Social Support Moderates the Rate of Transition between Alcohol Use Initiation and Depression

Abstract

Alcohol use and depression are well-documented to be highly correlated, with adolescent alcohol use predicting adult depression. However, the rate of developing depression after alcohol initiation, and factors that reduce the rate of development, are under researched. Higher social support is independently linked to reduced alcohol use and reduced depression, suggesting that it may slow the rate of developing depression after alcohol initiation. We used data from five years of the accelerated longitudinal cohort National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study (beginning 2012), participants of which were recruited from five sites across the United States (University of California San Diego, Duke University, Oregon Health & Science University, University of Pittsburgh, SRI International). NCANDA participants (n=831, aged 12-21, 51% female at baseline) were recruited to mirror national-level representation regarding race, ethnicity, and sex, oversampling for participants with family histories of problematic alcohol use. Survival analysis was applied to estimate the typical time (i.e., months) to depression onset (i.e., CES-D-10 score of 10 or higher) following age at alcohol use initiation (i.e., first alcoholic drink), age at first regular drinking period (i.e., first period of drinking at least once a week), and age at first binge drinking episode (i.e., first time consuming at least 4 or 5 drinks in one period). Moderation by social support was tested across models to determine the extent to which social support might buffer the rate of heterotypic transition. Participants who drank before experiencing depression were included (n=509, female=255, Mage=16.98). Higher social support was associated with a seven percent decreased rate of reaching the CES-D-10 threshold for depression after the first drink (HR 0.93, 95% CI [0.88, 0.98], p=0.001) and the first binge drinking episode (HR 0.93, 95% CI [0.87-0.98], p=0.009), but not the first regular drinking period or after controlling for demographics. Women reached depression significantly more quickly than men after the first drink (HR 0.57, 95% CI [0.4, 0.82], p=0.002) and the first binge drinking episode (HR 0.55, 95% CI [0.36, 0.85], p=0.006). As such, people with lower social support during the period following early drinking are not just vulnerable to experiencing depression, but they may also experience a faster onset and thus more long-term consequences (i.e., longer period of depression, additive or cascading symptoms).