title: Depression, posttraumatic stress, and alcohol misuse in young adult veterans: The transdiagnostic role of distress tolerance.
abstract: 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.
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States. Electronic address: holliday@rand.org.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Brooks Holliday
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Pedersen
authors.affiliation: University of Southern California, Los Angeles, CA 90089, United States.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Leventhal
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000150:complications / Q000523:psychology*; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Alcohol misuse; Depression; Distress tolerance; Mediation; PTSD; Veterans