Examining shame in the depressive-risk pathway to alcohol misuse in emerging adults: evidence from experimental and ecological studies
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Emerging adulthood (ages 18 to 25) is associated with self-discovery and coincides with rates of alcohol misuse and depression that are the highest across the lifespan. The self-medication hypothesis is the prevailing model that helps explain depression-alcohol misuse comorbidities by arguing that individuals crave and drink alcohol to cope with strong negative emotions. However, less is known about the etiological mechanisms and proximal emotions that explain this common comorbidity in emerging adulthood. Burgeoning research demonstrates that depression is associated with alcohol misuse via shame, a potent social emotion. However, this work is limited as much of it has been cross-sectional and has used retrospective self-report methods. Thus, there is a need for in-the-moment and experimental research to better understand the associations between shame and alcohol misuse among emerging adults with depression. The overarching goal of this dissertation was to further understand the role of shame in depression-motivated drinking among Canadian emerging adults by using prospective ecological momentary assessment (Study 1) and experimental methods (Study 2). Results of Study 1 (N = 184) found that shame, but not guilt, mediated the association between baseline depression and alcohol problems in “real life” drinking situations. Study 2 (N = 80) sought to examine associations between drinking context and shame among emerging adults with depression in a lab setting. The findings add to the story by demonstrating that shame mediated the association between depression and alcohol craving only in a solitary (versus social) context. Using sophisticated research designs and data analytic approaches, this dissertation identified that (a) shame helps explain depressed emerging adults’ propensity for alcohol misuse and (b) solitary contexts exacerbate shame’s influence. Overall, this work clarified the mediating role of shame and the additive influence of solitary context in the depressive-pathway to alcohol misuse among emerging adults. Results shed light on malleable treatment targets for emerging adults that experience mood and alcohol problems.