Regular drinking may strengthen the beneficial influence of social support on depression: findings from a representative Israeli sample during a period of war and terrorism.
BACKGROUND
Social support is consistently associated with reduced risk of depression. Few studies have investigated how this relationship may be modified by alcohol use, the effects of which may be particularly relevant in traumatized populations in which rates of alcohol use are known to be high.


METHODS
In 2008 a representative sample of 1622 Jewish and Palestinian citizens in Israel were interviewed by phone at two time points during a period of ongoing terrorism and war threat. Two multivariable mixed effects regression models were estimated to measure the longitudinal association of social support from family and friends on depression symptoms. Three-way interaction terms between social support, alcohol use and time were entered into the models to test for effect modification.


RESULTS
Findings indicated that increased family social support was associated with less depression symptomatology (p=<.01); this relationship was modified by alcohol use and time (p=<.01). Social support from friends was also associated with fewer depression symptoms (p=<.01) and this relationship was modified by alcohol use and time as well (p=<.01). Stratified analyses in both models revealed that the effect of social support was stronger for those who drank alcohol regularly than those who did not drink or drank rarely.


CONCLUSIONS
These findings suggest that social support is a more important protective factor for depression among regular drinkers than among those who do not drink or drink rarely in the context of political violence. Additional research is warranted to determine whether these findings are stable in other populations and settings.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, United States. Electronic address: jkane29@jhu.edu.
Jeremy C
JC
Kane
School of Political Science, University of Haifa, Mount Carmel, Haifa 31905, Israel.
Carmit
C
Rapaport
Department of Psychiatry, Rush University Medical Center, 1645 West Jackson Blvd, Suite 600, Chicago, IL 60612, United States; Department of Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Blvd, Suite 400, Chicago, IL 60612, United States.
Alyson K
AK
Zalta
School of Political Science, University of Haifa, Mount Carmel, Haifa 31905, Israel.
Daphna
D
Canetti
Department of Behavioral Sciences, Rush University Medical Center, 1645 West Jackson Blvd, Suite 400, Chicago, IL 60612, United States.
Stevan E
SE
Hobfoll
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, United States; Department of Psychology, University of Macau, Av. Padre Tomas Pereira, Taipa, Macau. Electronic address: brianhall@umac.mo.
Brian J
BJ
Hall
D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005006:Ethnicity; D005260:Female; D006304:Health Status; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D012067:Religion; D012944:Social Support; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D023481:Terrorism; D014857:Warfare
Alcohol use; Depression; PTSD; Political violence; Prolonged conflict; Social support