title: Longitudinal cohort study of depression, post-traumatic stress, and alcohol use in South African women who attend alcohol serving venues.
abstract: BACKGROUND
  In South Africa, alcohol use poses a public health burden. Hazardous alcohol use often co-occurs with psychological distress (e.g., depression and post-traumatic stress). However, the majority of the research establishing the relationship between alcohol use and psychological distress has been cross-sectional, so the nature of co-occurring changes in psychological distress and alcohol use over time is not well characterized. The objective of this study is to examine the longitudinal relationship between psychological distress and alcohol use among South African women who attend alcohol serving venues.
  
  
  METHODS
  Four waves of data were collected over the course of a year from 560 women in a Cape Town township who attended drinking venues. At each assessment wave, participants reported depressive symptoms, post-traumatic stress symptoms, and alcohol use. Multilevel growth models were used to: 1) assess the patterns of alcohol use; 2) examine how depressive symptoms uniquely, post-traumatic stress symptoms uniquely, and depressive and post-traumatic stress symptoms together were associated with alcohol use; and 3) characterize the within person and between person associations of depressive symptoms and post-traumatic stress symptoms with alcohol use.
  
  
  RESULTS
  Women reported high levels of alcohol use throughout the study period, which declined slightly over time. Post-traumatic stress symptoms were highly correlated with depressive symptoms. Modeled separately, both within person and between person depressive and post-traumatic stress symptoms were uniquely associated with alcohol use. When modeled together, significant between person effects indicated that women who typically have more post-traumatic stress symptoms, when controlling for depressive symptoms, are at risk for increased alcohol use; however, women with more depressive symptoms, controlling for post-traumatic stress symptoms, do not have differential risk for alcohol use. Significant within person effects indicated an interaction between depressive and post-traumatic stress symptoms; women reported more alcohol use than usual at times when they had higher post-traumatic stress symptoms, and this increase in alcohol use was further exacerbated for women who also had higher depressive symptoms than usual.
  
  
  CONCLUSIONS
  These findings suggest that interventions targeting post-traumatic stress, especially when post-traumatic stress is comorbid with depression, may reduce alcohol use among South African women who drink.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Abler
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Eaton
authors.forename: Karmel W
authors.initials: KW
authors.lastname: Choi
authors.forename: Seth C
authors.initials: SC
authors.lastname: Kalichman
authors.forename: Donald
authors.initials: D
authors.lastname: Skinner
authors.forename: Desiree
authors.initials: D
authors.lastname: Pieterse
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000434:Alcoholic Beverages / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D012931:Social Environment; D013019:South Africa / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*
references.citation: BMC Public Health. 2010 Mar 05;10:111
references.pmid: 20205721
references.citation: Psychiatry Res. 2011 Apr 30;186(2-3):159-64
references.pmid: 20728943
references.citation: Prev Sci. 2008 Mar;9(1):55-62
references.pmid: 18264762
references.citation: Psychol Aging. 1997 Jun;12(2):277-87
references.pmid: 9189988
references.citation: S Afr Med J. 2007 Aug;97(8 Pt 2):664-72
references.pmid: 17952223
references.citation: Subst Use Misuse. 2014 Jan 1;49(1-2):66-76
references.pmid: 23905586
references.citation: Afr J Psychiatry (Johannesbg). 2011 Mar;14(1):30-7
references.pmid: 21509408
references.citation: J Acquir Immune Defic Syndr. 2011 Jul 1;57(3):230-7
references.pmid: 21372724
references.citation: AIDS. 2003 Apr 11;17(6):895-903
references.pmid: 12660537
references.citation: Am J Orthopsychiatry. 1996 Jan;66(1):17-31
references.pmid: 8720638
references.citation: Arch Intern Med. 2003 Apr 14;163(7):821-9
references.pmid: 12695273
references.citation: Drug Alcohol Depend. 2007 May 11;88(2-3):259-71
references.pmid: 17127017
references.citation: Int J Environ Res Public Health. 2011 Jul;8(7):2629-39
references.pmid: 21845149
references.citation: Curr Opin Psychiatry. 2012 May;25(3):181-6
references.pmid: 22449761
references.citation: Soc Sci Med. 2006 Jan;62(1):217-27
references.pmid: 16054281
references.citation: BMC Psychiatry. 2009 Feb 20;9:6
references.pmid: 19232121
references.citation: Soc Sci Med. 2012 Oct;75(8):1417-25
references.pmid: 22832324
references.citation: Arch Gen Psychiatry. 1995 Dec;52(12):1048-60
references.pmid: 7492257
references.citation: Arch Intern Med. 1998 Sep 14;158(16):1789-95
references.pmid: 9738608
references.citation: Obstet Gynecol. 2009 Oct;114(4):839-847
references.pmid: 19888043
references.citation: Violence Against Women. 2008 Jun;14(6):634-54
references.pmid: 18535306
references.citation: Psychol Rep. 2007 Jun;100(3 Pt 2):1115-20
references.pmid: 17886497
references.citation: Subst Use Misuse. 2012 Oct;47(12):1271-80
references.pmid: 22738267
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2010 Mar;45(3):393-404
references.pmid: 19506789
references.citation: J Trauma Stress. 2011 Oct;24(5):515-25
references.pmid: 21882246
references.citation: Drug Alcohol Depend. 2013 Dec 1;133(2):502-12
references.pmid: 23932841
references.citation: J Nerv Ment Dis. 2003 Apr;191(4):230-6
references.pmid: 12695733
references.citation: Behav Res Ther. 1996 Aug;34(8):669-73
references.pmid: 8870294
references.citation: AIDS Behav. 2014 Mar;18(3):525-34
references.pmid: 23921585
references.citation: Alcohol Clin Exp Res. 2009 Jan;33(1):49-59
references.pmid: 18945223
references.citation: Compr Psychiatry. 2009 Mar-Apr;50(2):121-7
references.pmid: 19216888
references.citation: Clin Psychol Rev. 2005 Nov;25(7):841-61
references.pmid: 16095785
references.citation: Addiction. 2011 May;106(5):906-14
references.pmid: 21382111
references.citation: Health Psychol. 2000 Jan;19(1):28-38
references.pmid: 10711585
references.citation: Soc Sci Med. 2006 Apr;62(7):1641-9
references.pmid: 16213078
references.citation: AIDS Patient Care STDS. 2008 Feb;22(2):147-58
references.pmid: 18260806
references.citation: J Stud Alcohol Drugs. 2012 Jul;73(4):549-58
references.pmid: 22630793
references.citation: Psychol Addict Behav. 2009 Jun;23(2):226-37
references.pmid: 19586139
references.citation: Addict Behav. 2014 Jan;39(1):122-6
references.pmid: 24090621
references.citation: Br J Psychiatry. 2008 Feb;192(2):112-7
references.pmid: 18245026
references.citation: Addiction. 2005 Dec;100(12):1763-9
references.pmid: 16367976
references.citation: J Clin Child Adolesc Psychol. 2012;41(6):822-36
references.pmid: 22963207
references.citation: J Clin Psychol. 2006 Jul;62(7):815-35
references.pmid: 16703602
references.citation: Cult Health Sex. 2013;15(10):1221-36
references.pmid: 23927691