Addictive Behaviors 110 (2020) 106527
Contents lists available at ScienceDirect
Addictive Behaviors
journal homepage: www.elsevier.com/locate/addictbeh
Short Communication
Changes in alcohol use as a function of psychological distress and social
support following COVID-19 related University closings
T
⁎
William V. Lechnera, , Kimberly R. Laureneb, Sweta Patelb, Megan Andersonb, Chelsea Gregab,
Deric R. Kenneb
a
b
Kent State University, Department of Psychological Sciences, 232 Kent Hall, Kent, OH 44242, USA
Kent State University, College of Public Health, Center for Public Policy & Health Division of Mental Health & Substance Use, USA
H I GH L IG H T S
use increased significantly following COVID-19 related campus closure.
• Alcohol
social support was associated with less alcohol use overall.
• Higher
psychological distress was associated with steeper increases in alcohol.
• Elevated
• Social support did not moderate the effect of distress on increasing alcohol use.
A R T I C LE I N FO
A B S T R A C T
Keywords:
COVID-19
Alcohol use
Depressive symptoms
Anxiety symptoms
Social support
Amidst the coronavirus pandemic, universities across the country abruptly closed campuses and transitioned to
remote learning. The effects of these unprecedented closures are unknown. The current study examined reported
alcohol consumption during the week prior to and after campus closure at a public university in Northeast Ohio.
Analysis of data from 1,958 students, who endorsed using alcohol in the past 30 days, demonstrates that alcohol
consumption (amount and frequency) increased as time progressed. Those with more symptoms of depression
and anxiety reported greater increases in alcohol consumption (assessed via retrospective timeline follow-back)
compared to students with fewer symptoms. Furthermore, students with greater perceived social support reported less alcohol consumption. Together, these findings highlight the need for universities to offer services and
programs to students that will minimize risk factors and maximize protective factors in order to reduce or
prevent alcohol abuse during the coronavirus pandemic.
1. Introduction
depression) and social support in relation to changes in alcohol consumption surrounding campus closure.
Prior research has established that psychological distress and problematic alcohol consumption often co-occur (Bott, Meyer, Rumpf,
Hapke, & John, 2005; Markman Geisner, Larimer, & Neighbors, 2004;
Okoro et al., 2004). The relationship between symptoms of depression
and problematic alcohol use appear to be bi-directional in nature; that
is, elevated symptoms of depression predict increased likelihood of
developing an alcohol-related disorder, and alcohol problems predict
future depressive symptoms (Brière, Rohde, Seeley, Klein, & Lewinsohn,
2014). Similarly, individuals with alcohol use problems demonstrate
significant, elevated likelihood of co-occurring Generalized Anxiety
Disorder (Burns & Teesson, 2002). Investigations of factors driving
these relationships have often found that negative reinforcement-based
In the U.S., there were 24 reported cases of coronavirus disease
2019 (COVID-19) on March 1, 2020, by March 31st, the number increased to 163,539 cases (CDC, 2020). The COVID-19 pandemic has
had wide-scale impacts on society in the United States. Across the
country many states closed university campuses and businesses, and
enacted stay-at-home orders. Adverse consequences of these changes
are likely to include increased stress and social isolation (Holmes et al.,
2020), as well the potential for increased alcohol consumption (Clay &
Parker, 2020; Walsh et al., 2014). The current study aimed to examine
how alcohol use has changed over time following the closing of a large
public University. Moreover, the study aimed to examine the relationship between psychological distress (symptoms of anxiety and
⁎
Corresponding author.
E-mail address: wlechner@kent.edu (W.V. Lechner).
https://doi.org/10.1016/j.addbeh.2020.106527
Received 21 May 2020; Received in revised form 23 June 2020; Accepted 23 June 2020
Available online 26 June 2020
0306-4603/ © 2020 Elsevier Ltd. All rights reserved.
Addictive Behaviors 110 (2020) 106527
W.V. Lechner, et al.
Items 1–6 were included in this survey, the maximum score on this
scale is 18. The Multidimensional Scale of Perceived Social Support
(MSPSS) subjectively assesses perception of social support from family,
friends, and significant other. The MSPSS has good internal reliability
and moderate construct validity (Zimet, Dahlem, Zimet, & Farley,
1988). The maximum score on the scale is 84 with larger numbers indicating higher perceived support (α in the current study in the current
study = 0.92).
motives drive the relationship; individuals with symptoms of psychological distress report using alcohol to cope with or dampen their
symptoms (Bolton, Cox, Clara, & Sareen, 2006; Grant et al., 2005;
Robinson, Sareen, Cox, & Bolton, 2009). Social support has been shown
to be protective against psychological distress (Chao, 2011; Hefner &
Eisenberg, 2009; Wang & Castañeda-Sound, 2008), and problematic
alcohol consumption (Aldridge-Gerry et al., 2011; Menagi, Harrell, &
June, 2008; Pauley & Hesse, 2009).
Given the established relationships noted, we hypothesized as a
result of the pandemic, depression and anxiety symptoms would be
associated with increases in alcohol use (standard drinks consumed,
reported retrospectively) following campus closure. Furthermore, we
hypothesized that low social support would be associated with an increase in alcohol-use, and that higher social support would moderate
the relationships between psychological distress and increasing alcohol
use, such that those with high social support would not demonstrate
increased drinking as a function of worse mental health. Additionally,
we examined these hypotheses in terms of drinking frequency (number
of drinking days).
2.3. Analytic strategy
Generalized estimating equations (GEE) were used to examine alcohol consumption reported across a two-week assessment period, with
a negative binomial distribution specified for amount of alcohol consumption (standard drinks), binomial distribution (binary logistic)
specified for frequency (drinking days), and an exchangeable working
correlation matrix. First, main effects and two-way interactions were
modeled. Next, an omnibus test of 3-way interactions were examined.
Two separate models containing 5 components were tested (labeled
below); one model for depression and one for anxiety. Depression and
anxiety were modeled separately due to high observed correlation between these constructs (r = 0.75), apriori hypotheses regarding their
association with the dependent variables, and resulting concerns regarding multicollinearity. The independent variables for the models
were (1) psychological distress [PHQ-9 or Gad-7] (2) reported social
support [MSPSS], and (3) time [within-subjects effect: 14 time points,
coded as week 1 and week 2], as well as (4) the three two-way interactions [psychological distress by time, support by time, psychological
distress by support] and (5) the three-way interaction [psychological
distress by support by time]. Specifically, the 7 time points reflecting
days between March 3 and March 10th were coded as week 1 (0) while
the 7 time points reflecting days between March 11th and March 17th
were coded as week 2 (1). We predicted a three-way interaction between distress, support, and time; reflecting that individuals with
higher psychological distress would demonstrate greater increases in
alcohol consumption if they reported having poor social support.
Covariates included race: White (0) and Asian, Black, multiracial,
Native American, or other (1); grade-level: undergraduate (0), graduate
student or medical student (1); and biological sex: female (0) male (1),
and a measure accounting for the variability in time between participant’s response dates. One additional exploratory post-hoc model (with
standard drinks set as the dependent variable) included a covariate of
drinking frequency (total number of drinking days) in weeks 1 and 2. A
Bonferroni correction was applied to this post-hoc test, with significance set to p < .025.
2. Methods
2.1. Participants and procedure
Participants were 1,958 students at a large public University in
Northeast Ohio who endorsed alcohol use in the 30 days prior to the
study. Participants were recruited through email to participate in the
study which consisted of retrospective self-report measures and timeline follow-back assessment of substance use over two-weeks, collected
in cross-section. The initial recruitment email was sent on March 26th,
2020 to all students who were currently enrolled in spring semester
(N = 33,280). A reminder email was sent four days after the initial
invitation to those who had not responded; 97.7% of the sample completed the study between March 26th and March 31st. A total of 4,276
participants responded to the survey (response rate = 12.8%). The
sample was 79.97% female, 86.41% non-Hispanic white, and the mean
age was 24.94 (SD = 7.65) years. Participants were told their responses
would be confidential and that the purpose of the survey was to present
a broad picture of student wellness. The survey included items on
substance use, depression, anxiety, and perceived social support as well
as resiliency and self-perceived success. As an incentive, after completing the survey, participants were given the opportunity to enter a
drawing to win one of six $20 gift cards.
2.2. Measures
3. Results
The Timeline Follow-Back Interview (TLFB; (Sobell, Brown, Leo, &
Sobell, 1996) a well-validated calendar assisted measure, was administered to document alcohol use in the 2-weeks between March 4th
and March 17th. This time period was selected because it represents the
week immediately preceding (March 4th - March 10th) and the week
succeeding (March 11th–March 17th) the announcement of the closure
of campus. The Patient Health Questionnaire-9 (PHQ-9) was used to
assess symptoms of depression in the past two weeks (Kroenke, Spitzer,
& Williams, 2001). The scale consists of 9 items targeting each of the
primary diagnostic criteria for depression. The PHQ-9 was found to
have acceptable diagnostic properties for detecting major depressive
disorder and has demonstrated excellent reliability as well as criterion,
construct, and external validity (α in the current study = 0.90). The
maximum score on this scale is 27. Six items from the Generalized
Anxiety Disorder 7-item scale (Gad-7) were used to assess symptoms of
generalized anxiety in the past two weeks (Spitzer, Kroenke, Williams,
& Lowe, 2006). The Gad-7 demonstrates good reliability, as well as
criterion and construct validity with independent diagnoses made by
mental health professionals and functional status measures such as
disability days and health care use (α in the current study = 0.91).
Participants consumed a range of 0 to 63 standard drinks
(M = 3.48, SD = 5.45) and a range of 0 to 7 drinking days (M = 1.36,
SD = 1.55) in the first week of the assessment period and a range of 0
to 98 standard drinks (M = 5.01, SD = 6.86) and a range of 0 to 7
drinking days (M = 1.94, SD = 1.84) in the second week. The mean
score on the PHQ-9 was 9.44 (SD = 6.82), and the mean score on the
GAD-7 8.25 (SD = 5.21). The mean score on the Multidimensional
Support Scale was 66.2 (SD = 12.33).
First, we examined main effects and two-way interactions between
(1) symptoms of psychological distress and social support (respectively), and (2) time on alcohol consumption over the two-week observation period. A significant main effect for time indicated that alcohol consumption increased as time progressed, b = 0.369, 95%
CI = 0.316, 0.423, p < .001. Significant main effects for symptoms of
depression (b = 0.027, 95% CI = 0.017, 0.037, p < .001), and anxiety (b = 0.026, 95% CI = 0.014, 0.038, p < .001), indicated that
higher psychological distress was associated with higher alcohol consumption overall. Social support demonstrated a significant negative
2
Addictive Behaviors 110 (2020) 106527
W.V. Lechner, et al.
Table 1
Associations of time and psychological distress interactions with standard drinks.
Parameter
Intercept
Time since self-reported use
Student Class (undergraduate)
Biological Sex (female)
Race (white)
Time (week)
PHQ-9 (depressive symptoms)
Time by PHQ-9
Parameter
Intercept
Time since self-reported use
Student Class (undergraduate)
Biological Sex (female)
Race (white)
Time (week)
GAD-7 (anxiety symptoms)
Time by GAD-7
b
−0.684
0.017
−0.053
−0.495
0.174
0.266
0.021
0.012
b
−0.646
0.017
0.004
−0.511
0.153
0.252
0.017
0.013
Std. Error
0.115
0.013
0.058
0.070
0.082
0.048
0.005
0.002
Std. Error
0.117
0.013
0.059
0.072
0.084
0.049
0.007
0.005
Lower (95%Wald CI)
−0.911
−0.009
−0.168
−0.633
0.012
0.172
0.009
0.006
Lower (95%Wald CI)
−0.876
−0.009
−0.112
−0.654
−0.012
0.155
0.004
0.004
Upper (95% Wald CI)
−0.457
0.042
0.063
−0.356
−0.336
0.360
0.032
0.017
Upper (95% Wald CI)
−0.416
0.043
0.120
−0.368
0.317
0.349
0.031
0.023
p
0.000
0.198
0.370
< 0.001
0.035
< 0.001
< 0.001
0.011
p
< 0.001
0.197
0.943
< 0.001
0.069
< 0.001
0.012
0.004
Dependent Variable = Standard Drinks.
distress and time remained significant. Taken together, this set of results indicates that participants reported both increased alcohol consumption on drinking occasions, and more drinking occasions overall.
These results highlight the potential for universities to intervene
during this period of closure to possibly reduce or prevent alcohol
abuse. Although the current environment is unparalleled, past research
has found multicomponent and virtual approaches to be effective for
college student alcohol prevention. Internet-based interventions can be
effective in curbing problem drinking and are both cost-effective and
scalable (Riper et al., 2011). Programs that can be offered remotely and
target at-risk students to reduce drinking include eCHUG (Walters,
Vader, & Harris, 2007) and AlcholEdu (Paschall, Antin, Ringwalt, &
Saltz, 2011). Additionally, research has demonstrated promising results
regarding the benefits of using online interventions for the treatment of
depression in young people (Rice et al., 2014) and the benefits of using
social media as a modernized medium for social support (Cole, Nick,
Zelkowitz, Roeder, & Spinelli, 2017). Increasing awareness of helplines,
such as Substance Abuse and Mental Health Services Administration’s
free helpline for individuals and families facing mental and/or substance use disorders, can potentially be beneficial.
It is unknown to what degree the present findings generalize to
other populations and events. Data for the current study was collected
from university students, soon after the COVID-19 pandemic was
starting to significantly impact day-to-day routines in the US. Different
populations, as well events that are different from the COVID-19 pandemic but are also stress inducing and socially isolating (e.g., moving to
a new city by yourself), may produce different results. Additionally, the
cross-sectional nature of the current data precludes causal interpretation of relationships. Furthermore, variability in overlap between the
timeline follow-back alcohol use data and reporting of psychological
symptoms existed between participants. Although a covariate accounting for this variance was included in current analyses, longitudinal designs are needed to confirm the relationships observed. An
additional variable that would provide important information is an
assessment of how participants’ living situations changed as the result
of the pandemic, and how that might affect alcohol use in conjunction
with mental health. The response rate (12.9%) and high percentage of
female students, limits the generalizability of these results, despite
covariation for biological sex. Future research is needed to continue to
track and monitor alcohol use as the pandemic progresses as well as
examine the utility of remote technologies to reduce social isolation and
increase social support.
effect, indicating that those with more social support, consumed less
alcohol overall b = −0.009, 95% CI = −0.015, −0.002, p = .013.
Time by psychological distress interactions (Table 1) indicated that
individuals experiencing higher levels of symptoms of depression and
anxiety reported greater increases in alcohol consumption over time as
compared to individuals with fewer symptoms (b = 0.012, 95%
CI = 0.006, 0.017, p = .011; b = 0.013, 95% CI = 0.004, 0.023,
p = .004, respectively). The interaction between social support and
time was not significant. Next, we conducted an omnibus test for the
three-way interactions (psychological distress by social support by
time) for both anxiety and depression. Neither three-way interaction
was significant, indicating that hypothesized benefits of social support
do not moderate the relationship between symptoms of psychological
distress and increasing alcohol use over time. Exploratory analyses
tested the same set of hypotheses to determine if any differences would
emerge between relationships examining frequency (number of
drinking days) set as the dependent variable. Supplementary Table 1
demonstrates that the same pattern of results indicated for alcohol
consumption, was observed for alcohol use frequency (number of
drinking days). Lastly, number of drinking days in week 1 and 2 was
included as a covariate in the model with amount of alcohol consumption set as the dependent variable. The two-way interactions between depression and time (b = 0.010, 95% CI = 0.002, 0.010,
p = .016), and anxiety and time (b = 0.015, 95% CI = 0.005, 0.026,
p = .004) remained significant.
4. Discussion
The current study took place amidst a pandemic which brought with
it profound and unprecedented effects. To better understand these
consequences, consumption of alcohol, immediately prior to and after
the announcement of the closing of a large public university was assessed. An increase in alcohol consumption was observed following the
announcement of campus closing. Furthermore, as hypothesized and
consistent with past research, students with higher levels of depression
and anxiety reported greater increases in alcohol use over time as
compared to those with lower levels of distress. Perceived social support was associated with lower alcohol use overall. However, social
support did not moderate the effects of psychological distress on increasing alcohol use as time progressed. The same pattern of results was
observed for both alcohol consumption (standard drinks) and frequency
of alcohol use (drinking days). Additionally, in order to better understand if the observed increases in reported alcohol use over time was
driven by alcohol use frequency, a model examining alcohol consumption, covarying for number of drinking days was constructed.
Results demonstrated that the relationships between psychological
Author contributions
William Lechner wrote the manuscript and contributed to analyses.
3
Addictive Behaviors 110 (2020) 106527
W.V. Lechner, et al.
Kimberly Laurene contributed to the design of the study and writing the
manuscript. Sweta Patel contributed to analyses. Megan Anderson and
Chelsea Grega contributed to writing. Deric Kenne designed the study,
wrote the protocol, and contributed to writing and revisions.
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Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence the work reported in this paper.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://
doi.org/10.1016/j.addbeh.2020.106527.
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