Shuai Ruichong, Anker Justin J, Bravo Adrian J, Kushner Matt G, Hogarth Lee
School of Psychology, University of Exeter, Exeter, United Kingdom.
Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States.
Front Behav Neurosci. 2022 Feb 14;16:821693. doi: 10.3389/fnbeh.2022.821693. eCollection 2022.
Socioeconomic deprivation is associated with greater alcohol problems despite lower alcohol consumption, but the mechanisms underpinning this alcohol harm paradox remain obscure. Fragmented published evidence collectively supports a multistage causal risk pathway wherein socioeconomic deprivation increases the probability of exposure to aversive experience, which promotes internalizing symptoms (depression and anxiety), which promotes drinking alcohol to cope with negative affect, which in turn accelerates the transition from alcohol use to dependence. To evaluate this proposed risk pathway, 219 hazardous drinkers from an undergraduate population completed questionnaires assessing these constructs in a single, cross sectional, online survey. Partial correlation coefficients revealed that each variable showed the strongest unique association with the next variable in the proposed multistage model, when adjusting for the other variables. Bootstrapped serial mediation analysis revealed that the indirect pathway linking all the variables in the proposed serial order was significant, while all other permutations were non-significant. Network centrality analysis corroborated the serial order of this indirect path. Finally, risk ratios estimated by categorizing the variables suggested that socioeconomic deprivation increased the risk of aversive experience by 32%, which increased the risk of internalizing symptoms by 180%, which increased the risk of drinking to cope by 64%, which increased susceptibility to alcohol dependence by 59%. These preliminary findings need to be corroborated by future research, nevertheless, they call for prevention strategies founded on social justice and the minimization of aversive experience in socially deprived individuals to mitigate mental health problems, maladaptive coping and addiction.
尽管酒精消费量较低，但社会经济剥夺与更严重的酒精问题相关，然而，支撑这种酒精危害悖论的机制仍不明确。零散的已发表证据共同支持了一条多阶段因果风险路径，即社会经济剥夺增加了接触厌恶经历的可能性，这会促进内化症状（抑郁和焦虑），进而促使饮酒以应对负面情绪，这反过来又加速了从饮酒到酒精依赖的转变。为了评估这一提出的风险路径，来自本科生群体的219名危险饮酒者在一项单一的横断面在线调查中完成了评估这些构念的问卷。偏相关系数显示，在调整其他变量后，每个变量在所提出的多阶段模型中与下一个变量呈现出最强的独特关联。自抽样序列中介分析表明，以所提出的序列连接所有变量的间接路径是显著的，而所有其他排列均不显著。网络中心性分析证实了这条间接路径的序列顺序。最后，通过对变量进行分类估计的风险比率表明，社会经济剥夺使厌恶经历的风险增加了32%，使内化症状的风险增加了180%，使为应对而饮酒的风险增加了64%，使酒精依赖易感性增加了59%。尽管这些初步发现需要未来的研究加以证实，但它们呼吁基于社会正义以及尽量减少社会剥夺个体的厌恶经历来制定预防策略，以减轻心理健康问题、适应不良的应对方式和成瘾问题。
