Elsevier

Drug and Alcohol Dependence

Volume 140, 1 July 2014, Pages 175-182
Drug and Alcohol Dependence

Regular drinking may strengthen the beneficial influence of social support on depression: Findings from a representative Israeli sample during a period of war and terrorism

https://doi.org/10.1016/j.drugalcdep.2014.04.014Get rights and content

Abstract

Background

Social support is consistently associated with reduced risk of depression. Few studies have investigated how this relationship may be modified by alcohol use, the effects of which may be particularly relevant in traumatized populations in which rates of alcohol use are known to be high.

Methods

In 2008 a representative sample of 1622 Jewish and Palestinian citizens in Israel were interviewed by phone at two time points during a period of ongoing terrorism and war threat. Two multivariable mixed effects regression models were estimated to measure the longitudinal association of social support from family and friends on depression symptoms. Three-way interaction terms between social support, alcohol use and time were entered into the models to test for effect modification.

Results

Findings indicated that increased family social support was associated with less depression symptomatology (p = <.01); this relationship was modified by alcohol use and time (p = <.01). Social support from friends was also associated with fewer depression symptoms (p = <.01) and this relationship was modified by alcohol use and time as well (p = <.01). Stratified analyses in both models revealed that the effect of social support was stronger for those who drank alcohol regularly than those who did not drink or drank rarely.

Conclusions

These findings suggest that social support is a more important protective factor for depression among regular drinkers than among those who do not drink or drink rarely in the context of political violence. Additional research is warranted to determine whether these findings are stable in other populations and settings.

Introduction

Israel has traditionally had some of the lowest rates of alcohol use problems in the world (Adler and Kandel, 1983, Bamberger and Barhom-Kidron, 1998, Rahav et al., 1999). However, increases in immigration and ongoing terrorist attacks in recent decades have contributed to an increase in alcohol use rates (Bar-Hamburger et al., 2009, Bleich et al., 2003, Bleich et al., 2005, Shoham et al., 1980). Since 2000, over 6400 Palestinians and 1000 Israeli citizens have been killed (B’Tselem, 2012). Terrorism is particularly traumatogenic as it targets civilians and can occur anywhere, especially in highly populated civilian areas (Canetti et al., 2013). This perpetual violence has negatively affected the physical and mental health of people living in Israel (Hobfoll et al., 2012). Recent studies report a high incidence of depression and war-related stress in Israel and the Palestinian territories (Canetti et al., 2010).

Heavy drinking is associated with a number of negative consequences including unintentional injury, violence, risk-taking behaviors, neurological problems, liver disease, depression and risk for suicide (Castaneda et al., 1996, Centers for Disease Control and Prevention, 2012, Corrao et al., 2004, Heron, 2007, National Center on Addiction and Substance Abuse, 1999, Smith et al., 1999, Sullivan et al., 2005, Wechsler et al., 1994). Studies focusing on alcohol use following terrorist attacks primarily examine these adverse effects of heavy alcohol use. Findings have demonstrated that heavy alcohol use may impede recovery or treatment of psychiatric problems following a terrorist attack and is thought to be an avoidant coping strategy for dealing with stress in such circumstances (Adams et al., 2006, North et al., 2002, Schiff et al., 2006, Thoits, 1995).

Other research has described the potentially positive effects of alcohol use. A review by Baum-Baicker (1985) found that light to moderate alcohol use increased psychological well-being and that heavy drinkers and non-drinkers had higher rates of depression than moderate drinkers. A longitudinal investigation in Norway found that adults who abstained from alcohol their entire lives had weaker social networks and a higher risk for depression than those who did not abstain from alcohol (Pedersen, 2013). Despite these indications of the positive effects of moderate alcohol use, it is not yet known whether moderate drinking is causally associated with diminished psychiatric symptoms (Peele and Brodsky, 2000) or whether drinking behavior interacts with other factors to produce these benefits. The nature of this relationship within the context of terrorism also remains unclear.

People rely on social support as a coping mechanism following potentially traumatic events (Bleich et al., 2003, Thoits, 1995) and social support has consistently been shown to be a strong protective factor against the development of depression (Belle, 1987, Brown et al., 1986, Kendler et al., 2005). Although heavy alcohol use is generally and appropriately seen as an unhealthy coping strategy following traumatic events (Adams et al., 2006), it is plausible that there is a moderating effect of alcohol use on social support. For example, a study in Japan found that moderate drinkers reported greater social support from friends than did heavy drinkers or non-drinkers (Yoshihara and Shimizu, 2005). Ikehara et al. (2009) found an interactive effect between light-to-moderate alcohol drinking and social support such that light-to-moderate drinking demonstrated a stronger protective effect against cardiovascular disease among those with higher social support compared to those with lower social support.

We were unable to locate studies that investigated similar effects between moderate alcohol use and social support on mental health, and in particular, depressive symptomatology, within a population living under threat of terrorism. The present study explores the modifying effects of regular alcohol use on the relationship between perceived social support and depression among a representative sample of Israeli adults. We also extend the literature by examining whether modifying effects are similar for perceived support from family and perceived support from friends. We hypothesize that perceived social support from both family and friends will be associated with lower self-reported depression scores and that both of these relationships will be modified by regular alcohol use.

Section snippets

Participants and procedure

The institutional review boards of the University of Haifa, Kent State University, and Rush University Medical Center approved this study.

A nationally representative sample of 1622 Jewish and Palestinian citizens of Israel (PCI) was obtained through a random telephone survey. Structured telephone interviews were conducted at 3 time points during a period of ongoing violence in Israel; the first wave was conducted from May–July, 2007, the second wave was conducted from November, 2007 to January,

Results

Table 1 summarizes the demographic characteristics of the sample at time 1, stratified by drinking frequency. Regular drinkers were more likely to be male, have above average income, be Jewish rather than PCI, and have immigrated to Israel from Russia, but were less likely to be married than those who did not drink or drank rarely. No significant differences were found amongst any of the other variables.

The results of Model 1 indicated that greater familial social support was strongly

Discussion

This study utilized a large nationally representative sample of Israeli Jews and Palestinians to investigate the modifying effects of alcohol use on the relationship between social support and depression. We hypothesized that perceived social support from both family and friends would be associated with lower self-reported depression scores and that both of these relationships would be modified by regular alcohol use, defined as having at least one drink per week. Our findings indicate that

Role of funding source

This research was made possible in part by a grant from the National Institute of Mental Health (Hobfoll and Canetti; RO1MH073687). Mr. Kane's contribution was supported by a National Institute for Drug Abuse training grant in Drug Dependence Epidemiology (T32DA007292). Dr. Zalta's contribution was supported by the Rush Center for Urban Health Equity (NIH-NHLBI 1P50HL105189). Dr. Hall's contribution to this work was partially supported by the National Institute of Mental Health T32 in

Contributors

The original study was designed by Dr. Hobfoll and Dr. Canetti and they contributed substantially to the development of this manuscript. Mr. Kane and Dr. Hall conceived the research question for the present study. Dr. Rapaport and Dr. Canetti led in drafting the Introduction and Dr. Zalta led in drafting the Methods. Mr. Kane and Dr. Hall conducted the statistical analysis and led in writing the Discussion. All authors contributed significantly to and edited all sections of the manuscript and

Conflicts of interest

All authors declare that they have no conflicts of interest.

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