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Hopelessness and Excessive Drinking among Aboriginal Adolescents: The Mediating Roles of Depressive Symptoms and Drinking to Cope

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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.
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Hindawi Publishing Corporation
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 eect 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 dierences 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 [2123]). 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 eects 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 aect
[35]. However, the study did not test the possibility that
hopelessness might be related to drinking to cope indirectly
via its eects 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 eects; grey arrows represent paths hypothesized to be explained by indirect eects. 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 dierence 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
veitemswhichareratedonascalerangingfrom1=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 [3941]. The drinking
to cope scale measures drinking to reduce or avoid a range
of negative aective 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 dierences 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
oered 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 diculties with reading
were oered 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 oered 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
eorts 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 dierent in magnitude than the nonsignificant
relationship between hopelessness and excessive drinking
(see Figure 2).
A significant indirect eect indicates that mediation has
taken place [53]. We used bootstrap analyses to test the
significance level of the three hypothesized indirect eects
(see Figure 1). For each test of indirect eects, 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 eect in question. In the case of the indirect path
from hopelessness to excessive drinking, the indirect eect
was based on all paths and was computed by multiplying
(a) path coecients from the predictor to mediators and (b)
path coecients from mediators to the criterion. In addition,
CIs were computed. An indirect eect may be described as
significant (P<.05) when the 95% CI for this indirect eect
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 coecients are standardized.
Quantity =drinking quantit y; Frequency =drinking frequency; Binge =binge drinking.
Tab le 2: Bootstrap analyses of hypothesized indirect eects.
Bootstrap estimates
Hypothesized Indirect eect Unstandardized
indirect eect
Standardized
indirect eect
SE for standardized
indirect eect
95% confidence interval
for standardized indirect
eect (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 eect is based on all indirect paths. Confidence intervals excluding zero are significant at P<.05.
First, we tested the indirect eect of hopelessness on
drinking to cope. Bootstrap estimates indicated this hypoth-
esized indirect eect was significant: β=.143, B=.167, (95%
CI: .094, .192), and SE =.025. That is, the indirect eect
of hopelessness on drinking to cope through depressive
symptoms was significant (see Table 2). Next, we tested
the indirect eect of depressive symptoms on excessive
drinking. Bootstrap estimates indicated this hypothesized
indirect eect was also significant: β=.123, B=.019, (95%
CI: .074, .173), and SE =.025. Put dierently, the indirect
eect of depressive symptoms on excessive drinking through
drinking to cope was significant (see Table 2). Finally,
we tested the indirect eect of hopelessness on excessive
drinking. Bootstrap estimates indicated this hypothesized
indirect eect was again significant: β=.059, B=.013, (95%
CI: .002, .116), and SE =.029. That is, the indirect eect
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 eects 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 eect 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 eect 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 dierences 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]) buers the eects
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 dicult circumstances facing
many Canadian Aboriginal youth which set the stage for
maladaptive, but not necessarily irrational, hopeless thinking
styles. The direct eect of hopelessness on risky drinking to
cope also points to the importance of primary prevention
eorts (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 eect 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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... Brockie et al. (2015) found that Indigenous youth who reported high rates of historical loss were at an increased risk for depressive symptoms, PTSD symptoms, and substance use. Additionally, Stewart et al. (2011) found that depressive symptoms were directly linked to drinking to cope, which in turn was linked to heavy alcohol use among Indigenous youth in Canada. Conversely, the Dual Failure Model (Capaldi, 1991(Capaldi, , 1992 would suggest that adolescent drinking occurs in the larger context of externalizing symptoms such as rule breaking and aggressive behaviours, which lead to negative consequences and in turn can lead to internalizing symptoms including depressive symptoms (Colder et al., 2013;Paige et al., 2021). ...
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Negative affect (depression/anxiety) and alcohol use among Indigenous youth in Canada remain a concern for many communities. Disparate rates of these struggles are understood to be a potential outcome of colonization and subsequent intergenerational trauma experienced by individuals, families, and communities. Using a longitudinal design, we examined change in alcohol use and negative affect, and reciprocal associations, among a group of Indigenous adolescents. Indigenous youth ( N = 117; 50% male; M age =12.46–16.28; grades 6–10) from a remote First Nation in northern Quebec completed annual self-reported assessments on negative affect (depression/anxiety) and alcohol use. A Latent Curve Model with Structured Residuals (LCM-SR) was used to distinguish between- and within-person associations of negative affect and alcohol use. Growth models did not support change in depression/anxiety, but reports of drinking increased linearly. At the between-person level, girls reported higher initial levels of depression/anxiety and drinking; depression/anxiety were not associated with drinking. At the within-person level, drinking prospectively predicted increases in depression/anxiety but depression/anxiety did not prospectively predict drinking. When Indigenous adolescents reported drinking more alcohol than usual at one wave of assessment, they reported higher levels of negative affect than expected (given their average levels of depression/anxiety) at the following assessment. Our findings suggest that when Indigenous youth present for treatment reporting alcohol use, they should also be screened for negative affect (depression/anxiety). Conversely, if an Indigenous adolescent presents for treatment reporting negative affect, they should also be screened for alcohol use.
... Indeed, several studies have demonstrated a relationship between positive reinforcement sensitivity, particularly in relation to fun-seeking, and higher alcohol intake (Feil and Hasking 2008;Franken and Muris 2006;Loxton and Dawe 2001). On the other hand, decreased sensitivity to positive reinforcement was associated with the presence of negative affectivity, resulting in alcohol self-medicating as a way to alleviate negative emotional states (Heinz et al. 2009;Stewart et al. 2011;Veilleux et al. 2014). While many different approaches have been used to probe sensitivity to positive reinforcement, very few of them have tested it in the complex cognitive context, and even fewer have allowed for translational comparisons between humans and animal models. ...
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Introduction Alcohol use disorder (AUD) is one of the most common psychiatric disorders and a leading cause of mortality worldwide. While the pathophysiology underlying AUD is relatively well known, the cognitive mechanisms of an individual’s susceptibility to the development of alcohol dependence remain poorly understood. In this study, we investigated the theoretical claim that sensitivity to positive feedback (PF), as a stable and enduring behavioural trait, can predict individual susceptibility to the acquisition and maintenance of alcohol-seeking behaviour in rats. Methods Trait sensitivity to PF was assessed using a series of probabilistic reversal learning tests. The escalation of alcohol intake in rats was achieved by applying a mix of intermittent free access and instrumental paradigms of alcohol drinking. The next steps included testing the influence of sensitivity to PF on the acquisition of compulsive alcohol-seeking behaviour in the seeking-taking punishment task, measuring motivation to seek alcohol, and comparing the speed of extinction and reinstatement of alcohol-seeking after a period of abstinence between rats expressing trait insensitivity and sensitivity to PF. Finally, trait differences in the level of stress hormones and in the expression of genes and proteins in several brain regions of interest were measured to identify potential physiological and neuromolecular mechanisms of the observed interactions. Results We showed that trait sensitivity to PF in rats determines the level of motivation to seek alcohol following the experience of its negative consequences. They also revealed significant differences between animals classified as insensitive and sensitive to PF in their propensity to reinstate alcohol-seeking behaviours after a period of forced abstinence. The abovementioned effects were accompanied by differences in blood levels of stress hormones and differences in the cortical and subcortical expression of genes and proteins related to dopaminergic, serotonergic, and GABAergic neurotransmission. Conclusion Trait sensitivity to PF can determine the trajectory of alcohol addiction in rats. This effect is, at least partially, mediated via distributed physiological and molecular changes within cortical and subcortical regions of the brain.
... In addition, alcohol use is disproportionately reported to be a result of 'depressive' symptoms, such as drinking to cope and binge drinking. Seventy-three percent of First Nations community members report that alcohol is a problem in their communities (31). ...
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To date, there has been scarce effort to consider the intertwining of colonization and the commercial determinants of Indigenous health. This is a vital omission, and one that this paper proposes to address. We propose how four losses of tradition borne out of colonialism are intertwined with four respective commercial determinants of Indigenous health: 1) loss of traditional diets and the ultra-processed food industry; 2) loss of traditional ceremony and the tobacco industry; 3) loss of traditional knowledge and the infant formula industry; and 4) loss of traditional support networks and the alcohol industry. Building on Indigenous efforts to decolonize spaces and assert control over their own lives, we argue that analyzing the mechanisms through which industry activities intersect with colonial legacies will improve broader understandings of Indigenous health disparities.
... Baseline measurements also included the DMQ-R and the ISEL-shortened version. The DMQ-R measures how people score on a five-point scale to questions on four motivational dimensions: social motives (drinking to be sociable, to celebrate parties); coping motives (drinking because it makes one forget their problems); enhancement motives (drinking to feel better or to be able to do things otherwise impossible); and social pressure and conformity motives (drinking because others do, to fit in) [65][66][67]. The ISEL-shortened version was designed to measure perceptions of social support and is a four-point scale of agreement regarding statements concerning the perceived availability of potential social resources (appraisal support, belonging support, and tangible support) [68]. ...
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Background: Ecological momentary assessments (EMA) are one way to collect timely and accurate alcohol use data, as they involve signaling participants via cell phones to report on daily behaviors in real-time and in a participant's natural environment. EMA has never been used with American Indian populations to evaluate alcohol consumption. The purpose of this project was to determine the feasibility and acceptability of EMA for American Indian women. Methods: Eligible participants were American Indian women between the ages of 18 and 44 who were not pregnant and had consumed more than one drink within the past month. All participants received a TracFone and weekly automated messages. Self-reported measures of daily quantity and frequency of alcohol consumption, alcohol type, and context were assessed once per week for four weeks. Baseline measurements also included the Drinking Motives Questionnaire-Revised (DMQ-R) and the Interpersonal Support Evaluation List (ISEL). Results: Fifteen participants were enrolled in the study. All but one participant completed all data collection time points, and drinking patterns were consistent across the study period. A total of 420 records were completed across 86 drinking days and 334 non-drinking days. Participants reported drinking an average of 5.7 days over the 30-day period and typically consumed 3.99 drinks per drinking occasion. Sixty-six percent of participants met gender-specific cut-points for heavy episodic drinking, with an average of 2.46 binge drinking occasions across the four week study period. Conclusions: This proof-of-concept project showed that EMA was both feasible and acceptable for collecting alcohol data from American Indian women. Additional studies are necessary to fully implement EMA with American Indian women to better understand the drinking motives, contexts, patterns, and risk factors in this population.
... Similarly, clinicians working with female AI adolescents reporting to treatment as a result of alcohol consumption may benefit from assessing depressive symptomatology to discern whether alcohol use represents a means of coping. Such an approach may be especially important given that drinking alcohol to cope has been linked to significantly increased risk for subsequently experiencing negative alcohol-related consequences (Merrill et al., 2014;Stewart et al., 2011). ...
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Objectives: Depression, alcohol use, and alcohol-related consequences are experienced disproportionately by American Indian (AI) adolescents. The co-occurrence of depression and alcohol use is clinically relevant, as it is associated with increased risk for suicide, among other negative consequences. Understanding how the association between depressive symptoms and alcohol use and related consequences is influenced by gender is important to understand for whom intervention efforts might be particularly relevant. Thus, the present study seeks to evaluate gender differences in these associations among AI adolescents. Methods: Participants were a representative sample of AI adolescents (N = 3,498, Mage=14.76, 47.8% female) residing on or near reservations who completed self-report questionnaires in school classrooms. Study activities were approved by IRB, school boards, and tribal authorities. Results: The interaction of depressive symptoms and gender was significant in predicting past-year alcohol use frequency (b=.02, p=.02) and, among youth reporting lifetime alcohol use, alcohol-related consequences (b=.03, p=.001). Analysis of simple slopes revealed that, for females, depressive symptoms were significantly associated with past-year alcohol use frequency (b=.02, p<.001) and alcohol-related consequences (b=.05, p<.001). For males, depressive symptoms were only significantly associated with alcohol-related consequences (b=.02, p=.04), and this effect was weaker than for females. Conclusions: Results of the present study may inform the development of gender-sensitive recommendations for the assessment and treatment of alcohol use and alcohol-related consequences among AI adolescents. For instance, results suggest that treatments focusing on depressive symptoms may subsequently reduce alcohol use and related consequences for female AI adolescents.
... Coping motivations for alcohol use (i.e., using alcohol to relieve negative affect) may contribute to the association between alcohol consumption and the NMB. Indeed, endorsement of coping motivations underlying alcohol consumption is associated with greater frequency of BD episodes, greater quantities of alcohol consumed per episode (Stewart et al., 2011;Decaluwe et al., 2019), as well greater cumulative years of BD (Patrick and Schulenberg, 2011). All such factors may lead to more pronounced neurological consequences that may render individuals more vulnerable to the NMB. ...
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Background In this three-part study, we investigate whether the associations between binge and problematic drinking patterns with a negative emotional memory bias (NMB) are indirectly related through coping motivations and depressive symptoms. We also address potential sex differences in these relations. Methods Participants (N = 293) completed the Timeline Followback to assess binge drinking, the Alcohol Use Disorder Identification Test (AUDIT) to assess problematic alcohol use, the Drinking Motives Questionnaire-Revised to assess coping motivations, and the Depression, Anxiety, and Stress Scales-21 to assess depression. Participants were asked to identify whether 30 emotional sentences were self-referent or not in an incidental encoding task; 24 h later they were asked to recall as many sentences as possible and a negative memory bias score was calculated. Results Across all three studies, we found significant bivariate relations between AUDIT scores, coping, depression, and an NMB, particularly for sentences participants deemed self-referent. In two undergraduate samples, there were significant indirect effects through coping motivations and depressive symptoms between binge drinking and an NMB in females as well as between AUDIT scores and an NMB in females only. In the community sample, there was only an indirect effect through coping motives, but this was observed in both females and males. Conclusion These findings support a relation between binge drinking as well as problematic alcohol use and a self-referent NMB in the context of coping motivations for alcohol use and depressive symptoms. Moreover, the pattern of findings suggests this model primarily holds for females, yet may also apply to males at higher levels of problematic alcohol use.
... Subsequently, AI adolescents may turn to alcohol use to cope with negative mood (Yuan et al., 2010) stemming from these beliefs. Indeed, negative reinforcement (Baker et al., 2004) and self-medication (Khantzian, 1997) models suggest a central function of affect modulation for alcohol use broadly and specifically in the context of depression (Bolton et al., 2009;Turner et al., 2018), including among AI communities (Skewes & Blume, 2015;Stewart et al., 2011). ...
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Background Rates of both depression and alcohol use are disproportionately higher among American Indian (AI) adolescents than adolescents in the general population. The co‐occurrence of depression and alcohol use is common and clinically relevant given their reciprocal negative influences on outcomes. Family factors may be especially relevant because they could have a buffering effect on this relationship due to the importance of kinship and community in AI communities. The current study examines the roles of family warmth and parental monitoring in the association between depressive symptoms and alcohol use in a large, nationally representative sample of AI adolescents. Methods Data were collected from 3498 AI 7th to 12th graders (47.8% female) residing on or near a reservation during the period 2009 to 2013. Participants reported on their depressive symptoms, family factors, and alcohol use. Results There was a small, but statistically significant positive association between depressive symptoms and alcohol use (r = 0.11, p < 0.001). Greater depressive symptoms were associated with significantly less perceived family warmth (β = −0.09, 95% CI [−0.13, −0.06]), which was associated with significantly greater alcohol use (β = −0.39, 95% CI [−0.55, −0.23]). Family warmth significantly accounted for the association between depressive symptoms and alcohol use at high (β = 0.04, SE = 0.02, 95% CI [0.004, 0.09]), but not low, levels of parental monitoring (β = 0.02, SE = 0.02, 95% CI [−0.002, 0.06]). Conclusions Results of the present study suggest that developing culturally sensitive prevention and treatment approaches focusing on increasing both family warmth and parental monitoring are important to address the co‐occurrence of depression and alcohol misuse among AI adolescents.
... Findings support stress-related drinking pathways in an unselected community sample. Prior cross-sectional and more temporally limited work also support similar copingmotivated drinking within more diverse samples, including Canadian aboriginal (Stewart et al., 2011), English (Topper et al., 2011), Scottish , and South African (Hogarth et al., 2019) adolescents. Such results support the potential utility of universal stress-related drinking prevention and intervention. ...
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Objective: The present study examined whether early stressful events precipitate drinking risks across adolescence and whether coping-motivated drinking mediates such relations. Method: Families comprised 387 adolescents (55% female, 83% White) recruited for a longitudinal study. Caregivers reported on adolescents’ experience of potentially stressful events, including conflict (i.e., disruption of harmonious family relations) and separation (i.e., decreased contact with important persons) events, over the past year when adolescents were approximately 14 years of age. Adolescents reported on their drinking motives, alcohol use, and alcohol problems annually from 18 to 20 years of age. Growth curve models tested associations of stressful events with latent coping and enhancement/social drinking motives growth factors and subsequent alcohol outcomes. Results: Most adolescents experienced at least one potentially stressful event. Growth modeling suggested no change in coping motives, but increases in enhancement/social motives over time. Greater conflict events predicted higher frequency of drinking for coping reasons (i.e., coping intercept), which in turn predicted increases in alcohol problems as adolescents began transitioning into young adulthood. Conflict, separation, or total stressful events were not significantly associated with initial level or change in enhancement/social motives, suggesting specificity of mediation by coping-motivated drinking. Conclusions: Findings support enduring elevations in drinking risk over 6 years following disruptive family relations in early adolescence. Such risks appear to be driven by negative affect regulation mechanisms through coping-motivated drinking. Future work should assess generalizability of these findings across diverse samples and could test similar negative reinforcement mechanisms of drinking following exposure to clinically impairing traumatic experiences.
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Lise öğrencilerinin madde kullanma eğilimlerini etkileyen pek çok faktör bulunmaktadır. Bu araştırmanın temel amacı, lise öğrencilerinin madde kullanma eğilimlerini aile yapısı, bağlanma stilleri, umutsuzluk ve bazı sosyo demografik değişkenler açısından incelemektir. Çalışmada “cinsiyet, lise türü, sınıf düzeyi, aile tipi, aile tutumu, ailenin gelir düzeyi, öğrencinin ve/veya ailenin madde kullanma durumu ve kardeşler arası konum” sosyo demografik değişkenler olarak belirlenmiştir. Araştırma grubu 2015-2016 eğitim öğretim yılında Karadeniz Bölgesi’nde büyük şehir statüsünde olan bir il genelindeki öğrenimlerine devam eden 513 kız, 390 erkek olmak üzere toplam 903 lise öğrencisinden oluşmaktadır. Araştırma verilerinin toplanmasında Beck, Weissman, Lester ve Trexler (1974) tarafından geliştirilen, Türkçe’ye uyarlaması Durak ve Palabıyıkoğlu (1994) tarafından yapılan “Beck Umutsuzluk Ölçeği (BUÖ)”; Griffin ve Bartholomew (1994) tarafından geliştirilen, Türkçe’ye uyarlaması Sümer ve Güngör (1999) tarafından yapılan “İlişki Ölçekleri Anketi (İÖA)”; Gülerce (1996) tarafından geliştirilen “Aile Yapısı Değerlendirme Aracı (AYDA)” ve MacAndrew(1986) tarafından geliştirilen, Türkçe’ye uyarlaması Ceyhun, Oğuztürk ve Ceyhun (2001) tarafından yapılan “Madde Kullanma Eğilimi Ölçeği” kullanılmıştır. Öğrencilerin demografik özellikleri ile ilgili bilgileri elde etmek için araştırmacı tarafından hazırlanan “Kişisel Bilgi Formu” kullanılmıştır. Elde edilen veriler SPSS 22.0 (Statistical Packet for Social Sciences) paket programı ile analiz edilmiştir. Spearman Testi, Çoklu Doğrusal Regresyon Analizi Tekniği, Mann Whitney U Testi ve Kruskal-Wallis testinden yararlanılmıştır. Araştırma sonucunda madde kullanma eğiliminin umutsuzluk ve bağlanma stillerinden saplantılı bağlanma stili ile pozitif yönde anlamlı bir ilişkisi olduğu bulunmuştur. Madde kullanma eğilimi ile aile yapısı boyutlarından birlik, yönetim ve yetkinlik boyutlarıyla da pozitif yönde anlamlı ilişkisi olduğu bulgulanmıştır. Ayrıca; madde kullanma eğiliminin cinsiyete, lise türüne, sınıf düzeyine, aile tutumuna, ailenin gelir düzeyine, öğrencinin ve ailesinin madde kullanma durumuna göre anlamlı bir fark gösterdiği; kardeşler arası konum ve aile tipine göre ise farklılık göstermediği ortaya çıkmıştır. Sonuçlar literatür bulgularıyla tartışılmış ve öneriler sunulmuştur.
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Background: Inuit youth in Northern Canada show considerable resilience in the face of extreme adversities. However, they also experience significant mental health needs and some of the highest adolescent suicide rates in the world. Disproportionate rates of truancy, depression, and suicide among Inuit adolescents have captured the attention of all levels of government and the country. Inuit communities have expressed an urgent imperative to create, or adapt, and then evaluate prevention and intervention tools for mental health. These tools should build upon existing strengths, be culturally appropriate for Inuit communities, and be accessible and sustainable in Northern contexts, where mental health resources are often scarce. Objective: This pilot study assesses the utility, for Inuit youth in Canada, of a psychoeducational e-intervention designed to teach cognitive behavioral therapy strategies and techniques. This serious game, SPARX, had previously demonstrated effectiveness in addressing depression with Māori youth in New Zealand. Methods: The Nunavut Territorial Department of Health sponsored this study, and a team of Nunavut-based community mental health staff facilitated youth's participation in an entirely remotely administered pilot trial using a modified randomized control approach with 24 youths aged 13-18 across 11 communities in Nunavut. These youth had been identified by the community facilitators as exhibiting low mood, negative affect, depressive presentations, or significant levels of stress. Entire communities, instead of individual youth, were randomly assigned to an intervention group or a waitlist control group. Results: Mixed models (multilevel regression) revealed that participating youth felt less hopeless (P=.02) and engaged in less self-blame (P=.03), rumination (P=.04), and catastrophizing (P=.03) following the SPARX intervention. However, participants did not show a decrease in depressive symptoms or an increase in formal resilience indicators. Conclusions: Preliminary results suggest that SPARX may be a good first step for supporting Inuit youth with skill development to regulate their emotions, challenge maladaptive thoughts, and provide behavioral management techniques such as deep breathing. However, it will be imperative to work with youth and communities to design, develop, and test an Inuit version of the SPARX program, tailored to fit the interests of Inuit youth and Elders in Canada and to increase engagement and effectiveness of the program. Trial registration: ClinicalTrials.gov NCT05702086; https://www.clinicaltrials.gov/ct2/show/NCT05702086.
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Native Americans have higher rates of alcohol use, frequency of use, and increased rates of fetal alcohol syndrome, compared with other ethnic groups (J. Hisnan-ick, 1992; P. A. May, 1996; J. M. Wallace et al., 2003). High prevalence rates of alcohol misuse among Native Americans must be understood in light of their unique history, which has resulted in trauma and exposure to many risk factors for problem alcohol use. Many risk factors have been identified in the general population; however, only some of these risk factors have been examined among Native American populations. The unique history and world view of Native Americans mean that, often, risk factors operate differently from the way they do in other populations. The authors discuss interventions and promising treatments. ALCOHOL USE AMONG NATIVE AMERICANS shares commonalities with alcohol use among other ethnicities; however, Native Americans' uniqueness in terms of history, culture, and societal position has resulted in a distinct set of circumstances that are unlike those found in any other group. These circumstances are further complicated by the diversity within Native American groups. With over 500 federally recognized tribes, with each its own history, culture, and traditions , estimating the level of alcohol use and abuse is difficult, and preventions that work for one tribe may be inappropriate or even counterproductive in another. With these considerations in mind, in this article we will provide a review and
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The article which follows this introduction was originally published as a Special (Cover) Article in the American Journal of Psychiatry in the November, 1985 issue, the same month in which the First International Drug Symposium, sponsored by The Bahamas Ministry of Health and The Embassy of the United States of America, was convened to discuss the rock-cocaine epidemic in the Bahamas and other Caribbean Islands. Based on my article, I was invited to participate in the Symposium and to speak about some of my views on the psychological predispositions for drug dependence in general, and in particular, on the psychological predisposition for cocaine dependence. At first, I did not grasp the seriousness and scope of the cocaine problem, but I accepted the invitation, believing I might make a contribution to the Symposium. I was not long in attendance at the Symposium before I realized that the Bahamian citizens, professionals, and health care leaders were facing a major crisis as a consequence of the cocaine epidemic.
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Recent research suggests it is important to take individual differences into account when attempting to predict drinking or treat alcohol problems. One variable thought to exert a potent proximal influence on alcohol consumption is an individual’s self-reported motives for drinking (Cox and Klinger, 1988). Having high levels of internal, emotion-management motives for drinking, such as coping motives (CM; drinking to relieve sadness) or enhancement motives (EM; drinking to enhance happiness), is thought to be “risky” because internal, more than external (or social/affiliative), motives predict heavy and problematic alcohol consumption (cf. Cooper, 1994). Thus, the goal of recent alcohol research has been to identify the unique emotional antecedents of these “risky” reasons for drinking of EM and CM. Several studies provide indirect evidence suggesting that negative mood states prompt drinking specifically for CM drinkers, and that positive mood states prompt drinking specifically for EM drinkers; but only one recent unpublished study, conducted in our laboratory, has directly examined this hypothesis. While our chapter will include a review of previous relevant research, the primary purpose of our chapter shall be to report on the findings obtained from this latter investigation. In this investigation, 73 undergraduates who endorsed either extreme CM or EM for drinking were randomly assigned to listen to either positive or negative musical mood induction procedures (MMIP; Mongrain and Trambakoulos, 1997). Following a mood manipulation check, they were then asked to complete a mock taste-rating task, an excellent unobtrusive measure of drinking behaviour (cf. Higgins and Marlatt, 1973). As hypothesized, EM drinkers in the positive mood condition (vs. other groups) had significantly higher levels of average alcohol (but not non-alcohol) consumed. Unexpectedly, however, this effect was only significant for male (and not female) participants. Also as hypothesized, CM drinkers in the negative mood condition (vs. other groups) had a significantly higher ratio of alcohol consumed, as a function of total beverage consumed. Unexpectedly, however, this effect was only significant for female (and not male) participants. We suggest that emotions may frequently and powerfully influence drinking decision-making, but that mood-drinking relations cannot be adequately understood without a consideration of individual difference variables, such as drinking motives and gender. We conclude this chapter with an integration of the findings reviewed which highlights important areas for future research, as well as key implications for understanding and managing alcohol misuse.
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Structural equation modeling is a class of statistical models that includes confirmatory factor analysis, path analysis, and hybrid models, among others. It is a flexible framework that can be used to test causal and correlational data, and can be used for both exploratory and confirmatory processes. This entry describes the basic model-building process for all structural equation models. Additionally, distinctions between various models, all of which fall under the umbrella of structural equation modeling, are addressed.
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The Substance Use Risk Profile Scale (SURPS) is based on a model of personality risk for substance abuse in which four personality dimensions (hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) are hypothesized to differentially relate to specific patterns of substance use. The current series of studies is a preliminary exploration of the psychometric properties of the SURPS in two populations (undergraduate and high school students). In study 1, an analysis of the internal structure of two versions of the SURPS shows that the abbreviated version best reflects the 4-factor structure. Concurrent, discriminant, and incremental validity of the SURPS is supported by convergent/divergent relationships between the SURPS subscales and other theoretically relevant personality and drug use criterion measures. In Study 2, the factorial structure of the SURPS is confirmed and evidence is provided for its test–retest reliability and validity with respect to measuring personality vulnerability to reinforcement-specific substance use patterns. In Study 3, the SURPS was administered in a more youthful population to test its sensitivity in identifying younger problematic drinkers. The results from the current series of studies demonstrate support for the reliability and construct validity of the SURPS, and suggest that four personality dimensions may be linked to substance-related behavior through different reinforcement processes. This brief assessment tool may have important implications for clinicians and future research.
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Objective: To study patterns of co-occurrence of lifetime DSM-III-R alcohol disorders in a household sample. Methods: Data came from the National Comorbidity Survey (NCS), a nationally representative household survey. Diagnoses were based on a modified version of the Composite International Diagnostic Interview. Results: Respondents with lifetime NCS/DSM-III-R alcohol abuse or dependence had a high probability of carrying at least 1 other lifetimeNCS/DSM-III-R diagnosis. Retrospective reports have suggested that most lifetime co-occurring alcohol disorders begin at a later age than at least 1 other NCS/DSM-III-R disorder. Earlier disorders are generally stronger predictors of alcohol dependence than alcohol abuse and stronger among women than men. Lifetime co-occurrence is positively, but weakly, associated with the persistence of alcohol abuse among men and of alcohol dependence among both men and women. Conclusions: Caution is needed in interpreting the results due to the fact that diagnoses were made by nonclinicians and results are based on retrospective reports of the age at onset. Within the context of these limitations, though, these results show that alcohol abuse and dependence are often associated with other lifetime DSM-III-R disorders and suggest that, at least in recent cohorts, the alcohol use disorders are usually temporally secondary. Prospective data and data based on clinically confirmed diagnoses are needed to verify these findings.
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Numerous studies, inquiries, and statistics accumulated over the years have demonstrated the poor health status of Aboriginal peoples relative to the Canadian population in general. Aboriginal Health in Canada is about the complex web of physiological, psychological, spiritual, historical, sociological, cultural, economic, and environmental factors that contribute to health and disease patterns among the Aboriginal peoples of Canada. The authors explore the evidence for changes in patterns of health and disease prior to and since European contact, up to the present. They discuss medical systems and the place of medicine within various Aboriginal cultures and trace the relationship between politics and the organization of health services for Aboriginal people. They also examine popular explanations for Aboriginal health patterns today, and emphasize the need to understand both the historical-cultural context of health issues, as well as the circumstances that give rise to variation in health problems and healing strategies in Aboriginal communities across the country. An overview of Aboriginal peoples in Canada provides a very general background for the non-specialist. Finally, contemporary Aboriginal healing traditions, the issue of self-determination and health care, and current trends in Aboriginal health issues are examined.