Stressful events, personality, and mood disturbance:

Abstract

The present study examined relationships among stressful events, personality characteristics, and affective status in males and females of various alcohol drinking patterns. We examined a total of 154 participants from three distinct alcohol subgroups: alcohol dependent, problem drinker, and light social drinker. These subjects did not meet criteria for any concurrent nonalcohol comorbid psychiatric disorder. The study included an alcohol quantity–frequency interview and self-report questionnaires on stressful life events, depressive symptoms, trait anxiety, and personality characteristics. Results showed female alcoholics reported significantly greater depression, anxiety, and neuroticism compared to their male counterparts (and all other drinking groups). Female problem drinkers reported significantly greater depressive symptoms and health-related stressful events compared to male problem drinkers and the light drinkers. In contrast, male problem drinkers did not show elevations on these dimensions and more closely resembled light drinkers, of whom no gender differences were found. The findings support theories suggesting a “telescoping” of complications, health-related stress, and mood dysfunction in women at a lower threshold level of alcohol consumption compared to their male counterparts.

Introduction

In the US, men generally drink about twice as much alcohol as women (Dawson & Archer, 1992). Studies demonstrate a 4:1 male-to-female ratio of lifetime prevalence of alcohol dependence overall (Robins, Helzer, & Weissman, 1984) and a 2:1 male-to-female ratio of alcohol dependence within current drinker populations (Dawson, 1996). The converse is also true, i.e., lifetime abstention or very rare alcohol drinking is more common among adult females (45%) than males (22%; Dawson, Grant, & Chou, 1995). It has been suggested that environmental influences, psychological vulnerabilities, and individual differences may account for a large proportion of the variance in the progression from social drinking to hazardous drinking between the sexes.

Individual differences in response to stressful events have been hypothesized to be an important determinant in the development and maintenance of substance use disorders Cappell & Greeley, 1987, Goldman et al., 1987, Kreek, 1992, Leigh, 1989, Polich & Orvis, 1979. In some studies, the relationship among stressful events, emotional distress, and alcohol drinking has been reported to be stronger in men compared to women drinkers Cooper et al., 1992, Gottlieb & Green, 1984, Harlow et al., 1986, but these findings have been challenged in other investigations Cooke & Allan, 1984, Cronkite & Moos, 1984, Timmer et al., 1985, Wallen, 1992. In general, few studies examining this issue have systematically partialled out or excluded those persons with significant concurrent psychiatric or antisocial personality disorders (Allan & Cooke, 1985) and only recently have sufficient numbers of females been included to examine gender related issues underlying the mechanisms and consequences of alcohol intake.

The relationship between stress and associated psychological factors in persons who either do or do not progress to hazardous alcohol drinking would provide relevant information on the continuum of risk (low to high) for alcohol dependence (Birnbaum, Taylor, & Parker, 1983), especially in terms of gender and risk differences (Li, Lumeng, & Thomasson, 1995). For example, in social drinking women, even moderate increments in alcohol consumption are associated with increased symptoms of depression and anxiety that may lessen after a period of complete abstinence Birnbaum et al., 1983, Bjork et al., 1999. At the higher end of the drinking continuum, alcohol-dependent women have higher lifetime prevalence rates of major psychiatric disorders compared to male alcoholics (for review, see Preuss & Wong, 2000), including a two- to threefold greater rate of phobias, mood disorders, anxiety disorders, and posttraumatic stress disorder Regier et al., 1990, Schuckit et al., 1997. In contrast, some psychiatric conditions are more prevalent in males. There is a 1.5–3 times higher rate of antisocial personality disorder in male compared to female alcoholics Kessler et al., 1997, Regier et al., 1990, Schuckit et al., 1997. Few studies have examined psychosocial indices in individuals at the intermediate level of drinking, i.e., heavy social or problematic drinking, so it is unclear whether female problem drinkers would report similar elevations in stressful events and affective disturbance as female alcoholics. This issue is important because surveys and epidemiological reports indicate steady increases in binge drinking in women, especially at the younger ages (Johnston, O'Malley, & Bachman, 1999).

Although there is no empirical support for an overall “alcoholic personality,” distinct alcoholic typologies Babor et al., 1992, Cloninger et al., 1988 and a higher frequency of certain personality traits have been demonstrated Neuringer, 1982, Preuss & Wong, 2000. However, the usefulness and validity of such classifications, particularly with respect to females, has been called into question (Babor, 1996). This is largely due to the fact that the majority of research in this field has focused primarily on male alcoholism. For example, Eysenck's personality theory Eysenck, 1967, Eysenck & Eysenck, 1975, which posits a biological basis of personality, has been examined mainly in samples of male alcoholics. Results are not entirely consistent but generally indicate that alcoholics demonstrate elevations in psychoticism and neuroticism compared to nonalcoholic controls King et al., 1995, Orford, 1976, Rankin et al., 1982. One study examining scores on the Eysenck Personality Questionnaire (EPQ) in severely dependent male and female alcoholics showed similar elevations in both groups on the neuroticism and psychoticism scales as compared to moderate/mildly dependent male and female alcoholics (Rankin et al., 1982). This study may be difficult to interpret because few exclusion criteria were utilized so the potential confound of comorbid psychiatric diagnoses (particularly antisocial personality disorder) could not be ruled out. Therefore, the vast majority of studies examining alcoholics' scores on the Eysenck questionnaire are limited by the inclusion of patients with comorbid diagnoses, lack of research along the continuum of drinking levels, and inadequate research in females, particularly nonsociopathic female alcoholics.

Thus, the present study compared the relationship among stressful life events, affective status, and personality characteristics in males and females at different levels of alcohol drinking. Although no standard definitions exist for specific alcohol drinking categories across studies, we decided to examine three distinct groups of lifetime drinkers to represent the continuum of progressive heightened alcohol patterns. These groups were determined based on reported alcohol consumption and included moderate-to-severe alcohol-dependent drinkers, problematic or binge drinkers, and lifetime social drinkers. Consistent with prior studies, we predicted greater stressful events, mood disturbance, and personality alterations (neuroticism, psychoticism) in the male and female alcoholics compared to the other drinking groups. In addition, we predicted higher reported depression, anxiety, and stressful events in females compared to their male counterparts at each level along the continuum of alcohol drinking, and the relationship between these factors would be different in female versus male drinkers.