The use of alcohol has been an important part of most societies and culture in the world for many years. In the UK, people across all ages have been enjoying an close relationship with alcohol, which has led to some negative and positive impacts in the long run as well as short term (Johannessen et al., 2017). However, in most cases the reasons behind the use of alcohol by adolescents vary based on age and gender (Patton et al., 2016).
According to Skogen et al. (2014), there is a lot literature and scholarly explorations that focuses on identifying the link between depression and alcohol use, which to a greater extent, shows that the two correlates with each other. Specifically, adolescent and use of alcohol s is becoming a great concern for society, and if left unchecked, the situation can lead to grave consequences, more so poor academic performance, criminal and delinquent, psychological and mental health problems (Clark et al. 2011).
Literature or scholarly evidence have presented an intertwining relationship in the pathways for using alcohol and depression, and as such, the relation presents a major concern or problem in comorbidities during the adolescence stage and transitions into adulthood. Concern is also because combined alcohol and depression leads to profound severity impairment, risks the individuals to suicide as well as prolonged symptoms (Pedrelli et al., 2016).
It is within this concern that few studies have embarked to identify the relationship, even digging deep to find the link between the alcohol drinking among adolescents and issues surrounding depression incidences (Clark et al., 2011). Skogen et al., (2014) argue that girls are prone to early onset of drinking which also translates to early onset of depression while according to Marmorstein (2010), boys show later onset of depression and this increases their risk to depression. Hence, age and gender is a contentious issue when discussing depression and adolescent alcohol use.
Therefore, this study, as a literature review, seeks to shed some light on the issue, whether depression has a mediating role in youth’s drinking alcohol or vice versa and using the findings to recommend a mental health nurse-based public health promotion using the recommended guidelines for the National Health Service, regulatory recommendation from the Mental Health Act, best practice by adhering to the NHS code of conduct, the Royal College of Nursing as well as other pertinent organisations with the best practices for helping youths recover from addiction, psychological effects and embodying healthy lifestyles.
The study entirely relied on literature search from the school’s library.
Inclusion criteria: All studies, such as quantitative, qualitative, randomised control trials, systematic reviews, cross-sectional longitudinal studies, and clinical experiments (quasi-experimental designs) were included. This involved using key terms like: adolescent depression and alcohol use, adolescent gender difference and alcohol use and depression.
Search outcome: Initially, around 498 items were retrieved, then screened for duplication, abstract and only full texts were identified. Further screening left only 30 from which 15 articles were screened to have met the criterion for explain depression and alcohol use.
|Clark et al.(2011)||USA||Randomized control, n=5782 for 6th grade, n=5065 for 7th grade, and n=4940 for 8th grade
|Baseline depression increases likelihood of alcohol use with time, positive expectancies increased drug or alcohol use propensity|
|Danzo et al. (2017)||United states||Longitudinal study, 593 families||Depression and using alcohol differs in genders; no indirect effects observed in males but bidirectional effects on females|
|Edwards et al. (2014a)||UK||Prospective population-based cohort ages between 13 and 15, N=7,100, and compared with depression average age of 17 years and 10 months, n=4, 292||among the boys population, frequency of drinking positively linked to depression in later years but not anxiety; for girls, frequency of drinking and later years depression and anxiety identified|
|Edwards et al., (2014b)||UK||Prospective-based cohort; baseline 12years 10montsh and 17 years 10months, risk assessed at 18yrs 8 months||Increased drinking with baseline increase in depression among girls; limited changes observed among girls|
|Johannessen et al. (2017||Norway||Survey, n=6238 and age of between 16 and 18 years||greater depression symptoms among the earlier onset of alcohol drinking, intoxication and consumption frequencies; Early onset for drinking more prone to girls, and increases with anxiety in females|
|Marmorstein et al. (2010)||USA, Minnesota||Community-based survey, 1252, between 17 and 20 years (Family-Twin Study)||Depression and alcohol consumption increased with age onset, between 20 and 24 years|
|Marmorstein(2010)||USA||Longitudinal-community-based study, n=20,728||Depressive and alcohol use has reciprocal relationship, between childhood to adolescence, effects or relationship increase with time or age; High depression associated with increased risk, more so for females|
|Marmorstein (2009)||USA||Longitudinal-community-based study, n=20,728||Depressive and alcohol use has reciprocal relationship, between childhood to adolescence, effects or relationship increase with time or age; High depression associated with increased risk, more so for females|
|McCarty et al. (2012)||USA, Seattle||Interview research; 521 adolescents, mean age of 12.0 years||Increased alcohol use with age; those suffering from early depression were more prone to alcohol misuse|
|Miettunen et al. (2014)||Northern Finland||Cohort treatment||Externalizing problems at 8 years linked to substance abuse in later life; externalizing problems influence substance use in later years,(all genders)|
|Needham (2007)||USA||Longitudinal study, n=10, 828||Depression and substance abuse shows bidirectional relationship; those beginning in higher rates of consumption or depression reduce or adjust well|
|Pedrelli et al. (2016)||Review of studies||Review of studies||at the onset of adolescence, drinking behaviours, including heavy drinking and weekly use, increase the depressive symptom risks; gender association not clearly defined|
|Strandheim et al. (2009)||Norway||Questionnaires 8983||Anxiety and depression associated with alcohol use among girls; Alcohol use increased with anxiety and depression but no differences in depression between the genders|
|Skogen et al. (2014)||Norway||Population-based longitudinal study, n=9203, between 17 and 19 years||Depression symptoms linked to alcohol use; limited evidence linking age and gender|
|Shulte et al. (2009)||Review||Review of longitudinal studies||Psychosocial and biological factors affect girls and boys the same. Physiological factors expose boys to greater risks of developing depression and increased alcohol use with years|
In an effort to discuss Prevalence of depression and alcohol use in adolescence, Skogen et al. (2014 sought to identify whether there is a cross-sectional connotation between first-time alcohol or drug use and interrelated mental health problems. Skogen et al. (2014) noted that alcohol and drug was highly connected with depression indicators, hyperactivity and inattention and that there was a strong link to the positive hypothesis as it confirmed the direct link and high pervasiveness of using alcohol and depression among the adolescents.
The findings further confirm the general assumptions of this review that there is a bidirectional relationship between using alcohol among the adolescents and depression.
Marmorstein (2010) also affirms the assertion on the incidence of drinking alcohol and depression among the adolescent population, in his study considering the effects of delinquent behaviours, where the results indicated that alcohol issues and depression symptoms are reciprocal, but the extent and strength of the relation is dependent on gender. In this case, delinquent behaviours show that depressive symptoms and alcoholic problems are more augmented among the younger than the older age.
Moreover, Marmorstein (2010) showed that collaborative effects between aberrant behavioural traits and other problems like alcohol or depressive symptoms are signs that were more augmented among females than males. The implication of this finding is that it affirms the study’s hypothesis that alcohol use and depression is more prevalent among the adolescents, and at the onset, younger boys are less affected than girls but with age, boys are more prone to depression and alcohol use in the later years.
Pedrelli et al. (2016) in analysing depression and alcohol use among teenagers outlined how major depressive disorder is a common issue among the adolescents and coupled with alcohol use, the severe consequences are profoundly augmented. The study, from a systematic review, indicated that at the onset of adolescence, drinking behaviours, including heavy drinking and weekly use, increase the depressive symptom risks. The implication of this is the necessity for intervention mechanisms, frameworks and plans which aim at reducing alcohol use at the tender age and as such, focusing on the treatment of depressive symptoms as well as alcohol use disorders in preventing comorbid disorders occurrence.
In studying the prevalence of depressive symptomology and alcohol use, Clark et al. (2011) sought to explore whether depressed mood among sixth-graders as well as their positive substance use propensity would predict the onset or use of alcohol as well as substances. The findings reported baseline positive expectancies in all the measured elements of substance use as it reported that depressed mood predicted an overtime increment in alcohol and cigarettes lifetime use. The study, implication is that to a greater extent, depressed mood in the early adolescents is associated with alcohol use and as such, indicating the great occurrence of alcohol use and depression among the younger generation. Additionally, the study has profound implication for mental health prevention measures or programs as they health the practitioners in changing the perceptions that adolescents have as regards to positive consequences or implications of drug use.
Edwards et al. (2014) affirms the relationships between alcohol use and depression, especially how the issue is prevalent among adolescents and young adults. The study found differences in prevalence in age as findings revealed that among the boys population, frequency of drinking was positively linked to depression in later years but not associated with anxiety. However, for girls, it showed frequency of drinking in their later years and depression as well as anxiety. The study, hence, confirmed the high prevalence of depression and alcohol among adolescents of which alcohol use contributes to risks to depression in the later years and also the differences in the genders. In essence, the study confirms the high incidence rates and cases of alcohol use and depression among the adolescents and as such, a major or greater stride towards understanding areas to focus, especially gender, time of onset and the specific adolescent population to target so as to limit the negative implications of alcohol use and depression.
It is clear from the above studies that use of alcohol and depression forms part of the concerning health issue among adolescents. Thus, adds to the general understanding of the connection between depression and use of alcohol among adolescents. The studies adds to current knowledge base by examining gender and age differences in relation to use of alcohol and depression, and the health consequences which is important to inform future interventions for adolescents.
In all the studies analysed, there are numerous methodological factors that have led to the variability in understanding the dynamics of alcoholism and depression, especially those using community and clinical samples, or prospective and retrospective reports. Hence, like Danzo et al. (2017) indicated, there are gender differences attributed to substance abuse and depression. Consequently, Danzo et al. (2017) have supported the extent to which gender differences determine or define the disparities in prevalent rates of depression. In supporting the above assertion, equal body of research has presented evidence that the males shows escalated use of alcohol in faster rates in comparison to their female counterparts. However, there is a limitation to these studies, as Danzo et al. (2017) points out that gender differences with regard to alcohol use and depression has received limited scholarly exploration, and as such, all the findings or the developments in this study area has been limited.
Danzo et al. (2017) suggested that depression and the use of alcohol appeared to have been independent in males. However, the author presented that through the direct influence model, females showed significant and serious pathways between depression and alcohol use, indirect and direct effects observed, especially throughout the adolescent life. The findings are also supported by Schulte et al. (2009) who showed the bidirectional link in using alcohol and internalizing syndromes among females through maturity and as such, no association was observed among males.
Schulte et al. (2009) have outlined various risks as well as protective factors attributed to drinking problems that affect deviating alcohol paths as one change to young adult. Consequently, Schulte et al. (2009) noted that specific biological factors including neurological abnormalities especially those associated with P300 amplitudes and genetic risks), and psychosocial factors like personality traits, deviance propensity and effect of positive drinking expectations, have similar effects on girls and boys.
In addition, Schulte et al. (2009) recommend the necessity for parents in improving consistent in consequences and rules as regards to teen drinking across all genders as a way of avoiding mixed messages are concerning the acceptance of using alcohol among boys and girls. The implication of this finding is that for the individual levels, all the interventions should be challenging the media-mediated stereotypes of gender roles and as such, reinforcement of personal values are the best ways of strengthening the youth’s autonomy towards making healthy drinking decisions.
Needham (2007) contributes to the current research confirming the bidirectional connotation between depression symptoms and the use of illicit substances. The study noted that adolescents with high depressive symptomatology have higher affinity towards substance abuse, but always less vulnerable to smoking, only for girls, binge drinking, for both genders, illicit drug abuse, for girls only as they transition into adulthood. Moreover, it has been noted that adolescence beginning with higher levels of alcohol, cigarette, and illicit drug use shows faster declining fashion in depression symptoms within time as compared to those starting at relatively lower levels of using illicit substances, more pronounced for the boys than the girls.
However, in spite of the differences in the decline in depression symptoms, Needham (2007) reported that boys and girls with higher first intensities of using substances report considerably greater intensities of depressive indicators. The insinuation of this assertion is that using alcohol increases the rate of depression in boys as they advance into adulthood less than girls but in the same sense, heavy early onset use exposes both genders to greater risks of developing depressive symptomatology.
McCarty et al. (2012) ranks among those that have not highlighted any gender differences on how depressive indications premeditate alcohol use among girls and boys thereby challenging or confirming other studies that have shown or highlighted gender differences in recorded symptoms of depression and the prevalence of alcohol use among boys and girls.
In determining the inherent relationship between depression and alcohol use, Marmorstein (2009) focused on confirming the link between the two, with the focus on the moderating effects of gender and age as a an area that has not been comprehensively examined. In this case, grounding this study was the inference that alcohol abuse has a direct link to the depressive symptoms problems trajectory, how alcohol affects levels as well as development of depressive symptoms and whether there is any association within the inherent points of development or gender.
Marmorstein (2009) study confirmed reciprocal as well as positive link between problems related to using alcohol and depressive symptomology from early adolescent age through their adulthood years. The author also observed that there is the inherent difference in the prevalence or effects based on age and gender. The study confirmed that high depressive symptoms would be observed in high rate of alcohol use problems for females while faster increase in alcohol problems was observed as years went by for the males.
The research equally reported the more alcohol-related problems being associated with greater early depressive indicators, again for females while the depressive symptoms reduced with time. However, the difference became much smaller with time, more so for females, as they transitioned into adulthood. The findings from the study has profound implications because for the intervention mechanisms, policy interventions and clinical responses, it is imperative that the mental health sector should focus on including age and gender in formulating awareness programs in understanding bow affective disorders are associated with alcohol-use disorders.
Johannessen et al. (2017) also contributed on study about how gender differences moderate the implications of anxiety and depression as well as how this was associated with using alcohol by adolescents. The study measured the load of the symptom and gender differences from school-based survey in Norway (targeted at upper secondary schools). The results confirmed greater depression symptoms among the earlier onset of alcohol drinking, intoxication and consumption frequencies. Hence, with prevalence of the symptoms, the findings implied that for intervention, focus should shift towards amount and quantity of consumption, especially warning the adolescents against the dangers of overindulgence. Nonetheless, the study indicated that the link between depression and anxiety symptoms as well as early onset of drinking were all observed to be stronger among girls in comparison to boys.
Furthermore, anxiety, or higher levels of anxiety were identified as being profound among girls in comparison to boys. The findings of the study have insightful implications because it indicates and states that higher depressive symptoms in girls and boys as well as girls who have anxiety are greater folds likely to have unhealthy alcohol drinking patterns. From this insight, it is vital that preventive strategy should focus on the how depression and anxiety influence alcohol drinking behaviours among girls and boys differently, especially paying closer attention for girls who are in their mid-adolescence.
The support for gender differences has also been provided by Strandheim et al. (2009) who focused on Norwegian teenagers to explore how mental health and alcohol abuse or intoxications is associated with the age as well as gender of the individuals. The authors noted that proportion of the gender was equal and the numbers increased with age. In addition, the study reported conduct and attention problems being associated with frequent intoxications on alcohol for both genders. However, the study equally confirmed that depression and anxiety symptoms were found to be highly associated with intoxication among girls. The study, by far, is the only one that has identified smaller differences in gender intoxication but outlined that in both genders, there is high association between attention and conduct problems when both genders consume alcohol. Nonetheless, specifically, there is the inherent association between anxiety and depressive symptoms among girls and their frequent degrees or extent of alcohol intoxications.
Research evidence has equally confirmed and highlighted the direct impacts and relationship between age and alcohol use and depression, especially for the indirect effects. Accordingly, Danzo et al. (2017) reported “peer deviance effect on alcohol and depression, especially the increase in depression between 6th and 9th grade”. In addition, studies have equally identified and explained that depression associates with deviant peers. Danzo et al. (2017) also noted “that there was an indirect influence of using alcohol in 7th grade and 9th grade depression, which was also mediated by depression in 8th grade and as such, the findings indicated a relative durable influence of earlier use of alcohol which later develop into depression.
In support of this finding, Strandheim et al. (2009) noted that earlier use of alcohol increases the rate or levels of risk of subsequent depression. Equally, there is the cumulative failure model indicating that behavioural problems like alcohol use predict imminent academic and peer relational problems which to a greater extent, increase an individual’s risk for depression (Danzo et al., 2017).
McCarty et al. (2012) noted that despite the inconsistency in the literature, there is a connection with drinking alcoholic beverages among teens and depression. The findings from the study indicated that there was a progressive connection between depressing symptoms and liquor use in a year later or over and they also recorded behaviour problems with alcohol use throughout their early adolescence years. However, from the parental report, it was noted that only the early adolescent with depressive symptoms had noted or recorded alcohol use problems or implications. Therefore, the implication of this study is that for mental health practitioners, it is vital and imperative to consider that depressive signs are indicated affinity to alcohol use across the entire adolescence stage (McCarty et al., 2012).
It also follows from the research that behavioural and emotional problems are all attributed to substance abuse especially among adolescents. One of the challenges, as noted by Miettunen et al. (2014) is whether substance abuse always proceeds or if not so, follows mental health issues. Hence, the researchers focused on investigating the longitudinal link between internalizing and externalizing psychopathology and how these influence substance abuse. Accordingly, the researchers assessed both internalizing and externalizing mental health concerns at 8 years, with measurement of substance abuse and internalizing and externalizing problems at between 15 and 16 years. From the findings, the study showed that individuals having externalising problems or issues at age 8 had issues and concerns over substance abuse later in life.
Early internalizing risks or concerns were not linked with substance use in later life. However, for female adolescents, alcohol and cannabis use predicted their internalizing disorders during adulthood. The study has profound implications as it states or indicates that externalizing concerns leads to substance abuse in both males and female adolescents while internalizing leads to substance abuse for the females. In this case, it outlines age differences in substance abuse; especially girls being prone to substance abuse in earlier years, especially from internalizing problems like mood and depression while for boys, the externalized problems lead them into gradual use of substances in later life and mental health disorders.
In determining how age affect or impact the association between depression and alcohol use, Marmorstein (2010) outlined the changes in this relationship throughout adulthood. The study revealed that substance abuse and depression were stable over time thereby confirming that every single condition was associated for each risk for the same in years later, or bidirectional relationship. Specifically, the dependency on substance abuse, for ages between 17 and 20, increased the risk for depression in early adulthood, between 20 and 24 years. However, there was no gender difference in the association, hence, the study implies that intervention programs for mental health and substance abuse should be all-inclusive and not entirely focus on a specific population. The study adds to general knowledge because it supports the link between age and risk of alcohol use and depression and vice versa because dependency on alcohol predicts occurrence of major depression in later life.
In response to the concern about few studies failing to examine baseline intensities of depressive signs in addition to the changes in symptoms attributed to alcohol outcomes, (Edwards et al., 2014b) used data from prospective-based cohort within the UK and the including indicated that within the female population, there was an affirmative relationship between increment in drinking alcohol and depressive symptoms with no or little evidence for boys. The study was clear in confirming that changes in baseline depressive disorders are related with the increased risk of alcohol in later life. However, with limMited evidence within males, it challenges other research confirming that males’ risk increase with time or age while reduces with overtime for the females.
Implications of the findings for mental health intervention and promotion
Three inferences have been identified in the current literature analysis. The first one is that there is high prevalence rates of depression and drinking of alcohol among teenagers. Therefore, mental health nurses have a role to play as they understand the mechanisms of addiction and can use the information in devising treatment and intervention plants.
On the other hand, age is a determinant factor and a moderator in depression and high incidences of drinking alcohol. As shown from the study, depression increases with age and also shows an increased chance of drinking alcohol. The finding indicates that there is the necessity for intervention to treat depression or alcohol use before teens enter into early adulthood.
Third, gender association or link with depression and the use of alcohol is still not conclusive but the current studies tend to point towards female gender more prone early onset of using alcohol, especially when they have depression and combined with anxiety. Alternatively, males have low onset rate but are more prone to depression with age and as such, become highly susceptible to depression and indulgence in alcohol drinking in future.
Nurses Roles (Health Promotion), Mental Health Act and Mental Health Nurses Role On Depression
Role of Mental Health Nurses in Health Promotion
All healthcare professionals have a responsibility to promote the mental wellbeing of people they are in contact with as part of their treatment and care, and to help prevent mental health problems. The UK Department of Health suggests that there is the inherent responsibility of health care professionals of promoting the well-being of individuals living with mental health problems (NHS, 2018).
The mental health nurses have a role to play by understanding mental health needs of populations, communities and individuals, which in this case, revolves around knowing that girls are more susceptible at earlier years to anxiety and depression which drive them to alcohol use and abuse while boys have tendency of increasing their depression with time, which leads to them to alcohol use and depression (NHS, 2018)
Besides, mental health professionals have to understand the available resources for intervention along with understanding activities for preventing, protecting, and promoting mental health like health and education awareness on healthy drinking decisions at early onset of adolescent. Seemingly, nurses should liaise with schools to promote education and awareness on dangers of drinking as well as encouraging early screening for individuals experiencing depression and anxiety, more so for girls.
Nurses should follow the Mental Health Act guidelines, which require some people have to agree that an individual has mental disorder and hence, must stay in the hospital. Hospitalisation is only done when the individual pose safety risk to himself or herself or to others. However, a mental health nurse must also understand the right of the patient under this act, especially right of appealing or getting help from an advocate.
The roles of nurses in intervening on alcohol use among adolescent includes primary and secondary care setting (Bakhshi & While, 2013). The nurses should aim at achieving positive contributions towards social and health care among the alcoholic youths through applying a number of interventions. In UK, the use of alcohol interventions at public health is usually by the third sector and NHS trusts. Nurses can bring interventions by enhancing awareness of physical and health commodities. In this, the interventions to lower alcohol use should be based on evidence, levels, patterns and context of use on adolescents (Nyamathi et al., 2012).
The primary care setting include all programs that focuses on increasing awareness on the risks related with use of alcohol by nurses as well as use of policy initiatives (Nyamathi et al., 2012). The primary care setting requires mental health nurses to understand psychotherapeutic intervention methods, and cognitive behavioural approaches to address those negative schemas driving adolescents into risky behaviours. Helping adolescents to recover from depression and alcoholism entails mental health nurses developing positive relationships with the victims and working with their families or caregivers to provide further resources, help, as well as guidance on the specific mental health problems (NHS, 2018).
In most cases the secondary care setting includes conducting therapeutic sessions which include treatment and enhancing recovery process (Nyamathi et al., 2012). Here, the nurse apart from giving the required treatment needs to assess the social networks that the individual keeps to understand co-morbid conditions. The mental health nurse then guides the patient on steps for promoting positive mental health to enhance recovery, especially through self-care like sleep, eating habits, recreational habits, meditation, and mindfulness, and avoiding bad company.
The Health Department under the control of nurses should take actions for preventing factors leading to mental health concerns among teens including poverty, improving employment, housing and reducing violence. Also, there is need to implement integrated systems to help in identifying younger people with long-term mental health conditions. Promotion will also be done through the national department through the provision of information, accessing resources for supporting mental health courses in the community, creating education, and awareness against early alcohol use, providing alternatives to support self-growth and development for the younger generation like access to e-learning and training. The nurses can also promote and provide healthier lifestyle choices for the mental health or depressed individuals, especially access to physical activities, supporting them to reduce risky behaviours like alcohol use (Johannessen et al., 2017).
In dealing with depression, nurses should assess, screen, and treat the patients based on DSM-5 categorization. For instance, major depression disorder is the common type identified in the literature to be associated with alcohol use disorders. In the case of depression nurses can initiate promotional activities to integrate all the symptoms associated like helping the parents to note when the child feels unusually restless, difficulty with concentration, keyed up or highly tensed and loss of self-control.
When promoting health to educate the public about depression and alcoholism among adolescents, the mental health nurses should work with school nurses in providing accessible as well as non-stigmatized advice on dangers of alcohol use and depression. The mental health nurses can thus directly support adolescents on ways to control use of alcohol through education, and even providing support to other professionals like school nurses and teachers in promoting psychological and emotional well-being (Royal College or Nursing, 2017).
In summary, as the literature review and analysis shows age and gender is a factor to consider because early onset of depression, more so as witnessed with anxiety or depression among girls, increases their risks to alcohol abuse. Conversely, boys are prone to risk in later years and this explains why they have more susceptibility towards mental health issues or concerns in later years, especially towards adolescents. Therefore, intervention should be targeted at the ages when boys and girls are prone to depression and the risks to indulge in drinking. Thus, the intervention should be timed and public health promotion should also be planned with the consideration of how boys and girls as well as different age groups for the adolescents are affected differently by depression and also exposed to dangers of alcohol abuse.
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