Elsevier

Addictive Behaviors

Volume 76, January 2018, Pages 319-327
Addictive Behaviors

Depressive symptoms, ruminative thinking, drinking motives, and alcohol outcomes: A multiple mediation model among college students in three countries

https://doi.org/10.1016/j.addbeh.2017.08.028Get rights and content

Highlights

  • Tested a multiple mediation model among college drinkers in Argentina, Spain and US.

  • Ruminative thinking is a mechanism linking depressive symptoms to drinking to cope.

  • Depressive symptoms relate to alcohol problems via rumination and drinking to cope.

  • Models were invariant across countries/sex, suggesting a culturally-universal model.

Abstract

Background

Recent research suggests that ruminative thinking (specifically problem-focused thoughts) may explain why individuals engage in drinking to cope (DTC) when dealing with depressive symptoms; which in turn leads to increased negative alcohol-related consequences. Cross-cultural studies addressing these phenomena are scarce.

Objectives

The present study cross-culturally tested whether four rumination facets (problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts) uniquely mediate the relationships between depressive symptoms and drinking motives/alcohol outcomes in a multicultural sample of college student drinkers (n = 1429) from Spain, Argentina, and the U.S.

Method

Structural equation modeling was conducted to test the models, controlling for sex. Further, we conducted invariance testing to determine whether our models were culturally-specific or culturally-universal.

Results

Within both proposed models, no rumination facet uniquely mediated the relationship between depressive symptoms and drinking motives. However, an exploratory model with a second-order latent factor of ruminative thinking did significantly mediate these associations (exception was conformity motives). Further, there were two significant double-mediated associations that suggested that increased depressive symptoms is associated with increased ruminative thinking, which is associated with higher DTC motives, which in turn is associated with higher alcohol consumption and negative alcohol-related consequences. All models were found to be invariant across countries and sex, suggesting that these associations may be relatively universal.

Conclusions

Rumination is relevant to understand the increased vulnerability of college drinkers to exhibit greater alcohol consumption and negative consequences via DTC motives when dealing with depressive symptoms.

Introduction

Among college students, depressive symptoms has been found to be a robust risk factor associated with increased alcohol consumption (see Pedrelli, Borsari, Lipson, Heinze, & Eisenberg, 2016 for an overview) and negative alcohol-related consequences (Armeli, Conner, Cullum, & Tennen, 2010; Armeli et al., 2014; Dennhardt & Murphy, 2011). Drinking to cope motives has been found to be a robust psychosocial mechanism that explains (i.e., mediates) the associations between depressive symptoms and negative alcohol-related consequences among college students (Bravo & Pearson, 2017; Kenney, Jones, & Barnett, 2015; Kenney, Merrill, & Barnett, 2017). Despite the extensive support of depressive symptoms relating to negative alcohol-related consequences via drinking to cope motives, few studies have examined psychosocial factors that may explain why individuals engage in drinking to cope when dealing with depressive symptoms and how this may lead to increased negative alcohol-related consequences.

Ruminative thinking is one construct that has been recently proposed as a mechanism linking depressive symptoms to drinking to cope motives and in turn to negative alcohol-related consequences. Supporting Response Styles Theory (Nolen-Hoeksema, 1991; Nolen-Hoeksema, Wisco, & Lyubormisky, 2008), rumination has been shown to be a robust risk factor for alcohol use/misuse (Ciesla, Dickson, Anderson, & Neal, 2011; Nolen-Hoeksema & Harrell, 2002; Nolen-Hoeksema, Stice, Wade, & Bohon, 2007). Ciesla et al. (2011) concluded, “It is possible that individuals may drink in order to interrupt the repetitive, obsessive thoughts which exacerbate and prolong negative moods, rather than simply drinking due to the affective state itself” (pg. 149). Recently, Bravo, Pearson, and Henson (2017) tested this assertion by examining whether four distinct facets of rumination (i.e., problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts) mediated the associations between depressive symptoms and drinking to cope motives, which in turn relate to negative alcohol-related consequences. The researchers found only one significant double-mediated association such that elevated depressive symptoms was associated with higher problem-focused thoughts (i.e., consistent thinking of causes, consequences, and symptoms of negative affect), which was associated with higher drinking to cope motives, which in turn was associated with higher negative alcohol-related consequences. Taken together, this study provides preliminary support for ruminative thinking as a mechanism linking depressive symptoms to drinking to cope motives.

Although an important preliminary study, the present study sought to cross-culturally replicate and extend these findings by examining, in a multicultural sample, four distinct research questions: a) are the effects they found in the double-mediation model extendible to alcohol consumption as an outcome, b) to what extent are the effects they found in the double-mediation model replicable when other drinking motives are introduced into the model (hypothesized mediation model), c) do rumination facets mediate the relationship between depressive symptoms and other drinking motives (comprehensive model), and d) are these models invariant across sex and different cultures/countries. Based on findings from Bravo et al. (2017), we expected that problem-focused thoughts would emerge as the strongest facet most relevant in the pathway to problematic alcohol consumption.

Section snippets

Participants & procedures

College students from four distinct universities (n = 1864) across the U.S. (two universities; one located in the southeast and the other in the southwest), Argentina, and Spain participated in an online survey study regarding personal mental health, personality traits, and alcohol use behaviors (for more information on recruitment procedures, see Bravo et al., in press). For the present study, we only used data from students who completed the rumination measure and consumed alcohol at least once

Results

The measurement model and all multi-group models (including constrained models) provided acceptable-to-excellent fit based on fit criteria suggested by Hu and Bentler and the minimal changes in CFI/TFI and RMSEA indicated measurement/model invariance across countries and sex (see Table 1). Based on these results, we present results of all our models within the total sample. Bivariate correlations, descriptive statistics, and reliability coefficients of all study variables for the total sample

Discussion

The central goals of the present study were to cross-culturally test whether four rumination facets uniquely mediate the relationships between depressive symptoms and drinking to cope motives (replication of Bravo et al.’s (2017) model) as well as other drinking motives (extension of Bravo et al.’s (2017) model) and in turn account for an increase in alcohol consumption and negative alcohol-related consequences among a multicultural sample of college-student drinkers in Spain, Argentina, and

Role of funding sources

There was no direct funding for this study. However, Dr. Bravo is supported by a training grant (T32-AA018108) from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in the United States and Dr. Pearson is supported by a career development grant (K01-AA023233) from the NIAAA. NIAAA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Data collection in Spain was supported,

Contributors

Dr. Bravo organized the research study and coordinated the efforts of the research team, conceptualized the research questions, conducted the analyses, drafted the introduction, statistical analyses, and results sections (including tables and figures). Dr. Pilatti wrote the abstract, method section, and part of the discussion section. Dr. Pearson assisted with the statistical analyses, wrote the clinical implications section, and edited the introduction, method, and results sections of the

Conflict of interest

No conflict declared.

Acknowledgments

No acknowledgments declared.

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