Depression stigma and alcohol use among adults with major depressive disorder: a daily diary study

The comorbidity between depression and alcohol use problems is well-documented, yet little research has examined how depression-related stigma may contribute to this comorbidity. Utilizing a daily diary design, the current study examined the concurrent (i.e., same-day) and lagged (i.e., next day) associations between felt depression stigma (i.e., shame and fear of being discriminated against or socially rejected due to one's depression) and alcohol use behaviors among a community sample of adults diagnosed with major depressive disorder (MDD). Participants (N = 92) reported experiences of felt depression stigma, number of alcoholic drinks consumed, and general psychological distress once a day over a period of 14  days, as well as their recent alcohol use and depressive symptoms at baseline. Multilevel modeling revealed that within-person fluctuations in felt depression stigma were positively associated with increased alcohol consumption and greater odds of engaging in heavy drinking on the same day, while controlling for relevant baseline and daily covariates. However, within-person fluctuations of felt depression stigma were not associated with the likelihood of same-day alcohol use or any of the next-day alcohol use outcomes. These findings highlight the role of stigma as a potential risk factor for harmful patterns of alcohol use among individuals with MDD, thus advancing our understanding of the etiology of depression-alcohol use comorbidity. Results also underscore the utility of addressing felt depression stigma and fostering adaptive coping in alcohol use prevention and treatment interventions tailored for individuals with MDD.