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Effects of a Brief Safe Drinking Intervention on Depressive and Anxiety Symptomatology: Examining Potential Side Effects of Deviance Regulation Theory Interventions

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Title: Effects of a Brief Safe Drinking Intervention on Depressive and Anxiety Symptomatology: Examining Potential Side Effects of Deviance Regulation Theory Interventions
Language: English
Authors: Angelina V. Leary (ORCID 0000-0002-1374-5437), Robert D. Dvorak, Emily K. Burr, Ardhys N. De Leon, Samantha J. Klaver, Gabrielle Lynch, Ethan Toth, Michelle J. Diaz, Sebastian Martin
Source: Journal of Drug Education. 2024 53(3-4):102-117.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 16
Publication Date: 2024
Sponsoring Agency: National Science Foundation (NSF), Graduate Research Fellowship Program (GRFP)
National Institutes of Health (NIH) (DHHS)
Contract Number: 2035702
1R15AA02642001A1
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Program Effectiveness, Drinking, Intervention, Depression (Psychology), Anxiety, Symptoms (Individual Disorders), College Students, Behavior Modification, Student Behavior, Emotional Intelligence, Behavior Standards, Social Behavior, Communication Strategies
DOI: 10.1177/00472379241272587
ISSN: 0047-2379
1541-4159
Abstract: College students are at a heightened risk of experiencing depression and anxiety symptomatology and engaging in maladaptive alcohol use. Understanding how alcohol interventions impact emotional functioning is essential. One such intervention uses Deviance Regulation Theory (DRT), which posits that behavior can be modified using targeted messaging as a function of perceived norms. DRT has been shown to be effective at increasing responsible drinking behaviors and decreasing alcohol-related consequences. However, it is unclear if this intervention influences emotional functioning. The current examines the impact of a DRT intervention on emotional functioning. Participants (n = 147) were recruited from a large Southeastern university. The study included a screening phase, intervention, and six-week follow-up. Participants were randomly assigned to one of three conditions: a positive message condition about people who drink responsibly, a negative message condition about people who do not drink responsibly, and an active control condition. During the study, all participants reported on depression/anxiety symptoms, alcohol use, responsible drinking, and alcohol-related consequences. Mixed-effects regression was used to analyze the data. Results suggest an overall reduction of depressive and anxiety symptomatology in the intervention conditions but not in the control condition. In the positive condition, there was a decrease in depressive and anxiety symptomatology. The messaging was not moderated by normative beliefs. The negative condition also led to decreases in depression and anxiety symptomatology over time. In addition, perceived norms moderated the negative message in the first week after the intervention, an effect consistent with DRT. Prior research indicates this intervention is efficacious for the reduction of adverse alcohol outcomes; these data show that the intervention may also have positive effects on downstream mental health outcomes.
Abstractor: As Provided
Notes: https://osf.io/akef9
Entry Date: 2024
Accession Number: EJ1438495
Database: ERIC
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  Value: <anid>AN0179435148;jdr01sep.24;2024Sep06.05:45;v2.2.500</anid> <title id="AN0179435148-1">Effects of a Brief Safe Drinking Intervention on Depressive and Anxiety Symptomatology: Examining Potential Side Effects of Deviance Regulation Theory Interventions </title> <p>College students are at a heightened risk of experiencing depression and anxiety symptomatology and engaging in maladaptive alcohol use. Understanding how alcohol interventions impact emotional functioning is essential. One such intervention uses Deviance Regulation Theory (DRT), which posits that behavior can be modified using targeted messaging as a function of perceived norms. DRT has been shown to be effective at increasing responsible drinking behaviors and decreasing alcohol-related consequences. However, it is unclear if this intervention influences emotional functioning. The current examines the impact of a DRT intervention on emotional functioning. Participants (n = 147) were recruited from a large Southeastern university. The study included a screening phase, intervention, and six-week follow-up. Participants were randomly assigned to one of three conditions: a positive message condition about people who drink responsibly, a negative message condition about people who do not drink responsibly, and an active control condition. During the study, all participants reported on depression/anxiety symptoms, alcohol use, responsible drinking, and alcohol-related consequences. Mixed-effects regression was used to analyze the data. Results suggest an overall reduction of depressive and anxiety symptomatology in the intervention conditions but not in the control condition. In the positive condition, there was a decrease in depressive and anxiety symptomatology. The messaging was not moderated by normative beliefs. The negative condition also led to decreases in depression and anxiety symptomatology over time. In addition, perceived norms moderated the negative message in the first week after the intervention, an effect consistent with DRT. Prior research indicates this intervention is efficacious for the reduction of adverse alcohol outcomes; these data show that the intervention may also have positive effects on downstream mental health outcomes.</p> <p>Keywords: Deviance regulation theory or DRT; brief intervention; anxiety or anxious symptoms; depression or depressive symptoms; depressive and anxiety symptomatology</p> <hd id="AN0179435148-2">Introduction</hd> <p>The transition into college can be an intimidating life experience, where many students face new responsibilities and challenges as they become acclimated to a young adult lifestyle ([<reflink idref="bib34" id="ref1">34</reflink>]). Because of these changes, students may be at a heightened risk of experiencing anxiety and depression ([<reflink idref="bib31" id="ref2">31</reflink>]). Indeed, it is estimated that 32–47% of college students experience symptoms of anxiety and depression. Major Depressive Disorder (MDD) is common among college students, with 53% of college students meeting the criteria for MDD at some point during their college career ([<reflink idref="bib16" id="ref3">16</reflink>]). In addition, it is estimated that 11.9% meet the criteria for an anxiety disorder ([<reflink idref="bib1" id="ref4">1</reflink>]). Among college students, increases in depressive and anxiety symptomatology may also lead to maladaptive alcohol use ([<reflink idref="bib30" id="ref5">30</reflink>]). Therefore, it is important to understand the relationship between alcohol use and depressive and anxiety symptomatology as well as mechanisms that may target both.</p> <p>Despite the widespread implementation of universal prevention programs, college alcohol use continues to be a significant public health concern. Negative consequences of alcohol use continue to be rampant, including nearly 2,000 college student deaths from alcohol use, and 100,000 reported sexual assault cases each year ([<reflink idref="bib33" id="ref6">33</reflink>]). Furthermore, over 50% of full-time college students 18–24 years of age are active drinkers and are more likely to develop a substance use disorder than their non-college attending peers or people in any other age group ([<reflink idref="bib33" id="ref7">33</reflink>]). Many substance-use problems that start in college years can continue to develop and potentially become harmful later in life ([<reflink idref="bib28" id="ref8">28</reflink>]). Thus, it is imperative to assess interventions aimed at preventing harmful alcohol consumption early on in college.</p> <p>Many interventions for problematic drinking among college students center around protective behavioral strategies (PBS). Protective behavioral strategies are responsible drinking habits that aim to prevent consequences related to alcohol use ([<reflink idref="bib24" id="ref9">24</reflink>]; [<reflink idref="bib29" id="ref10">29</reflink>]). PBS can be broken down into three subtypes: stop/limiting drinking (SLD), manner of drinking (MD), and serious harm reduction (SHR). SLD PBS is related to strategies aimed at the reduction of alcohol consumption, such as adding extra ice to a drink or not drinking after a specific limit. MD PBS consists of strategies aimed at minimizing getting intoxicated quickly by altering specific drinking habits, such as avoiding shots and pre-gaming. SHR PBS consists of strategies aimed at reducing chances of serious consequences from alcohol use occurring, and include strategies such as never drinking and driving, drinking only with trusted friends, and knowing where one's drink is at all times.</p> <p>PBS use has been consistently associated with reduced alcohol consumption and alcohol-related consequences ([<reflink idref="bib2" id="ref11">2</reflink>]; [<reflink idref="bib20" id="ref12">20</reflink>]; [<reflink idref="bib29" id="ref13">29</reflink>]). Further, PBS appears to have significant inverse relationships with anxiety and depressive symptomology, potentially via associations with self-efficacy and self-esteem ([<reflink idref="bib35" id="ref14">35</reflink>]; [<reflink idref="bib36" id="ref15">36</reflink>]). [<reflink idref="bib21" id="ref16">21</reflink>] found that students with increases in depressive symptoms were less likely to use PBS and, therefore, engaged in heavier alcohol use. [<reflink idref="bib15" id="ref17">15</reflink>] found similar results suggesting individuals with high rates of anxious and depressive symptoms used PBS at lower rates. Indeed, using PBS also appears to have some protective properties against suicidality among college students. De Leon and colleagues found that PBS use was negatively correlated with depressive symptoms and suicidal ideation, and attenuated the association between depression and suicidal ideation ([<reflink idref="bib8" id="ref18">8</reflink>]). Consequently, interventions aimed at increasing PBS use may have downstream effects on negative emotional functioning. However, this has yet to be examined.</p> <p>Recent research has investigated an intervention aimed at reducing alcohol use and consequences by increasing PBS use based on a theory called Deviance Regulation ([<reflink idref="bib3" id="ref19">3</reflink>]; [<reflink idref="bib4" id="ref20">4</reflink>]). Deviance Regulation Theory (DRT) posits that positive or negative messages can motivate behavior as a function of an individual's normative beliefs ([<reflink idref="bib4" id="ref21">4</reflink>]). It rests on the notion that small groups tend to "stand out", and this can take a positive or negative valence ([<reflink idref="bib3" id="ref22">3</reflink>]). For example, if a person believes a positive behavior (e.g., using safe drinking strategies) is uncommon, a message highlighting the positive aspects of individuals who use safe drinking strategies would allow them to stand out (as the minority do use these strategies) in positive and meaningful ways. In contrast, if an individual believes PBS use is quite common, a message highlighting the negative characteristics of individuals who do not use PBS should increase PBS use as a way to prevent standing out in a negative light (as the minority do not use these strategies). Prior research has shown this approach does affect PBS use; however, it may also result in less depressive or anxious symptoms – either via more PBS use or via some alternative mechanism (e.g., enhance social status). The current study examines this possibility.</p> <p>Figure 1 shows the theoretical model of how a DRT intervention may also result in decreases in anxious and depressive symptomatology. Across multiple studies, DRT has been shown effective at increasing safe drinking strategies and reducing alcohol use and alcohol-related problems ([<reflink idref="bib11" id="ref23">11</reflink>]; [<reflink idref="bib12" id="ref24">12</reflink>]; [<reflink idref="bib19" id="ref25">19</reflink>]). It has been hypothesized that this theory works by allowing individuals to identify as "safe drinkers" and subsequently to act in ways consistent with this identity ([<reflink idref="bib4" id="ref26">4</reflink>]; [<reflink idref="bib18" id="ref27">18</reflink>]). Prior research shows that acting in ways consistent with our internalized beliefs and values (i.e., our identity) is linked to better emotional functioning ([<reflink idref="bib5" id="ref28">5</reflink>]; [<reflink idref="bib6" id="ref29">6</reflink>]; [<reflink idref="bib7" id="ref30">7</reflink>]). Further, research shows that engaging in safe drinking strategies is associated with more adaptive emotional functioning ([<reflink idref="bib8" id="ref31">8</reflink>]; [<reflink idref="bib32" id="ref32">32</reflink>]). Therefore, an intervention such as DRT, that increases PBS, may result in decreased anxiety and depressive symptoms, a downstream effect that was not targeted by the intervention. However, it is also plausible that the messaging in DRT interventions could result in reactivity and subsequent increases in negative emotion as a person evaluates themselves in the context of the messaging. For example, if a person receives negative examples of individuals who do not use PBS, and they themselves do not use PBS, this incongruence could result in negative emotion ([<reflink idref="bib25" id="ref33">25</reflink>]). The current study examines these competing ideas to assess if the DRT intervention produces iatrogenic effects, or if, consistent with the hypothesis, the intervention would result in salutary effects on depression and anxiety.</p> <p>Graph: Figure 1. Theoretical model of DRT intervention effects on depression and anxiety.</p> <hd id="AN0179435148-3">Method</hd> <p></p> <hd id="AN0179435148-4">Participants</hd> <p>Participants (<emph>n </emph>= 147; 77.71% female) were first-time-in-college (FTIC; first year enrolled at a university) students from a large, Southeastern university who endorsed alcohol use at least twice a month. Participants ranged in age 18–20 years (<emph>M </emph>= 18.12, <emph>SD </emph>= 0.35). The majority of the sample identified as White (74.83%), followed by Biracial (13.61%), Black or African American (4.08%), Asian (2.04%), and 5.44% did not respond; 27.21% of participants identified as being ethnically Latino/a/x.</p> <hd id="AN0179435148-5">Procedure</hd> <p>The current study is a part of a larger study ([<reflink idref="bib19" id="ref34">19</reflink>]). All participants from the larger study were included in this analysis. The study was reviewed and approved by the university's Institutional Review Board. The clinical trial record for this study is NCT04699955. All project measures, stimuli, data, and analyses, can be found at https://osf.io/akef9</p> <p>The larger study was separated into two phases. Phase 1 was a screening phase. FTIC students at the university were emailed to complete a survey entitled "Longitudinal Use of Protective Strategies (Phase 1)." This online screen assessed demographics, alcohol consumption and consequences, use of safe drinking strategies, and affect (i.e., depressive and anxious symptoms). Qualified participants were then invited to be included in Phase 2 of the study. If the participant accepted the invitation, the participant was randomly assigned a condition (Positive framed message, negative framed message, or an active control).</p> <p>Phase 2 consisted of six weeks of monitoring, including one pre-intervention week and five follow-up weeks. During this period, every Monday, participants were assessed on the previous week's alcohol use and problems, depression and anxiety symptomatology, and use of safe drinking strategies. Participants in the positive-framed message condition received ten brief, socially positive messages about individuals who DO use safe drinking strategies, such as being "seen as leaders by their peers" and "tend to be seen as more responsible by their peers." Participants who were randomly assigned to be a part of the negative-framed message condition received ten brief, socially negative messages about individuals who DO NOT use PBS, such as being "viewed as less responsible by their peers" and "are more impulsive and have worse self-control". These messages were based on the themes identified through focus group discussions with current college students (see [<reflink idref="bib19" id="ref35">19</reflink>]). Each week, participants were given reminder messages of the same ten messages previously received based on which condition they were assigned. Participants in the active control condition only engaged in the assessment aspect of the study. Greater detail on the intervention and conditions is available in [<reflink idref="bib19" id="ref36">19</reflink>].</p> <hd id="AN0179435148-6">Measures</hd> <p></p> <hd id="AN0179435148-7">Demographics</hd> <p>Demographic information including sex assigned at birth, gender identity, age, race, ethnicity, sexual orientation, high school and college grade point averages (GPAs), and first-time-in-college standing was collected during the screening process.</p> <hd id="AN0179435148-8">Patient health questionnaire-4 (PHQ-4)</hd> <p>To examine participants' overall depressive and anxiety symptoms, participants were asked to complete the Patient Health Questionnaire-4 (PHQ-4; [<reflink idref="bib17" id="ref37">17</reflink>]). The PHQ-4 is a brief, 4-item self-report measure that asks participants to rate the frequency to which they experienced several core depressive and anxious symptoms on a Likert-type scale that ranged from 0 (<emph>Not at All</emph>) to 3 (<emph>Nearly Every Day</emph>). The PHQ-4 assesses four symptoms, core depression symptoms including anhedonia and depressed mood, and core anxiety symptoms including anxious mood and having difficulty controlling or stopping the worry. Internal consistency in the current sample was excellent (α =.90).</p> <hd id="AN0179435148-9">Responsible drinking norms</hd> <p>Normative use of safe drinking strategies (i.e., protective behavioral strategies) was assessed with a single item prior to the intervention. Participants were provided with a list of protective behavioral strategies and then asked: "<emph>How often do you believe university students use these strategies when drinking?</emph>" This was rated on a 5-point Likert-type scale from 1 (<emph>Never</emph>) to 5 (<emph>Always</emph>). Consistent with prior DRT interventions ([<reflink idref="bib11" id="ref38">11</reflink>]; [<reflink idref="bib12" id="ref39">12</reflink>]; [<reflink idref="bib19" id="ref40">19</reflink>]), this was used as a moderator of the messaging conditions.</p> <hd id="AN0179435148-10">Statistical analyses</hd> <p>The analysis was conducted using a mixed effects multilevel regression model in M<emph>plus</emph> 8.11 using the Bayes estimator ([<reflink idref="bib26" id="ref41">26</reflink>]). This estimator is robust to small samples, allows for inclusion of missing data in analyses via full information estimation, and calculation of variance at both levels of analysis ([<reflink idref="bib14" id="ref42">14</reflink>]; [<reflink idref="bib23" id="ref43">23</reflink>]). Two dummy-coded conditions were used to contrast intercept and slope effects across conditions. The negatively framed message condition was coded 1 for negative and 0 for the positive and control conditions. The positively framed message condition was coded 1 for positive and 0 for the negative and control conditions. The baseline model used the control condition as the comparison group, thus main effects are the primary effects in control condition while interactions represent deviations from those effects as a function of condition. At level 1, weekly PHQ-4 scores were regressed onto time since the intervention in weeks (i.e., −1, 0, 1, 2, 3, 4). At level 2, negative condition, positive condition, and pre-intervention norms were added to the model. Cross-level interactions between time and the level 2 variables were added to test for intervention effects across time. Quadratic slopes were tested to examine non-linear trajectories.</p> <hd id="AN0179435148-11">Results</hd> <p></p> <hd id="AN0179435148-12">Descriptive statistics</hd> <p>Participants endorsed an average score of 1.67 (<emph>SD </emph>= 0.82) on the total PHQ-4 measure. Participants scored an average of 3.35 (<emph>SD </emph>= 0.58) on perceived norms. Participants were nearly evenly split among the Positive (<emph>n </emph>= 50), Negative (<emph>n </emph>= 51), and Control (<emph>n </emph>= 46) conditions. Biological sex was equally distributed across conditions (<emph>p </emph>=.778). The analysis had 777 weeks of data across <emph>n </emph>= 147 participants for a compliance rate of 88.10% (<emph>n </emph>= 147 participants across 6 weeks [6 × 147 = 882 total possible weeks]).</p> <hd id="AN0179435148-13">Primary analysis</hd> <p>A mixed effects multilevel regression model was used to examine the effects of the DRT intervention on depressive and anxiety symptomatology (assessed by the PHQ-4) across time. Depressive and anxiety symptomatology at each week was regressed onto time since intervention (in weeks), positive condition (coded: 1 = positive condition, 0 = negative or control condition), negative condition (coded: 1 = negative condition, 0 = positive or control condition), pre-intervention PBS norms, and interactions of the conditions, PBS norms, and time (see Table 1). The initial model converged in 2800 iterations. This was increased by a factor of 10, allowing for 14000 burn-in iterations followed by 14000 MCMC iterations. Potential scale reduction ranged from 1.051 to 1.006 in the final 14000 iterations indicating model convergence. The intraclass correlation (ICC) for the PHQ-4 was 0.76 (<emph>SE </emph>= 0.02). The overall model explained 36% of the variance in PHQ-4 scores within-subjects and 10% of the variance in PHQ-4 scores between- subjects. The intercept, linear slope, and quadratic slope were all allowed to vary randomly.</p> <p>Table 1. Mixed effects model of weekly PHQ-4 scores as a function of positive message, negative message, PBS norms, and time (linear and quadratic) since intervention.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="(" /><col align="left" /></colgroup><thead><tr><th align="left">Parameter</th><th align="center"><italic>B</italic> (SD<sub>p</sub>)</th><th align="center">95% BCI</th></tr></thead><tbody><tr><td>Time</td><td>−0.01 (0.26)</td><td>−0.04 to 0.02</td></tr><tr><td>Time2</td><td /><td /></tr><tr><td>Positive Condition</td><td>−0.26 (0.15)</td><td>−0.55 to 0.04</td></tr><tr><td>Negative Condition</td><td>−0.15 (0.15)</td><td>−0.44 to 0.14</td></tr><tr><td>PBS Norms</td><td>0.22 (0.19)</td><td>−0.14 to 0.59</td></tr><tr><td>Positive Condition × PBS Norm</td><td>−0.10 (0.26)</td><td>−0.61 to 0.42</td></tr><tr><td>Negative Condition × PBS Norm</td><td>−0.53 (0.24)</td><td>−1.01 to −0.06</td></tr><tr><td>Time × PBS Norm</td><td>−0.03 (0.03)</td><td>−0.08 to 0.10</td></tr><tr><td>Time2 × PBS Norm</td><td /><td /></tr><tr><td>Positive Condition × Time</td><td>−0.05 (0.02)</td><td>−0.09 to −0.01</td></tr><tr><td>Positive Condition × Time2</td><td /><td /></tr><tr><td>Negative Condition × Time</td><td>−0.04 (0.02)</td><td>−0.08 to −0.00</td></tr><tr><td>Negative Condition × Time2</td><td /><td /></tr><tr><td>Positive Condition × Norm × Time</td><td>0.03 (0.04)</td><td>−0.05 to 0.10</td></tr><tr><td>Positive Condition × Norm × Time2</td><td /><td /></tr><tr><td>Negative Condition × Norm × Time</td><td>0.05 (0.04)</td><td>−0.02 to 0.12</td></tr><tr><td>Negative Condition × Norm × Time2</td><td /><td /></tr><tr><td>Biological sex</td><td>0.15 (0.16)</td><td>−0.14 to 0.44</td></tr><tr><td>Intercept</td><td>1.75 (0.16)</td><td>1.43 to 2.06</td></tr><tr><td>Random Variance Components</td><td /><td /></tr><tr><td>Intercept</td><td /><td /></tr><tr><td>Time</td><td /><td /></tr><tr><td>Time2</td><td /><td /></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note:</emph> Depressive and anxiety symptomatology at each week was regressed onto time since intervention (in weeks), time<sups>2</sups>, positive condition (coded: 1 = positive condition, 0 = negative or control condition), negative condition (coded: 1 = negative condition, 0 = positive or control condition), PBS norms, and the interaction of these variables.</p> <p>Table 1 shows all model parameters. The model trajectories are depicted in Figure 2. There was a nonsignificant linear (<emph>B </emph>= 0.01, 95% BCI = -0.06 to 0.07) and quadratic (<emph>B </emph>= -0.01, 95% BCI = -0.02 to 0.01) trajectory in the control condition. In the positive message condition, there was a significant linear decline in symptoms (<emph>B </emph>= -0.13, 95% BCI = -0.19 to −0.08) as well as a significant flattening out of this linear trajectory across time (quadratic slope: <emph>B </emph>= 0.02, 95% BCI = 0.01 to 0.04). Similar to the positive message condition, in the negative message condition there was a significant linear decline in symptoms (<emph>B </emph>= -0.10, 95% BCI = -0.16 to −0.04) as well as a significant flattening out of this linear trajectory across time (quadratic slope: <emph>B </emph>= 0.02, 95% BCI = 0.04 to 0.00).</p> <p>Graph: Figure 2. Depressive and anxiety symptomatology across time as a function of the DRT intervention.</p> <p>Inconsistent with hypotheses, there was no positive condition × PBS norms interaction on depressive and anxiety symptomatology on the model intercept. Nor was there an effect of this interaction on depressive and anxiety symptomatology across time relative to control. However, there was a significant difference in the trajectory of the positive condition (irrespective of norms), relative to control, across time (i.e., a positive condition × time interaction; <emph>B </emph>= -0.14, 95% BCI = 0.23 to 0.05) on depressive and anxiety symptomatology. Further, the quadratic effect was more robust in the positive condition versus control (<emph>B </emph>= 0.03, 95% BCI = 0.01 to 0.05). Thus, these conditions differed in that the positive condition showed a significant linear decline that tapered off across time, while the control condition was relatively flat across time.</p> <p>In contrast to the positive condition, there was a significant interaction between the negative condition and PBS norms (<emph>B </emph>= -0.53, 95% BCI = -1.02 to −0.05), relative to control, on the post-intervention intercept (i.e., the first week after the intervention). A comparison of the negative and control conditions was examined at high (+1<emph>SD</emph>) and low (−1<emph>SD</emph>) levels of PBS norms on the post-intervention intercept (see Figure 3). In the negative message condition when PBS norms were high, depressive and anxiety symptomatology was significantly lower in the week immediately after the intervention (<emph>B </emph>= -0.49, 95% BCI = -0.06 to −0.91; Cohen's <emph>d </emph>= 0.63) relative to control. There were no differences in conditions at mean or low levels of PBS norms. Thus, the DRT consistent effect resulted in lower depressive and anxiety symptomatology in the first post-intervention week.</p> <p>Graph: Figure 3. Differences in intercepts between negative and control after the first post-intervention week.</p> <p>The three-way interaction of negative condition × PBS norm × time was not significant. However, similar to the positive condition, there was a significant difference in the trajectory of the negative condition (irrespective of norms), relative to control, across time (i.e., a negative condition × time interaction, relative to control; <emph>B </emph>= -0.11, 95% BCI = 0.19 to 0.02) on depressive and anxiety symptomatology. While the quadratic effect in the negative condition was significant, it did not differ significantly from the quadratic effect in control condition. Thus, these conditions differed in that the negative condition showed a significant linear decline with a modest tapering off across time, while the control condition was relatively flat across time.</p> <hd id="AN0179435148-14">Discussion</hd> <p>The current study assessed whether a DRT intervention to promote safer alcohol consumption among college students also impacted depressive and anxiety symptomatology, which tend to be elevated at disproportionate rates among college students ([<reflink idref="bib1" id="ref44">1</reflink>]), and are predictive of a greater likelihood of problematic alcohol use in this population ([<reflink idref="bib30" id="ref45">30</reflink>]). Findings from this study indicated reductions in overall depressive and anxiety symptomatology, as measured by the total score on the PHQ-4, over time following a DRT intervention that uses either positive messaging about individuals who use safe drinking strategies or negative messaging about individuals who do not use safe drinking strategies. Hypotheses were partially supported and discussed below.</p> <hd id="AN0179435148-15">Positive messaging</hd> <p>In the current study, there was no impact of perceived norms within the positive messaging condition across time. However, within the positive message condition, there were decreases in depressive and anxiety symptomatology over time. This is slightly inconsistent with what DRT posits, which would argue lower perceived norms would be particularly salient to individuals receiving a positive message ([<reflink idref="bib3" id="ref46">3</reflink>]). For individuals receiving positive messaging, anxious and depressive symptomatology does not appear to be impacted by perceived norms. However, we also noted that the message content itself could be iatrogenic, irrespective of norms. These results suggest that not only is this not the case, but the exact opposite of this effect. Several prior studies have shown that (a) positive messaging and norms interact to predict behavioral change ([<reflink idref="bib11" id="ref47">11</reflink>], [<reflink idref="bib9" id="ref48">9</reflink>], [<reflink idref="bib12" id="ref49">12</reflink>]; [<reflink idref="bib19" id="ref50">19</reflink>]) and (b) these changes tend to occur immediately after the intervention and not across time ([<reflink idref="bib11" id="ref51">11</reflink>], [<reflink idref="bib9" id="ref52">9</reflink>], [<reflink idref="bib12" id="ref53">12</reflink>]; [<reflink idref="bib19" id="ref54">19</reflink>]). However, these prior studies were all targeting PBS use. It seems that the benefits of the intervention on anxiety and depression may be more a function of message content, and less related to the ways in which DRT is hypothesized to affect behavioral targets (e.g., standing out vs not standing out).</p> <p>We have several possible explanations for this pattern of results. First, perhaps, as individuals engage in more PBS use, the socially positive message becomes more internalized. Thus, they recognize these positive attributes in themselves, and subsequently develop a more positive self-perception, and consequently less negative emotion. Another possible reason for these results is that participants in this condition did drink less and had fewer alcohol-related consequences (see [<reflink idref="bib19" id="ref55">19</reflink>]). This is an effect consistently seen throughout other DRT intervention studies as well ([<reflink idref="bib10" id="ref56">10</reflink>], [<reflink idref="bib11" id="ref57">11</reflink>], [<reflink idref="bib12" id="ref58">12</reflink>]). It may be that because participants were experiencing less alcohol-related consequences, they also experienced less overall depressive and anxiety symptomatology resulting in unintended salutary effects on emotional functioning.</p> <hd id="AN0179435148-16">Negative messaging</hd> <p>In contrast to the positive condition, there was a significant negative condition × PBS norms interactions on the intercept, as would be predicted by DRT. Among those who believed PBS use was more common, a negative message resulted in an immediate drop in depressive and anxiety symptomatology in the week following the intervention. DRT posits that if something is common, a negative message should be more impactful. Thus, higher norms should lead to more PBS use and as a result, less negative emotion, if individuals receive a negative message. This is consistent with other DRT research which suggests the negative message may have broader implications for overall well-being ([<reflink idref="bib9" id="ref59">9</reflink>]; [<reflink idref="bib19" id="ref60">19</reflink>]). It is unclear why this interaction of norms x negative message worked only for the negative message and only on the immediate post-intervention intercept. Perhaps this allows individuals to see themselves as discrepant from non-PBS users, and thus view themselves and their own behavior in a more positive light. If so, there would be no need for norms as it results in a straightforward social comparison. Future research on the mechanisms that result in messaging, irrespective of norms, to be linked to better outcomes, especially outcomes that were not the target of the intervention.</p> <p>In addition, there was a similar interaction with time, that was observed for the positive condition. Similar to the positive condition, depressive and anxiety symptomatology decreased significantly across time if an individual received a negative message about non-PBS users, and this also did not vary by norms. As with the positive message, this may be due to changes in adverse drinking experiences, lower consumption rates, and/or enhanced views of themselves as safe and responsible individuals. This remains an important area of study.</p> <hd id="AN0179435148-17">Limitations</hd> <p>The present study has several limitations. First, our sample was primarily White, female, cisgender students at a large Southeastern University. Thus, our results may not be generalizable to all FTIC students—especially Black, Indigenous, people of color (BIPOC) students, males, and/or gender minorities. To extend generalizability to underrepresented groups, future research may use stratified random sampling based on demographic criteria. Furthermore, though the current study aims to examine the DRT intervention's effects on depressive and anxiety symptomatology, the research participants were not sampled from a clinically diagnosed population. While the data used in this study were intentionally collected during students' first semester of college to address the increase in drinking that FTIC students often exhibit ([<reflink idref="bib27" id="ref61">27</reflink>]), the present study does not address how the effects of the intervention may change over longer periods of time. Future research should examine potential changes in the efficacy of the DRT intervention for reducing depressive and anxiety symptomatology as a function of time spent in college. Another limitation of the study is the fact that, while weekly diaries are a source of valuable longitudinal data, they may still suffer from retrospective recall bias ([<reflink idref="bib13" id="ref62">13</reflink>]). More frequent assessments or <emph>in situ</emph> momentary assessments could limit the effects of recall bias in future research. Lastly, the PHQ-4, which was the measure of depressive and anxiety symptomatology in this study, was developed as an ultra-brief screening tool to improve physicians' detection rates of depression and anxiety among their patients with minimal additional burden ([<reflink idref="bib22" id="ref63">22</reflink>]). Though the measure appears to be an effective initial screening tool, it cannot provide a robust picture of negative emotional functioning. Future research would benefit from using more comprehensive measures—particularly those used as diagnostic tools rather than screening measures—to assess facets of depressive and anxiety symptomatology.</p> <hd id="AN0179435148-18">Conclusion</hd> <p>Results suggest DRT messaging has salutatory effects on negative mood, which may operate via changes in personal identity associated with safe drinking, reductions in adverse alcohol outcomes, or greater use of responsible drinking behaviors. The exact rationale for this change is unclear, however, it is important to note that neither messaging resulted in iatrogenic effects. A DRT intervention to increase protective behavioral strategies in college student drinkers may also help students' mental health by both increasing safe drinking (the primary target) and also by enhancing overall mental health (a downstream effect). This may be especially effective among those receiving a negative message as it appears to exert both main effects across time as well as more robust immediate effects as a function of perceived norms.</p> <hd id="AN0179435148-19">Public health significance</hd> <p>This study supports the efficacy of a deviance regulation theory (DRT) intervention for increasing protective behavioral strategies (PBS) among first-time-in-college (FTIC) students while also decreasing negative affect across time. The findings highlight the potential reductions in negative affect associated with administration of the DRT intervention.</p> <ref id="AN0179435148-20"> <title> References </title> <blist> <bibl id="bib1" idref="ref4" type="bt">1</bibl> <bibtext> Acharya L., Jin L., Collins W. (2018). College life is stressful today – emerging stressors and depressive symptoms in college students. 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Personality and Individual Differences, 89(1), 47–54. https://doi.org/ https://doi.org/10.1016/j.paid.2015.09.048.</bibtext> </blist> </ref> <ref id="AN0179435148-21"> <title> Footnotes </title> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> This study has been approved by the University of Central Florida's Institutional Review Board (IRB; IRB ID: STUDY00002070).</bibtext> </blist> <blist> <bibtext> The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This material is based upon work supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. 2035702 to AVL. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation. In addition, preparation of this manuscript was supported in part by grant 1 R15 AA026420-01A1 to RDD.</bibtext> </blist> <blist> <bibtext> Angelina V. Leary https://orcid.org/0000-0002-1374-5437</bibtext> </blist> </ref> <aug> <p>By Angelina V. Leary; Robert D. Dvorak; Emily K. Burr; Ardhys N. De Leon; Samantha J. Klaver; Gabrielle Lynch; Ethan Toth; Michelle J. Diaz and Sebastian Martin</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib34" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib31" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib16" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib30" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib33" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib28" firstref="ref8"></nolink> <nolink nlid="nl7" bibid="bib24" firstref="ref9"></nolink> <nolink nlid="nl8" bibid="bib29" firstref="ref10"></nolink> <nolink nlid="nl9" bibid="bib20" firstref="ref12"></nolink> <nolink nlid="nl10" bibid="bib35" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib36" firstref="ref15"></nolink> <nolink nlid="nl12" bibid="bib21" firstref="ref16"></nolink> <nolink nlid="nl13" bibid="bib15" firstref="ref17"></nolink> <nolink nlid="nl14" bibid="bib11" firstref="ref23"></nolink> <nolink nlid="nl15" bibid="bib12" firstref="ref24"></nolink> <nolink nlid="nl16" bibid="bib19" firstref="ref25"></nolink> <nolink nlid="nl17" bibid="bib18" firstref="ref27"></nolink> <nolink nlid="nl18" bibid="bib32" firstref="ref32"></nolink> <nolink nlid="nl19" bibid="bib25" firstref="ref33"></nolink> <nolink nlid="nl20" bibid="bib17" firstref="ref37"></nolink> <nolink nlid="nl21" bibid="bib26" firstref="ref41"></nolink> <nolink nlid="nl22" bibid="bib14" firstref="ref42"></nolink> <nolink nlid="nl23" bibid="bib23" firstref="ref43"></nolink> <nolink nlid="nl24" bibid="bib10" firstref="ref56"></nolink> <nolink nlid="nl25" bibid="bib27" firstref="ref61"></nolink> <nolink nlid="nl26" bibid="bib13" firstref="ref62"></nolink> <nolink nlid="nl27" bibid="bib22" firstref="ref63"></nolink>
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  Data: Effects of a Brief Safe Drinking Intervention on Depressive and Anxiety Symptomatology: Examining Potential Side Effects of Deviance Regulation Theory Interventions
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  Data: <searchLink fieldCode="AR" term="%22Angelina+V%2E+Leary%22">Angelina V. Leary</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-1374-5437">0000-0002-1374-5437</externalLink>)<br /><searchLink fieldCode="AR" term="%22Robert+D%2E+Dvorak%22">Robert D. Dvorak</searchLink><br /><searchLink fieldCode="AR" term="%22Emily+K%2E+Burr%22">Emily K. Burr</searchLink><br /><searchLink fieldCode="AR" term="%22Ardhys+N%2E+De+Leon%22">Ardhys N. De Leon</searchLink><br /><searchLink fieldCode="AR" term="%22Samantha+J%2E+Klaver%22">Samantha J. Klaver</searchLink><br /><searchLink fieldCode="AR" term="%22Gabrielle+Lynch%22">Gabrielle Lynch</searchLink><br /><searchLink fieldCode="AR" term="%22Ethan+Toth%22">Ethan Toth</searchLink><br /><searchLink fieldCode="AR" term="%22Michelle+J%2E+Diaz%22">Michelle J. Diaz</searchLink><br /><searchLink fieldCode="AR" term="%22Sebastian+Martin%22">Sebastian Martin</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Drinking%22">Drinking</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Behavior%22">Student Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Intelligence%22">Emotional Intelligence</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Standards%22">Behavior Standards</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Behavior%22">Social Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Strategies%22">Communication Strategies</searchLink>
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  Data: 10.1177/00472379241272587
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  Label: Abstract
  Group: Ab
  Data: College students are at a heightened risk of experiencing depression and anxiety symptomatology and engaging in maladaptive alcohol use. Understanding how alcohol interventions impact emotional functioning is essential. One such intervention uses Deviance Regulation Theory (DRT), which posits that behavior can be modified using targeted messaging as a function of perceived norms. DRT has been shown to be effective at increasing responsible drinking behaviors and decreasing alcohol-related consequences. However, it is unclear if this intervention influences emotional functioning. The current examines the impact of a DRT intervention on emotional functioning. Participants (n = 147) were recruited from a large Southeastern university. The study included a screening phase, intervention, and six-week follow-up. Participants were randomly assigned to one of three conditions: a positive message condition about people who drink responsibly, a negative message condition about people who do not drink responsibly, and an active control condition. During the study, all participants reported on depression/anxiety symptoms, alcohol use, responsible drinking, and alcohol-related consequences. Mixed-effects regression was used to analyze the data. Results suggest an overall reduction of depressive and anxiety symptomatology in the intervention conditions but not in the control condition. In the positive condition, there was a decrease in depressive and anxiety symptomatology. The messaging was not moderated by normative beliefs. The negative condition also led to decreases in depression and anxiety symptomatology over time. In addition, perceived norms moderated the negative message in the first week after the intervention, an effect consistent with DRT. Prior research indicates this intervention is efficacious for the reduction of adverse alcohol outcomes; these data show that the intervention may also have positive effects on downstream mental health outcomes.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Note
  Label: Notes
  Group: Note
  Data: https://osf.io/akef9
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1438495
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1438495
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/00472379241272587
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 16
        StartPage: 102
    Subjects:
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Drinking
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Depression (Psychology)
        Type: general
      – SubjectFull: Anxiety
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Behavior Modification
        Type: general
      – SubjectFull: Student Behavior
        Type: general
      – SubjectFull: Emotional Intelligence
        Type: general
      – SubjectFull: Behavior Standards
        Type: general
      – SubjectFull: Social Behavior
        Type: general
      – SubjectFull: Communication Strategies
        Type: general
    Titles:
      – TitleFull: Effects of a Brief Safe Drinking Intervention on Depressive and Anxiety Symptomatology: Examining Potential Side Effects of Deviance Regulation Theory Interventions
        Type: main
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      – PersonEntity:
          Name:
            NameFull: Angelina V. Leary
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            NameFull: Robert D. Dvorak
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            NameFull: Emily K. Burr
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            NameFull: Ardhys N. De Leon
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            NameFull: Samantha J. Klaver
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            NameFull: Gabrielle Lynch
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            NameFull: Ethan Toth
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          Name:
            NameFull: Michelle J. Diaz
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            NameFull: Sebastian Martin
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          Dates:
            – D: 01
              M: 09
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 0047-2379
            – Type: issn-electronic
              Value: 1541-4159
          Numbering:
            – Type: volume
              Value: 53
            – Type: issue
              Value: 3-4
          Titles:
            – TitleFull: Journal of Drug Education
              Type: main
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