Depression, Posttraumatic Stress, and Alcohol Misuse in Young Adult Veterans

The Transdiagnostic Role of Distress Tolerance

Published in: Drug and Alcohol Dependence, 2016

Posted on RAND.org on March 14, 2016

by Stephanie Brooks Holliday, Eric R. Pedersen, Adam M. Leventhal

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Research Question

  1. What is the role of distress tolerance in the relationship between mental health and alcohol misuse in a U.S. military veteran population?

BACKGROUND: Alcohol misuse is common among young adult veterans, and is commonly associated with depression and posttraumatic stress disorder (PTSD). In fact, rates of comorbid depression, PTSD, and problem drinking are high in this population. Although distress tolerance, the capacity to experience and withstand negative psychological states, has been examined as a potential transdiagnostic factor that accounts for the development of mental health disorders, problem drinking, and the comorbidity between these presenting concerns, its role has not been evaluated in a veteran population. METHODS: Young adult veterans were recruited for an online survey related to alcohol use. Participants (n = 783) completed self-report measures of alcohol use, depression and PTSD symptoms, and distress tolerance. Mediation models were conducted to examine whether distress tolerance mediated the relationship between (1) probable PTSD, (2) probable depression, and (3) comorbid probable PTSD and depression with alcohol misuse. Moderated mediation models were conducted to examine gender as a moderator. RESULTS: Significant bivariate associations were observed among mental health symptoms, distress tolerance, and alcohol misuse. Distress tolerance significantly mediated the relationship between probable depression and PTSD (both alone and in combination) and alcohol misuse. Evidence of moderated mediation was present for probable PTSD and probable comorbid PTSD and depression, such that the indirect effect was stronger among males. CONCLUSIONS: These results suggest that distress tolerance may be a transdiagnostic factor explaining the comorbidity of depression and PTSD with alcohol misuse in young adult veterans. These findings may inform screening and intervention efforts with this high-risk population.

Key Findings

  • Both probable PTSD and depression are strongly correlated with problem drinking among adult veterans.
  • Distress tolerance—or the ability to tolerate negative psychological states—accounted for comorbidity of both PTSD and depression with alcohol problems, as well as the tri-morbidity among all three concerns.

Recommendation

  • Building distress tolerance skills, in addition to targeting symptoms of PTSD and/or depression among heavy drinkers, may be an appropriate target for interventions.

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