardians. Parents/guardians were
encouraged to contact the researchers or school principal
for any further information they desired about the study.
Parents/guardians were asked to let the researchers/school
principal know if they did not consent to having their child
participate (i.e., a negative consent procedure was used).
Parents/guardians were provided with a toll-free number to
contact the researchers for additional information, if they so
desired.
School administration partners at each site also advised
as to whether announcements describing the study should
be delivered school-wide through the loud-speaker sys-
tem along with regular morning announcements and/or
delivered by individual classroom teachers. Prior to survey
administration, students were informed about the nature of
the study, and willing students provided written informed
consent at the time of the survey. Consent forms were
maintained separately from the completed questionnaires
to ensure confidentiality and anonymity. Students were
informed that the purpose of the survey was to investigate
individual differences in reasons for alcohol use.
The student consent form provided potential partici-
pants with information about the purpose of the survey,
as well as the voluntary and confidential nature of the
questions. Students were told that they were free to decline
to participate and free to withdraw at any time. Those who
declined participation were invited to the school library
(under the librarian’s supervision) or were asked to remain
seated and read while their classmates were completing the
survey. All students in grades 7–12 in participating schools
were invited to take part in the survey. Approximately 20
students in total declined study participation resulting in a
very high response rate (approximately 98% from among
eligible students who were attending school on the day of
survey administration). Data collection was conducted on a
grade-by-grade basis during class time, with the permission
and input of the school principal. Data collection was
led by one of the coauthors (MNC). Following survey
administration, the researcher leading the data collection
offered a brief presentation on psychology research. No
feedback was given to parents, teachers, or students regarding
individual students’ scores. Teachers had the option of
remaining in the classroom at the time of the survey.
Measures were administered in a standard order as follows:
demographics, excessive drinking indices, BSI-DEP, DMQ-
R, and SURPS. During questionnaire completion, students
were permitted to ask questions of the researchers. The
small minority of students who had difficulties with reading
were offered assistance in reading the survey questions
by trusted teachers or classroom aides. Translation into
French was provided for the students in the Cree school in
Quebec.
In order to protect any student from being singled
out and labeled, the survey was anonymous. To maintain
anonymity and confidentiality, students were asked not
to write their names on the forms. The toll-free number
mentioned above that was established for parent commu-
nication was also offered to students in case they had
Depression Research and Treatment 5
Tab le 1: Descriptive statistics and bivariate correlations between study measures.
(1) (2) (3) (4) (5) (6) Mean (SD)
(1) Hopelessness — 14.1 (4.0)
(2) Depressive symptoms .42∗∗ — 7.4 (5.9)
(3) Drinking to cope .26∗∗ .39∗∗ — 2.1 (0.9)
(4) Drinking quantity .12∗∗ .02 .25∗∗ — 3.4 (1.4)
(5) Drinking frequency .14∗∗ .13∗∗ .30∗∗ .49∗∗ — 2.7 (1.1)
(6) Binge frinking .13∗∗ .10∗.30∗∗ .56∗∗ .73∗∗ — 2.8 (1.0)
Note. Sample sizes vary from 486 to 531 due to missing data on various study measures.∗P<.05. ∗∗P<.01.
had any questions about the survey forms in particular,
or about the research project more generally. The privacy
of each call was ensured because one of the coauthors
(M. N. Comeau) was the only person who took the calls.
Although participants were not compensated financially,
survey administrations were concluded with a snack or meal.
By integrating an educational component into data collec-
tion and engaging the students, they had the opportunity
to participate in a project where the ultimate goal was to
develop future culturally relevant alcohol abuse prevention
efforts that are more meaningful to the lives of youth in their
communities.
3. Results
3.1.DescriptiveStatisticsandBivariateCorrelations.Mean
(and SD) scores on each of the study measures for the
total group of 551 drinkers are displayed in the right hand
column of Table 1. The descriptive statistics for the three
excessive drinking indices suggest that the average student
was drinking relatively frequently, heavily, and intensely
(i.e., drinking 2 to 3 times per month, consuming 5 or
6 standard drinks on each drinking occasion, and binge
drinking monthly).
Bivariate correlations between the various study mea-
sures are also shown in Table 1. All study measures were
significantly intercorrelated with one exception: depressive
symptoms were not significantly correlated with drinking
quantity. Several of the correlations among study variables
were moderate to strong. However, multicollinearity and
redundancy of variables are only a concern when correlations
exceed 90 [48]. While the data in Table 1suggests some
expected overlap between several of the study variables
(e.g., 24%–53% shared variance between the three indices
of excessive drinking), none of the variables should be
considered redundant. It is important to note that the
correlation between hopelessness and depressive symptoms
was significant (r=.42, P<.01) but did not approach the
strength at which there would be concern about multi-
collinearity or redundancy. This result lends support to our
conceptualization of hopelessness and depressive symptoms
as distinct constructs.5
3.2. Structural Equation Modeling (SEM). SEM was con-
ducted using AMOS 7.0 [49]. Full information maximum
likelihood estimation was utilized to deal with missing data
[50]. For the structural model, fit was evaluated via multiple
indices [51]. Adequate fit is indicated by a chi-square/degrees
of freedom ratio (χ2/df ) around 2, a comparative fit
index (CFI) and an incremental fit index (IFI) around .95,
and a root-mean-square error of approximation (RMSEA)
around .06 [52]. We report the RMSEA value along with 90%
confidence intervals (90% CI).
Three manifest variables were selected to represent
the excessive drinking latent variable: drinking quantity,
drinking frequency, and binge drinking. Each observed
variable showed substantial and significant loadings (ranging
from .63 to .89) on the excessive drinking latent variable.
Fit indices also suggested the structural model fit the data
well: χ2(6, N=551) =12.93, P<.05; χ2/df =2.16; CFI =.99;
IFI =.99; RMSEA =.05 (90% CI: .01,.08). The final model
is depicted in Figure 2with significant paths indicated
with black arrows and nonsignificant paths indicated with
grey arrows. As hypothesized, (a) hopelessness was directly
linked to depressive symptoms, (b) depressive symptoms
were directly linked to drinking to cope, and (c) drinking to
cope was directly linked to excessive drinking (see Figure 2).
These three above-mentioned direct paths were significant,
substantial, and consistent with the hypothesized structural
model(seeFigure1). Congruent with two of the mediational
hypotheses, depressive symptoms were unrelated to excessive
drinking, and hopelessness was unrelated to excessive drink-
ing (see Figure 2). Unexpectedly though, hopelessness was
directly linked to drinking to cope (P<.05; see Figure 2). It
should be noted, however, that while the direct relationship
between hopelessness and drinking to cope was significant, it
was not much different in magnitude than the nonsignificant
relationship between hopelessness and excessive drinking
(see Figure 2).
A significant indirect effect indicates that mediation has
taken place [53]. We used bootstrap analyses to test the
significance level of the three hypothesized indirect effects
(see Figure 1). For each test of indirect effects, we used
random sampling replacement to create 20,000 (n=551)
bootstrap samples. These samples were then utilized to esti-
mate bias-corrected standard errors for each hypothesized
indirect effect in question. In the case of the indirect path
from hopelessness to excessive drinking, the indirect effect
was based on all paths and was computed by multiplying
(a) path coefficients from the predictor to mediators and (b)
path coefficients from mediators to the criterion. In addition,
CIs were computed. An indirect effect may be described as
significant (P<.05) when the 95% CI for this indirect effect
does not include zero.
6Depression Research and Treatment
Depressive
symptoms
Hopelessness
Drinking
to cope
Excessive
drinking
Quantity
Frequency
Binge
0.41
0.11
0.35
−0.07
0.1
0.36
0.63
0.82
0.89
Figure 2: The hypothesized structural model. Rectangles represent manifest variables; ovals represent latent variables. Black arrows
represent significant paths (i.e., P<.05). Grey arrows represent nonsignificant paths (i.e., P>.05). Path coefficients are standardized.
Quantity =drinking quantit y; Frequency =drinking frequency; Binge =binge drinking.
Tab le 2: Bootstrap analyses of hypothesized indirect effects.
Bootstrap estimates
Hypothesized Indirect effect Unstandardized
indirect effect
Standardized
indirect effect
SE for standardized
indirect effect
95% confidence interval
for standardized indirect
effect (lower and upper)
Hopelessness to drinking to cope
through depressive symptoms .167 .143 .025 .094, .192∗
Depressive symptoms to excessive
drinking through drinking to cope .019 .123 .025 .074, .173∗
Hopelessness to excessive
drinkinga.013 .059 .029 .002, .116∗
Note. SE =bias-corrected standard error. aindirect effect is based on all indirect paths. ∗Confidence intervals excluding zero are significant at P<.05.
First, we tested the indirect effect of hopelessness on
drinking to cope. Bootstrap estimates indicated this hypoth-
esized indirect effect was significant: β=.143, B=.167, (95%
CI: .094, .192), and SE =.025. That is, the indirect effect
of hopelessness on drinking to cope through depressive
symptoms was significant (see Table 2). Next, we tested
the indirect effect of depressive symptoms on excessive
drinking. Bootstrap estimates indicated this hypothesized
indirect effect was also significant: β=.123, B=.019, (95%
CI: .074, .173), and SE =.025. Put differently, the indirect
effect of depressive symptoms on excessive drinking through
drinking to cope was significant (see Table 2). Finally,
we tested the indirect effect of hopelessness on excessive
drinking. Bootstrap estimates indicated this hypothesized
indirect effect was again significant: β=.059, B=.013, (95%
CI: .002, .116), and SE =.029. That is, the indirect effect
of hopelessness on excessive drinking through depressive
symptoms and drinking to cope was significant (see Table 2).
In sum, results suggest the hypothesized structural model
is a well-fitting model that is consistent with the expected
pattern of direct and indirect effects in this group of
Canadian Aboriginal adolescent drinkers (see also Endnote
5).
4. Discussion
Consistent with hypotheses, hopelessness was directly linked
to depressive symptoms. This finding replicates, in an
Aboriginal adolescent group, much previous work linking
hopelessness with depression in nonAboriginal groups [17–
19]. This is an important finding since hopelessness has not
always been linked to mental health outcomes in Aboriginal
groups in the same way it has been in nonAboriginal groups
(e.g., [20]). The finding of a direct path from hopelessness
to depressive symptoms within the structural model is
consistent with predictions of models positing a key role
for hopelessness as a cognitive risk factor for depression
(e.g., [15,16]). The discrimination, disruptions to family
connections, geographic dislocation, and abject poverty
arising from colonial policies have resulted in social and
economic circumstances which are often objectively bleak
for Canadian Aboriginal people, setting the stage for the
development of hopelessness [6,14]. But even Beck’s model
of depression acknowledges that such negative cognitions
are not always distorted or inaccurate—merely that they
are maladaptive in terms of increasing risk for depressive
symptoms [54].
The present finding linking depressive symptoms directly
to drinking to cope replicates, in Canadian Aboriginal ado-
lescents, previous findings from nonAboriginal adolescents
showing that depressive symptoms were related to drinking
to cope with negative emotions [35]. The structural model
also pointed to two ways in which hopelessness is linked to
drinking to cope: the hypothesized indirect relation through
depressive symptoms and an additional (unexpected) direct
relation. This suggests that Aboriginal youth with higher
levels of hopelessness are at increased risk of drinking to
cope for two reasons. First, they are at risk of developing
depressive symptoms which may motivate them to drink
to eliminate or numb those unpleasant feelings. Second,
hopeless individuals may attempt to block their pessimistic
thoughts through drinking. It can be concluded, consistent
Depression Research and Treatment 7
with findings in nonAboriginal Canadian adolescents, that
both hopelessness and depressive symptoms play a role in
Aboriginal adolescents’ motivations for alcohol use [35],
with both reflecting a desire to diminish unpleasant cogni-
tions or emotional states.
The third hypothesized direct effect in the current study
was a path from drinking to cope to excessive drinking.
Cooper’s model of adolescent drinking motives contends
that drinking to cope is a particularly risky motivation for
drinking that sets teens up for greater rates of excessive
drinking and drinking-related problems [39]. The present
finding showing a significant and substantial direct path
between drinking to cope and excessive drinking in a
Canadian Aboriginal group adds to the growing literature
suggesting that the link between drinking to cope and
excessive drinking persists cross-culturally [42].
As hypothesized, the relation of depressive symptoms
to excessive drinking was indirect—an effect mediated
through drinking to cope. This finding contributes to the
understanding of the significant overlap between depression
and alcohol use disorders in adults and adolescents alike
[23] by suggesting one possible mechanism underlying
this relationship. Specifically, the present findings suggest
that adolescents with higher levels of depressive symptoms
drink to excess more so than other adolescents because
they are drinking to alleviate or numb negative emotions.
This finding is consistent with the negative reinforcement
mechanism postulated in self-medication theory [30]to
explain the overlap of depressive symptoms and excessive
drinking. The lack of a relation between depressive symp-
toms and drinking quantity in the bivariate correlations is,
however, inconsistent with some previous research which has
demonstrated such a link [55]. Nonetheless, this previous
research was conducted with nonAboriginal adults rather
than Aboriginal adolescents.
Previous cross-sectional and longitudinal research with
nonAboriginal youth suggests a relationship between hope-
lessness and excessive drinking [19,27,28]. Consistent
with hypothesis, the path from hopelessness to excessive
drinking in the present study was indirect—mediated
through depressive symptoms and drinking to cope. It is
interesting to consider this finding in relation to another
model (alternative to the meditational model tested herein)
that has been posited to account for the high overlap
of depression and alcohol disorders—namely the common
factors model [23,29]. Specifically, it has been suggested
that a third factor or common underlying vulnerability (such
as hopelessness) contributes to the apparent association
between depression and excessive drinking ([e.g., [17]). In
other words, hopelessness is thought to independently and
directly contribute to the development of both depressive
symptoms and excessive drinking creating an apparent
association between the latter two variables. The present
findings are inconsistent with the common factors model
given that we did not observe any direct relation between
hopelessness and excessive drinking. Instead, the association
between hopelessness and excessive drinking was indirect,
and mediated through depressive symptoms and drinking to
cope.
Two comments should be made on the composition
of our study group. Although data were collected across
three Canadian provinces, from both urban and rural
communities, and included distinct Aboriginal groups (i.e.,
First Nation, Inuit, and M´
etis), national representation and
ability to generalize across all Canadian Aboriginal groups
were nonetheless limited. While initially this may appear
a limitation of the present study, this criticism would be
misguided. For example, in Canada, there are 11 major
Aboriginal language families and 65 distinct dialects [56].
To expect that there is a singular, representative, and general
Aboriginal group in Canada, to which all results would apply,
only serves to perpetuate biases that all Aboriginal groups
are the same. While there are significant similarities that
might be related to alcohol misuse (e.g., discrimination,
disruptions to family connections, geographic dislocation,
and abject poverty), all Aboriginal groups have rich cultures
and histories that are unique.
Second, participants in the present study did not entirely
consist of Aboriginal youth, and included at least 12% of
student drinkers who were nonAboriginal (see Endnotes 3
and 4). However, the 10 participating schools were schools
with high proportions of Aboriginal students, and the
large majority of the study participants were Aboriginal.
The decision to include all student drinkers regardless
of ethnicity/race was consistent with the wishes of our
community partners (see Endnote 3) and enhanced our
ability to generalize the findings to a wide variety of students
attending such schools in Canada.
Several potential limitations to the present study should
be acknowledged, each of which suggests important avenues
for future research. The study was cross-sectional in nature
and lies in contrast with the time frame of the theoretical
model, which implies unfolding of relations between the
study variables over time (i.e., hopelessness leading to the
later development of depression, which leads to the eventual
development of drinking to cope, which in turn results in
excessive drinking). While this cross-sectional analysis is a
first step in testing the utility of the proposed structural
model, the model still requires further investigation within
a multiwave longitudinal design [57]. Second, the proposed
model is linear and unidirectional and does not acknowledge
the possible reciprocal relations between study variables over
time. For example, it is possible that excessive drinking
actually increases depressive symptoms and/or hopelessness
in the longer term either through the physiological or
psychological consequences of heavy drinking [58]. It is
also possible that depressive symptoms cause increases in
hopelessness [59]. Such more complex reciprocal relations
between study variables over time could be tested using
longitudinal methods and multiwave data (e.g., see [60]),
consistent with calls for examination of more complex
models in Aboriginal alcohol research [61].
A third possible limitation is that study measures were
developed for use with nonAboriginal adolescents and not
all have been investigated in terms of their psychometric
properties when used with Aboriginal youth. Nonetheless,
all showed good internal consistency in the present study
and some (e.g., DMQ-R coping motives subscale; [43]) have
8Depression Research and Treatment
been previously validated in Aboriginal adolescents. Fourth,
all study variables were assessed via retrospective self-report
which may be subject to various biases including memory
distortions and social desirability. Nevertheless, we did use
methods for increasing the accuracy of participants’ reports
(e.g., [45]) and studies using other methodologies have
shown similar results (e.g., sad mood induction leading to
increased drinking in the lab among female young people
who drink to cope; [62]). A forth potential limitation was
that drinking to cope was assessed with a “generic” coping
motives scale [39]. More recently, a measure has been
developed and validated that distinguishes drinking to cope
with depression from drinking to cope with anxiety [63]; this
refined measure might be useful for future studies in this
area.
Fifth, the present study did not consider potential
moderators. For example, given known gender differences in
depressive symptoms (greater in females [64]), drinking to
cope with depression (greater in females [65]), and excessive
drinking (greater in males [66]), future research should
examine whether the hypothesized model is moderated
by gender. Moreover, given recent evidence that resilience
(individual, family, and community; [67]) buffers the effects
of violence exposure on symptoms of posttraumatic stress
disorder in Aboriginal youth [68], resilience might prove a
useful variable to examine in future as a moderator in our
proposed model. In particular, the construct of resilience
might prove useful in further research to understand how
some Aboriginal youth fare so well in terms of their
emotional and behavioral health in spite of the gross social
inequities they face daily in their environments. Given such
a complex and multidimensional issue as excessive drinking
among Aboriginal youth, it is likely that many environmen-
tal, interpersonal, and individual risk and protective factors
will be found to play moderating roles in the preliminary
model tested herein. Finally, the present study only focused
on one possible pathway to excessive drinking in Aboriginal
youth. While the present results do suggest that hopelessness
may be one risk factor for excessive drinking in Aboriginal
adolescents, other studies support additional risk pathways.
For example, a recent study showed that exposure to violence
was related to excessive drinking in Aboriginal youth and that
this relation was mediated by symptoms of posttraumatic
stress disorder rather than depressive symptoms [69].
The present findings of an indirect relation between
hopelessness and excessive drinking suggest that targeted
interventions for Aboriginal youth who are high in hopeless-
ness are needed to prevent or decrease excessive drinking.
The meditational results can be helpful for informing the
content of such preventative or early interventions [70].
Mediational findings from the present study suggest the
need to focus on depressive symptoms and maladaptive
drinking to cope in targeted interventions for Aboriginal
youth with high levels of hopelessness. Additionally, the
unexpected direct path from hopelessness to risky drinking
to cope suggests that hopeless cognitions may need to
be a direct target in such preventative interventions as
well. Cognitive practitioners would need to be particularly
mindful of the objectively difficult circumstances facing
many Canadian Aboriginal youth which set the stage for
maladaptive, but not necessarily irrational, hopeless thinking
styles. The direct effect of hopelessness on risky drinking to
cope also points to the importance of primary prevention
efforts (e.g., improving schools, developing sustainable local
economies grounded in natural resources, and providing
better education and employment opportunities) to deter
the development of hopelessness among Aboriginal youth.
A comprehensive approach to the problem of excessive
drinking would pair community-wide primary prevention
with school-based secondary prevention targeted toward
high risk (e.g., high hopeless) youth.
A cognitive-behavioral secondary prevention program
focusing on hopelessness, depressive symptoms, and drink-
ing to cope has been tested in the form of a school-based
intervention among nonAboriginal youth via two random-
ized controlled trials (RCTs). The intervention targeting
adolescents with high levels of hopelessness was shown
to increase alcohol abstinence, decrease problem drinking
[71], and reduce depressive symptoms [72]. More recently,
this approach has been culturally adapted and has shown
promise for reducing excessive and problematic drinking
in a group of Canadian Aboriginal youth in an open trial
[47]. The culturally adapted intervention still needs to be
tested in an RCT. Such a trial could also test if intervention-
induced changes in depressive symptoms, drinking to cope,
and/or hopelessness mediate intervention-induced changes
in excessive drinking among youth high in hopelessness at
baseline. This would prove an even more stringent test of the
theoretical model supported in the present study.
5. Conclusions
In sum, we used structural equation modeling to demon-
strate the excellent fit of a model which links hopelessness
to excessive drinking indirectly via depressive symptoms and
drinking to cope in Canadian Aboriginal youth. Bootstrap-
ping indicated that this indirect effect of hopelessness on
excessive drinking was significant. Both depressive symptoms
and drinking to cope should be intervention targets in
school-based programs designed to prevent or decrease
excessive drinking among Aboriginal youth with high levels
of hopelessness.
Acknowledgments
This project was supported in part by a funding agreement
from the First Nations and Inuit Health Branch, Health
Canada held in partnership with Dr. M. Nancy Comeau,
Dr. Sherry H. Stewart, and Christopher J. Mushquash as
well as a funding agreement from Justice Canada held
in partnership with Dr. M. Nancy Comeau, Dr. Sherry
H. Stewart, and Pamela Collins. Dr. Stewart was sup-
ported through a Killam Research Professorship from the
Dalhousie University Faculty of Science at the time this
research was conducted. Christopher Mushquash is sup-
ported through doctoral awards from the Atlantic Aboriginal
Health Research Program and the National Network for
Aboriginal Mental Health Research. The authors would like
Depression Research and Treatment 9
to extend their thanks to the many community partners who
contributed to making this project a success including Elders,
policing partners, principals and teachers at the participating
schools, as well as the student participants themselves. We
would also like to thank Brian McLeod of Strongheart
Teaching Lodge Incorporated for his assistance in facilitating
the project.
Endnotes
1. Aboriginal people can include First Nations, Inuit, and
M´
etis peoples as recognized by the Constitution of
Canada [73]. In this paper, we use the term Aboriginal
to refer collectively to people from all three groups. Oth-
erwise, we specify the particular Aboriginal/Indigenous
group in question.
2. The “Other” Aboriginal category included youth who
self-identified as belonging to the following Abo-
riginalgroups:Nakota,Inuit,Nakota-Cree,Cree-
Saulteaux, Saulteaux, Assiniboine, Sioux, Dene, Nakota-
Assiniboine, Cree-Metis, and Ojibway-Black.
3. All students at the six participating Saskatchewan
schools were invited to be involved in the research
including a number of Caucasian youth and a few
Black youth. Elders and school partners stressed the
importance of including all students in the study in
order to demonstrate a cultural value of connectedness
and collaboration rather than risk marginalization and
stigmatizing of certain groups by exclusion from the
study. Three of the six Saskatchewan schools included
students from First Nations communities encompassed
within the provincial government education division;
the three other Saskatchewan schools included students
from First Nations communities governed within the
educational jurisdiction of the Tribal Council. The
respectful cooperation among school governance part-
ners to implement this study is noteworthy.
4. This relatively high rate of missing data for the ethnic-
ity/race item is likely due to the manner in which the
question was structured. Students were provided five
options which consisted of the five groups we expected
to be most represented in the total group of students
based on consultation with Elders and school partners
(i.e., Cree, Ojibway, Metis, Oji-Cree, and Dakota). If
students did not self-identify with one of these five
groups, they were asked to specify their ethnicity/race
in an open-ended item placed on the survey itself. It
appears that many students either did not understand
the instructions for this item or did not wish to provide
this information to the investigators.
5. The first and second authors, both of whom are
registered clinical psychologists, independently rated
the BSI-DEP items for potential overlap with the
hopelessness construct. Both raters agreed that there
was only one BSI-DEP item that could be considered
redundant with hopelessness (i.e., BSI-DEP item 5 “I
am hopeless about the future”). Our central analysis
(i.e., the hypothesized structural model depicted in
Figure 1) was rerun after rescoring the BSI-DEP with
this overlapping item removed. We found our results
were virtually unaltered when using a version of the
BSI-DEP that dropped this overlapping (redundant)
item. Detailed results of this supplementary analysis are
available from the first author upon request.
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