Unhealthy Alcohol Use among Adults with Depression or Anxiety: Changes During COVID-19 and Associations with Mental Health Treatment.

OBJECTIVE: Individuals with unhealthy alcohol use and comorbid depression or anxiety may be vulnerable to alcohol use escalation in times of stress such as the COVID-19 pandemic. Among a cohort of individuals with pre-pandemic unhealthy drinking, we compared changes in alcohol use by whether people had a depression or anxiety diagnosis, and examined whether mental health treatment was related to these changes. METHODS: Using electronic health record data from Kaiser Permanente Northern California, we analyzed drinking changes during the pandemic (3/1/2020-6/30/2022) among adults identified in primary care with unhealthy alcohol use (exceeding daily/weekly recommended limits) pre-pandemic (1/1/2019-2/29/2020). Outcomes were mean changes in number of heavy drinking days (prior three months), drinks/week, drinks/day, and drinking days/week. Multivariable linear regression models were fit to: 1) compare outcomes of patients with depression or anxiety diagnoses to those without, and 2) among patients with depression or anxiety, estimate associations between mental health treatment and outcomes. RESULTS: The sample included 62,924 adults with unhealthy alcohol use, of whom 12,281 (19.5%) had depression or anxiety. On average, alcohol use significantly decreased across all measures during the pandemic, but patients with depression or anxiety had greater decreases in drinks/week (adjusted mean difference [aMD] [CI]=-0.34 [-0.55, -0.12]) and drinking days/week (-0.15 [-0.20, -0.10]). No associations were found between mental health treatment and changes in drinking. CONCLUSIONS: Contrary to expectations, patients with unhealthy alcohol use and depression or anxiety decreased alcohol use more than those without depression or anxiety during COVID-19, whether or not they accessed mental health services.

The naturalistic reinforcement of worry from positive and negative emotional contrasts: Results from a momentary assessment study within social interactions.

BACKGROUND: The Contrast Avoidance Model (Newman & Llera, 2011) proposes that worry is reinforced by avoiding a negative contrast and increasing the likelihood of a positive contrast. OBJECTIVE: To determine if reinforcement of worry occurs naturalistically via contrasts in both negative and positive emotion. METHOD: Using event-contingent momentary assessment we assessed social interactions, pre-interaction state worry and pre-post interaction positive and negative emotion. Participants with generalized anxiety disorder (GAD; N = 83) completed an online questionnaire after social interactions lasting at least 1 min for 8 days. Three-level multilevel models were conducted. RESULTS: Higher worry was concurrently associated with increased negative emotion and decreased positive emotion. Regardless of pre-interaction worry level, negative emotion decreased, and positive emotion increased from before to after interactions, suggesting that most interactions were benign or positive. At lower levels of pre-interaction worry, participants experienced increased negative emotion and decreased positive emotion from before to after interactions. At higher levels of pre-interaction worry, participants experienced decreased negative emotion and increased positive emotion from before to after interactions. CONCLUSION: Among persons with GAD, worrying before social interactions may be both negatively and positively reinforced; furthermore, not worrying before social interactions may be both negatively and positively punished.

Culture Moderates the Relationship Between Emotional Fit and Collective Aspects of Well-Being.

The present study examined how emotional fit with culture - the degree of similarity between an individual' emotional response to the emotional response of others from the same culture - relates to well-being in a sample of Asian American and European American college students. Using a profile correlation method, we calculated three types of emotional fit based on self-reported emotions, facial expressions, and physiological responses. We then examined the relationships between emotional fit and individual well-being (depression, life satisfaction) as well as collective aspects of well-being, namely collective self-esteem (one's evaluation of one's cultural group) and identification with one's group. The results revealed that self-report emotional fit was associated with greater individual well-being across cultures. In contrast, culture moderated the relationship between self-report emotional fit and collective self-esteem, such that emotional fit predicted greater collective self-esteem in Asian Americans, but not in European Americans. Behavioral emotional fit was unrelated to well-being. There was a marginally significant cultural moderation in the relationship between physiological emotional fit in a strong emotional situation and group identification. Specifically, physiological emotional fit predicted greater group identification in Asian Americans, but not in European Americans. However, this finding disappeared after a Bonferroni correction. The current finding extends previous research by showing that, while emotional fit may be closely related to individual aspects of well-being across cultures, the influence of emotional fit on collective aspects of well-being may be unique to cultures that emphasize interdependence and social harmony, and thus being in alignment with other members of the group.