Self-compassion buffers the internalized alcohol stigma and depression link in women sexual assault survivors who drink to cope

Unhealthy drinking, defined as any alcohol use associated with the risk or likelihood of negative consequences (Saitz et al., 2021, US Preventive Services Taskforce, 2018), has increased among women in the United States in recent years (Keyes et al., 2019). Increases in women’s alcohol consumption compounds the well-established adverse effects of drinking on women’s health and contributes to chronic disease burden (McCaul et al., 2019). Depression is among the factors strongly implicated in unhealthy drinking and the development of alcohol use disorders (AUD) in women relative to men (McHugh & Weiss, 2019) and rates of comorbid depression are much higher among women than men with AUD (Karpyak et al., 2016, Lau-Barraco et al., 2009).

These associations are exacerbated among women with a history of sexual assault victimization (SAV). Unhealthy alcohol use increases the risk of experiencing SAV, while SAV increases the likelihood of developing psychiatric disorders including depression and alcohol problems (Langdon et al., 2016). A recent meta-analysis of psychopathology among women with a history of SAV found a lifetime prevalence rate of 39 % for depression and 36 % for posttraumatic stress disorder (PTSD) (Dworkin, 2020). While PTSD and depression following SAV are highly comorbid and have been identified as contributors to women’s alcohol use (Gradus et al., 2008, Langdon et al., 2016, Levahot et al., 2014, Wanklyn et al., 2016), some research suggests that depression, rather than PTSD symptoms, may be a more proximal indicator of problematic alcohol use in this population (Creech and Borsari, 2014, Kelley et al., 2013).

Additionally, drinking to cope with negative affect (i.e., coping motives) increases the strength of the relationship of depression with drinking, AUD, and drinking problems (Crum et al., 2013, Holahan et al., 2003), and has been identified as a proximal risk factor for problem drinking and consequences among survivors of trauma and SAV (e.g., Brockdorf et al., 2021, Lindgren et al., 2012, Ullman et al., 2013). For instance, prospective evidence in women shows that SAV increases subsequent coping motives for drinking (Nelson & Fischer, 2021), and that drinking increases as daily SAV-related distress increases, particularly among women reporting deficits in effective coping (Stappenbeck et al., 2015). As such, a better understanding of factors that may contribute to the etiology of depressive symptoms among the subset of women sexual assault survivors who drink to cope – a key behavioral phenotype that may increase risk of developing or maintaining AUD – may ultimately contribute toward effective intervention development.

Problematic substance use, including alcohol, is one of the most stigmatized behaviors in the world (Room, 2005, Schomerus et al., 2011) and women’s problem alcohol use is even more stigmatized compared to men, given longstanding gendered drinking norms in the US (Gomberg, 1988, Jarvis, 1992, Sanders, 2021). Models of substance use stigma describe how stigma experiences and/or exposure can often result in the self-application of stereotypes among stigmatized individuals (i.e., internalized stigma), with adverse effects on mental health (Corrigan et al., 2011, Earnshaw, 2020, Quinn et al., 2015, Schomerus et al., 2011).

Internalized stigma may also potentially contribute to depressed mood and feelings of worthlessness or excessive guilt, two DSM-5 criteria for major depressive disorder (American Psychiatric Association, 2013), thereby driving depression. Indeed, evidence shows internalized substance use stigma (e.g., “a major reason for my drinking is my own poor character”; Luoma et al., 2013) is associated with depressive symptoms among people undergoing alcohol detoxification (Brown et al., 2015, da Silveira et al., 2018, Schomerus et al., 2011), as well as in women with hazardous drinking (Vilus & Perich, 2021).

Some research also suggests history of SAV may increase vulnerability to internalizing diverse forms of stigma (Keirns et al., 2021, Schröder et al., 2021). Only one study to our knowledge has examined internalized-AS in trauma survivors, which found history of childhood trauma to increase its likelihood (Stolzenburg et al., 2018). Internalized AS may thus be an understudied contributor to depressive symptoms among women reporting SAV and unhealthy drinking. Less still is understood of factors that may moderate (i.e., buffer) the association between internalized-AS and depression in this population.

Self-compassion, treating oneself as a loved one might during times of distress (Neff, 2003), is an affect regulation strategy broadly implicated as stigma protective (Wong et al., 2019) and inversely linked with sexual assault-related mental health sequelae (Allen et al., 2021, Strickland et al., 2019, Winders et al., 2020). An increasing body of research shows self-compassion to buffer the link between stigma-related constructs and distress or wellbeing in various populations (Chan et al., 2020, Vigna et al., 2017, Yang and Mak, 2016, Zhang et al., 2021). Self-compassionate individuals may be more likely reappraise cognitions related to internalized stigma; to engage in healthier behaviors that adaptively soothe negative affect and quiet stigmatizing cognitions; and to experience greater positive affect (e.g., compassion, kindness) during times of distress, all in turn decreasing risk of depression. Specifically with respect to internalized-AS, a more self-compassionate individual might recognize they are having a self-stigmatizing thought or affect (e.g., shame) pertaining to their alcohol use. They could then decide to either reappraise this thought by generating a thought that is more compassionate, and/or engage in a supportive behavior or practice to shift the corresponding affect, with repetition in time decreasing risk of depression. Despite these promising empirical and theoretical linkages, no research has examined whether self-compassion buffers the link between internalized-AS and depression, including among SAV survivors.

The present study in sexual assault survivors with unhealthy drinking and elevated coping motives aimed to a) assess proportion of variance in depressive symptoms accounted for by internalized-AS and self-compassion, and b) test whether self-compassion moderated the link between internalized-AS and depression.

留言 (0)

沒有登入
gif