Cross-sectional comparison of mental health symptom network among university students with low- and high-risk alcohol consumption. Results from SHoT2018.


Background: The association between alcohol-related problems and poor mental health is evident from several studies. Few studies have, however, investigated potential differences in the relationship between different symptoms (symptom connectivity) of mental health problems across different levels of alcohol-related problems. The aim of the present study was to employ a network analytical approach to increase our understanding of symptom connectivity among low-risk alcohol consumers and high-risk alcohol consumers in a university student population.

Methods: Using data from a large population (N=50,054) based on the Norwegian university student survey SHoT2018, we estimated models of the relationship between different symptoms of mental health problems. Mental health problems were assessed using Hopkins Symptom List Scale 25 (HSCL-25), which is constructed to measure symptoms of anxiety, depression and somatization. The Alcohol Use Disorder Identification Test was used to discriminate between low-risk consumers (scores below 8; N=28,351; 56.6%) and high-risk consumers (scores above 16; N=2,713; 5.4%), as well as those at intermediate risk levels (scores 8-16; N=18,990; 37.9%). The analytical procedure included the use of a network modelling approach, employing both exploratory graphical analysis, and comparisons of connectivity, community structure, and strength centrality (i.e., connectedness to other symptoms in the network) across low- and high-risk consumers.

Results: For low-risk consumers four symptom communities were identified, comprising general anxiety, two depression communities and a somatization community. For high-risk consumers three symptom communities were identified, one general anxiety with somatic symptoms, one depression and one somatization community. The latter community in the high-risk group comprised symptoms of dizziness, headaches, low in energy, loss of appetite and sleep problems. Furthermore, there were substantial differences in the centrality of some symptoms across low- and high-risk consumers. This included symptoms related to a) lack of energy, tremors, feeling trapped, feeling lonely, feeling hopeless, crying easily which was less central among those with high risk, and b) restlessness, worrying and suddenly frightened without reason which was more central among those with high risk.

Conclusions: The present study suggests that the relationship between different symptoms of mental health problems are different among low- compared to high-risk alcohol consumers. The difference is expressed both as differences in the clustering of symptoms, but also in relation to the connectivity and centrality of different symptoms. This study may help to shed light on the potential symptom-level mechanisms behind the association between alcohol-related problems and poor mental health. Future studies should use a longitudinal approach to further increase our understanding of the relationship between alcohol use and mental health.


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