Loneliness and Alcohol use among College Students During the COVID-19 Pandemic in Rural Appalachia.

Objective: Binge drinking and heavy alcohol use are highly prevalent among college students. During the COVID-19 pandemic, due to lockdown restrictions and other challenges, many college students were burdened with loneliness, which can contribute to chronic stress, and substance use. The current study explores the association between loneliness and various levels of alcohol use among college students in the rural, underserved region of Central Appalachia, USA. Methods: Data were collected from a regional sample (n = 320) of college age adults, age 18-25 in the Central Appalachian region. The UCLA-3 item Loneliness Scale (UCLA-3) was used in the study to evaluate loneliness. Logistic regression analysis was conducted to assess the association between levels of loneliness and three separate outcomes, including past year binge drinking, past year heavy alcohol use, and past year weekly alcohol use. Results: Overall, 25.5% of the participants reported severe loneliness, 33.6% reported moderate, and 40.9% reported low levels of loneliness. Results of the adjusted models revealed that severe loneliness was associated with higher odds of heavy alcohol use (AOR = 1.89, 95% CI [1.02, 3.50]) and binge drinking (AOR = 2.96, 95% CI [1.16, 7.51]), and not associated with weekly alcohol use. Conclusion: The study found that higher levels of loneliness were linked to both binged drinking and heavy alcohol use. Further efforts for counseling and treatment among college students who are burdened with severe loneliness should be considered. The chronic stress associated with severe loneliness needs to be further addressed, particularly among emerging adults.

Substance Use Disorder and Suicidal Ideation in Rural Maryland.

Background: Rural areas in the United States have been disproportionately burdened with high rates of substance use, mental health challenges, chronic stress, and suicide behaviors. Factors such as a lack of mental health services, decreased accessibility to public health resources, and social isolation contribute to these disparities. The current study explores risk factors to suicidal ideation, using emergency room discharge data from Maryland. Methods: The current study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) from the State of Maryland. Logistic regression was used to assess the association between ICD-10 coded opioid use disorder, alcohol use disorder, cannabis use disorder, major depressive disorder, and the outcome variable of suicidal ideation discharge. We controlled for income, race, age, and gender. Results: Lifetime major depressive disorder diagnosis (odds ration [OR] = 79.30; 95% confidence interval [CI] 51.91-121.15), alcohol use disorder (OR = 6.87; 95% CI 4.97-9.51), opioid use disorder (OR = 5.39; 95% CI 3.63-7.99), and cannabis use disorder (OR = 2.67; 95% CI 1.37-5.18) were all positively associated with suicidal ideation. Conclusions: The study highlights the strong link between prior substance use disorder, depression, and suicidal ideation visit to the emergency room, indicating the need for prevention and intervention, particularly among those in rural areas where the burden of suicidal ideation and chronic stress are high. As health disparities between rural and urban areas further widened during the COVID-19 pandemic, there is an urgent need to address these issues.