The Great Recession, somatic symptomatology and alcohol use and abuse

Abstract

While most research has examined the long-term effects of alcohol consumption on health, the current study examines how health status impacts on drinking behavior. Using data from a national study conducted between 2010 and 2011 to assess the impact of the recession on drinking behavior, this study examines how economic hardships linked to the recent economic recession affect physical health, and how physical health may in turn affect alcohol use. Structural equation models were used to test the predicted associations. The data demonstrate that many of the economic stressors linked to the recession are associated with increased somatic symptoms. Somatic symptoms are also associated with increased drinking for men, but not for women. These findings suggest that men may use alcohol to self medicate somatic symptomatology. The current findings are consistent with gender role-based explanations that account for gender disparities in the utilization of medical care.

Introduction

Psychological distress, including anxiety and depressive symptoms, has been shown to mediate the association between stressful life events and drinking (Colder & Chassin, 1993). Similarly, research which has examined the association between employment related stressors and drinking shows that psychological distress mediates the association between job related stressors and drinking (Dooley and Prause, 1998, Power and Estaugh, 1990, Richman et al., 2002). Findings in both cross sectional and longitudinal studies show that employment status impacts not only the psychological well-being of individuals but also the physical well-being of individuals (McKee-Ryan, Song, Wanberg, & Kinicki, 2005). The longitudinal studies have followed individuals over time from unemployment back into employment, showing increases in physical well-being among those who become reemployed. Studies have also followed individuals over time from employment into unemployment, showing decreases in physical well-being among individuals experiencing job loss. While unemployment, job insecurity, and employment frustration leads to physical health problems (Burgard et al., 2009, De Castro et al., 2010, McKee-Ryan et al., 2005, Mossakowski, 2009, Thomas et al., 2005), there has been no investigation as to whether physical health problems mediate the association between employment problems and drinking, similar to the manner in which psychological distress acts as a mediator between employment-related stressors and drinking. In order to further explore the association between employment-related stressors and drinking, the current study examines whether somatic symptoms mediate the association between economic adversity and alcohol use. In the general population, among commonly reported somatic symptoms are fatigue, sleep complaints, headaches, pain in the limbs, back pain, chest pain, shortness of breath, and gastrointestinal discomfort. According to literature, somatic symptoms account for more than half of all general medical visits, and in at least up to a third of these cases lack a definitive medical explanation (Kroenke et al., 2010, Tsai, 2010).

The self medication model of alcohol use suggests that individuals use alcohol, at least in part, to cope with the emotional distress resulting from stressors. There is considerable empirical evidence in the drinking motives and alcohol expectancies literatures showing that individuals use alcohol to diminish feelings of psychological distress (Carey and Correia, 1997, Carpenter and Hasin, 1998a, Carpenter and Hasin, 1998b, Cooper, Russell, Skinner, Frone and Mudar, 1992, Cooper, Russell, Skinner and Windle, 1992, Leigh, 1989). According to this research, individuals use alcohol to cope with negative affect resulting from stressful life events and daily hassles (Cooper, Russell, Skinner, Frone and Mudar, 1992, McCreary and Sadava, 1998, Newcomb and Harlow, 1986). The self medication model has also been used to explain the association between unemployment and drinking and between work stress and drinking (Butler et al., 2010, Frone, 1999, Greenberg and Grunberg, 1995, Grunberg et al., 1999, Martin et al., 1992, Martin et al., 1992, Mossakowski, 2008, Parker and Farmer, 1988, Richman et al., 1996, Svare et al., 2004, Vasse et al., 1998). Employees who are confronted with high work demands, longer work hours, low job control, and poor interpersonal relations at work have been shown to use alcohol because of the tension-reducing properties of alcohol. Based on previous studies (Burgard et al., 2009, De Castro et al., 2010, McKee-Ryan et al., 2005, Mossakowski, 2009, Thomas et al., 2005), it is possible that economic adversity resulting from the current recession such as job losses, underemployment, benefit reductions, and the inability to pay a mortgage or the loss of a home, may negatively impact the physical well-being of individuals. Similar to the manner in which unemployed individuals use alcohol to self medicate emotional distress, it is possible that individuals use alcohol to self medicate their physical health problems.

Women have higher health care utilization rates than men (Cleary et al., 1982, Verbrugge, 1979), and the largest sex differences in utilization rates occur in those categories which represent more mild morbidities where there is discretion in defining illness. Thus, the largest sex differences in utilization rates have been observed in the case of vague and mild symptoms not indicative of a disease state, and in the case of acute conditions involving microorganisms that are often self-limiting and are of shorter duration (Hibbard & Pope, 1986). Explanations for this disparity have focused on sex differences in the response to illness. For example, women have been socialized toward the more ready acknowledgement of illness and comfort in help seeking in contrast to men who have been socialized toward stoic denial of illness (Muller, 1986). While socialization and traditional role expectations may discourage men from adopting the sick role and seeking medical help, it is possible that men may respond to health problems in other, more gender normative, ways — for example, with the use to alcohol to self medicate health problems. To examine this gender role based argument, we test whether men with health problems are more likely to use alcohol than similarly situated women.

For the last several years, the United States has been experiencing the most severe economic crisis since the Great Depression. The Great Recession, as it has been labeled, began in December, 2007 and was declared over, in National Bureau of Economic Research terms, in June, 2009 (Aruoba & Diebold, 2010). However, the human devastation resulting from the U.S. economic crisis has persisted, starting with an unemployment rate that remained close to 10% in 2010 (Current Population Survey on Labor Force Statistics, 2010), remained at 9.1% in August, 2011 (Hall, 2011) and was reported to be 8.3% in January 2012 (Bureau of Labor Statistics, 2012). Recession related deleterious social experiences have included an increase in home foreclosures (Pollack & Lynch, 2011), loss of retirement savings and limited opportunities for those entering the labor force (Taylor et al., 2010, Uchitelle, 2010). Moreover, according to a recent Gallup poll, 3 in 10 workers expressed fears of being laid off (Saad, 2011). Examining the ways in which economic stressors linked to the Great Recession affect the physical health of individuals, and the manner in which that may in turn affect drinking behavior, will expand our understanding of the relationship between economic hardships and alcohol use.

In the current study, we extend the focus of the current self-medication and medical care utilization literature in several ways. We are interested in finding out whether economic adversity linked to the current economic crisis leads to physical health problems. We also examine the ways in which physical health problems influence drinking behavior, including whether men have a greater tendency than women to self medicate physical health problems by using alcohol. Considerable empirical evidence suggests that men are less likely than women to seek medical care for health problems and that men spend less in health care dollars than women (Bertakis et al., 2000, Cylus et al., 2011, Kaur et al., 2007, Owens, 2008, Stoverinck et al., 1996). If our data indicate that men are more likely than women to self medicate somatic symptoms using alcohol, this finding could shed some light on men's lower propensity to use medical help than women. While the major focus of the self-medication literature has been on psychological distress consequences of life stressors such as anxiety and depression, there has been little focus on physiological consequences of stressors (Colder, 2001). Our study fills this gap by examining whether individuals use alcohol to self-medicate somatic symptoms.

The conceptual model relating economic stressors, somatic symptomatology, and drinking behavior is shown in Fig. 1.