Gender and Direction of Effect of Alcohol Problems and Internalizing Symptoms in a Longitudinal Sample of College Students

Abstract

Background Alcohol problems and internalising symptoms are consistently found to be associated but how they relate to each other is unclear. Objective The present study aimed to address limitations in the literature of comorbidity of alcohol problems and internalising symptoms by investigating the direction of effect between the phenotypes and possible gender differences in college students. Method We utilised data from a large longitudinal study of college students from the United States (N=2607). Three waves of questionnaire-based data were collected over the first two years of college (in 2011–2013). Cross-lagged models were applied to examine the possible direction of effect of internalising symptoms and alcohol problems. Possible effects of gender were investigated using multigroup modelling. Results There were significant correlations between alcohol problems and internalising symptoms. A direction of effect was found between alcohol problems and internalising symptoms but differed between genders. A unidirectional relationship varying with age was identified for males where alcohol problems initially predicted internalising symptoms followed by internalising symptoms predicting alcohol problems. For females, a unidirectional relationship existed wherein alcohol problems predicted internalising symptoms. Conclusions/Importance We conclude that the relationship between alcohol problems and internalising symptoms is complex and differ between genders. In males, both phenotypes are predictive of each other, while in females the relationship is driven by alcohol problems. Importantly, our study examines a population-based sample, revealing that the observed relationships between alcohol problems and internalising symptoms are not limited to individuals with clinically diagnosed mental health or substance use problems.

Unpacking the Mississippi blues: Relationship between internalizing problems and health behaviors

“…Substance use was another statistically significant predictor of internalizing behaviors in our study. This finding is consistent with Homman et al’s (2017) recent research with students. It is possible that some students tend to cope with life and academic stressors by smoking and consuming alcohol (Churakova et al, 2017).…”

“…Although these conditions often co-occur developmentally, internalizing symptoms can be detected as early as age 3 (Burlaka et al, 2015) while substance use typically begins around adolescent age (Burlaka, 2017; Kessler, 2004). However, Homman et al (2017) found that for male students, alcohol problems first predicted internalizing problems and then internalizing problems would predict alcohol problems, whereas for female college students, a unidirectional relationship was found with alcohol problems predicting internalizing behavior problems.…”

“…Given the previous literature, we hypothesized that students with higher scores on health-promoting behaviors, including quality sleep (Beiter et al, 2015), regular exercise, healthy diet (Doom and Haeffel, 2013), and lower scores on substance use (Hilt et al, 2017; Homman et al, 2017), would report fewer internalizing symptoms; also, that students who are African American (Riolo et al, 2005; Shim et al, 2012; Williams et al, 2007) and of older age (Riolo et al, 2005) would have lower scores on internalizing problems.…”