East Asian Arch Psychiatry 2017;27:18-25 Original Article

College Binge Drinking and Its Association

with Depression and Anxiety: A Prospective
Observational Study
R Nourse, P Adamshick, J Stoltzfus

Abstract
Objective: Binge drinking is a significant public health problem across college campuses in the United
States. Despite substantial research and the use of evidence-based methods, the binge drinking culture
remains an obstinate health crisis on campuses. This study examined the current binge drinking rate on
a selected college campus, the association between binge drinking and anxiety and depression as well as
the associated consequences of students’ alcohol use.
Methods: A sample of 201 students from a small, private Mid-Atlantic college completed validated scales
as well as demographics and questionnaires. Primary outcome measures were the 9-item Patient Health
Questionnaire, 7-item Generalised Anxiety Questionnaire, and Alcohol Use Disorders Identification
Test (AUDIT). Secondary measures were the Brief Young Adult Alcohol Consequences Questionnaire,
questionnaires, and demographics. Descriptive outcomes, frequencies and percentages, and separate Chi-
square tests methodologies were utilised for analyses.
Results: According to the AUDIT, 93% of students engaged in hazardous drinking, with a binge drinking
rate of 38.8%. No significant associations were found between hazardous drinking and depression (p =
0.20) or anxiety (p = 0.68) levels in students. A significant relationship was found between their amount
of drinking and negative consequences (p < 0.001). A substantial number of students reported moderate
and severe levels of anxiety and depression.
Conclusions: Our student sample engaged in binge drinking, suffered negative consequences, and
presented with anxiety and depression issues along with gender implications as females had higher rates
of depression and anxiety. Males drank significantly more and binged more often than females. The
majority of students who binged experienced memory loss. Both females and males reported taking
foolish risks and being impulsive when drinking. Students are vulnerable to harmful consequences when
binging and have poor insight regarding binge drinking.

Key words: Alcohol drinking; Anxiety; Binge drinking; Depression

Ms Rosemary Nourse, BS, RN, CCRC, St. Luke’s University Hospital,
Bethlehem, Pennsylvania, United States.
Dr Pamela Adamshick, RN, PhD, Moravian College, Bethlehem, Pennsylvania,
United States.
Dr Jill Stoltzfus, PhD, Research Institute, St. Luke’s University Hospital,
Bethlehem, Pennsylvania, United States.
Address for correspondence: Ms Rosemary Nourse, St. Luke’s University
Hospital, Behavioral Health, 801 Ostrum Street, Bethlehem, Pennsylvania,
United States 18105.
Tel: (1-484) 526 4421; Fax: (1-484) 526 3840; Email: rinorse@aol.com
Submitted: 2 March 2016; Accepted: 8 August 2016
Introduction
At an estimated national rate of 39% to 44%, and with some
schools reporting significantly higher rates, binge drinking
(BD) among college students remains an obstinate health
crisis in the US.1-7 As studies report two thirds of college
students drink alcohol, that nearly half of all freshman
binge drink, and about half of all students who use alcohol
are also binging, BD is a primary public health problem in
the US college campuses.1,2,4,6,8 Furthermore, despite the
considerable research that has been conducted to better
understand, predict / prevent, combat, and treat the college
BD phenomenon and despite the deployment of evidence-
based methods, rampant campus BD persists.4,6,7,9-11
Binge drinking (heavy episodic drinking) is defined
as ≥ 5 consecutive drinks in ≤ 2 hours for males and ≥ 4
consecutive drinks in ≤ 2 hours for females.1,3,4 Binge
drinking is associated with impulsive decision-making,
sensation-seeking, and high-risk behaviours with the most
harmful events occurring at the level of 4 to 5 drinks.10,12
The deleterious effects and consequences that BD can have
on students’ health range from mild to severe and transient
to permanent with the most resolute consequence being
death: there are approximately 1400 to 1700 alcohol-related
student deaths per year.1,4,10
Past studies have elucidated the most common
negative / harmful issues associated with BD as sexual assault
or participating in regretted sexual activity, physical injuries
(falling, fighting, drunk driving), hangover symptoms,

18 © 2017 Hong Kong College of Psychiatrists


blacking out (conscious / functioning but amnesic) or
passing out (unconscious or sleeping), and academic
compromise (drop in grade point average, dropping out,
being expelled).2,4,6,11-14 Particularly alarming is the frequency
of “blackout” experiences. One study indicated that 13.8%
of student participants reported ≥ 5 blackouts a full half or
more of their college career.9 Additionally, BD can induce
or contribute to student behavioural or emotional changes
such as uncharacteristic aggressiveness or the development
or exacerbation of anxiety, depressive feelings, or even
suicidal ideation.13,15-17 The National Institute on Alcohol
Abuse and Alcoholism states that 1.2% to 1.5% of college
students who attempt suicide have drinking or drug use
problems and that suicide is the second leading cause of
death in the student population.1,16 More troubling is that
students at risk for suicide who are heavy drinkers tend to
minimise their need for mental health services, regardless of
their symptom severity.18
Despite the serious situations and implications that
have resulted from BD, studies have shown that most
students will continue to binge drink.4,6,10,11,19 Prior research
has identified factors that contribute to the initiation and
continuation of BD as well as to the amount of alcohol
students consume; these components are associated with the
students’ perception of peer alcohol use habits and desiring
the approval of those peers close to them or those considered
important / influential.8,10 Other motivators for BD are
the positive expectations students associate with it: many
students consider intoxication fun or funny and believe that
it enhances their social abilities or the events attended and
that it may increase their chances for a sexual encounter /
sexual attractiveness.13,15,20,21 Studies have also linked BD to
cultural masculinity roles and stereotypes as males continue
to BD more than females and also to those who are prone
to impulsivity / sensation seeking.5,15,21-23 Additionally,
some students drink to cope with emotional issues such as
depression, bullying, stress, worry, social anxiety disorder,
general anxiety, or suicidal ideation.5,17,19,24-26
Past studies have shown that college students have
poor insight with regard to their alcohol use patterns / habits
and are resistant to seeing them as problematic or excessive
as evidenced by the less than 4% to 5% of students who
seek any type of alcohol counselling or treatment.1,4,10-12,19,27
Furthermore, although 1 in 4 students report that BD
negatively affects their academic life, they do not view
their drinking as problematic; nonetheless regretted sexual
activity, arrests, drinking alone, and increased weekly
drinking have led some students to cite their drinking as
problematic while another study showed that students only
identified their alcohol use as “binging” or excessive if they
blacked out or vomited.1,11,27
Similarly, depression and anxiety are common in the
college population but only 36% to 38% of students with
these symptoms seek treatment. One study reported that
fewer than 20% of students with anxiety sought professional
help. Students often assume it is “normal” to experience
distressful emotions during college and that symptoms
East Asian Arch Psychiatry 2017, Vol 27, No.1
College Binge Drinking and Depression
will be transient; furthermore, they would rather deal
with symptoms alone or talk to a friend or family member
rather than seek professional help and feel the process of
seeking treatment takes too much time.18,28,29 Ergo, in light
of students’ limited insight regarding BD, mental health
issues or need for treatment, one might question their
ability to discern whether the motivation driving their
alcohol use might transit from “socially fun” purposes to
a means of self-medicating or coping with stressors and /
or mental health problems. Studies suggest that “drinking
to cope” is a dangerous technique and that there is an
association between those students who drink alone to
cope and suicidal ideation.5,17,18 Conflicting research exists
about the association of BD with anxiety, depression, and
suicidal ideation.5,13,16-18,24,30,31 Some studies have identified
an association between BD and depression and / or suicidal
ideation while other studies have found no association
between BD and depression or psychopathology.5,16,28,30,31
One study showed that students with higher levels of suicidal
ideation engaged in heavy drinking alone and used alcohol
to cope; other studies indicated that BD and depression were
associated in men and not women but that it was associated
with school-related stressors in both men and women.13,16,17
Nonetheless students who have binged and then suffered a
mental health crisis with suicidal ideation or gestures have
been admitted to hospital psychiatric units. While some
students have experienced depression, anxiety or suicidal
ideation prior to their alcohol usage, BD may exacerbate
these symptoms.32-35 Alcohol-related events and their
consequent complications reach beyond the affected student
and family to impact the entire campus and community.11,21
In struggling to address campus BD problems,
colleges have enacted empirically based methods and
protocols intended to decrease and / or eradicate BD and
promote awareness through alcohol education, alcohol /
mental health counselling and screenings, community /
business involvement, campus and town police involvement,
campus sober support / social groups, student privileges /
opportunities restriction, or even college ejection.6,10,19,20,36
Additionally, some colleges have individualised their
interventions according to their specific student population
needs in order to increase their benefit / outcome.6,10,19,20,36
Nonetheless regardless of increased awareness and
interventions, BD remains a poorly controlled problem on
many campuses and more research is required. This study
aimed to obtain data regarding the current rates of BD in a
college campus in relation to the national rate, to examine
the association of BD with anxiety and depression, and to
elucidate the consequences for students of such alcohol
use.
Methods
Participants
Questionnaires and scales were distributed to and completed
by 201 students at a small private college in the northeastern
United States in May 2015. Participants consisted of 201
19
R Nourse, P Adamshick, J Stoltzfus
young adults, 51 males (25.4%) and 150 females (74.6%)
with a mean (± standard deviation) age of 21.1 ± 3.8 years
who gave informed consent in accordance with the college’s
Institutional Review Board regulations. Some participants
in this study received 1 extra credit point and all participants
were included in a draw for 8 gift cards valued $25 each;
there was no reported financial conflict of interest associated
with this research. Participants were considered to be at
minimal risk regarding their involvement and participation
in this study.
Measures
Participants completed questionnaires and validated
psychometric scales: the 7-item Generalised Anxiety
Questionnaire (GAD-7)36 is a validated and reliable
tool designed to measure severity of anxiety symptoms.
The 9-item Patient Health Questionnaire (PHQ-9)37 is a
validated and reliable tool designed to measure severity
of depressive symptoms. The Alcohol Use Disorders
Identification Test (AUDIT)38 is a validated 10-item
screening questionnaire designed to identify hazardous
alcohol consumption and alcohol abuse. The Brief Young
Adult Alcohol Consequences Questionnaire (YAACQ)39 is
a validated 24-item tool designed to assess the broad range
of consequences of heavy drinking.
Additionally, participants were asked to provide
demographic information and answer questions regarding
the presence of any anxiety and depressive symptoms before
and after drinking alcohol, and whether these symptoms
were affected by alcohol (made better or worse).
Procedure
Participants were recruited and invited to participate during
classroom visits by the principal investigators to student
athletes, and psychology and nursing students. They were
informed that participation was voluntary; students who did
not wish to participate did not remain after class to complete
study materials. For study participation and screening
purposes, students were eligible if they were currently
attending college and were aged ≥ 18 years. Students
were excluded if they currently abused prescription drugs,
painkillers, or illegal drugs. Informed consent was then
obtained from eligible study participants. Instructions
were given to participants prior to their completion of
study packets that comprised questions on demographics,
questionnaires, and scales. Additionally, following study
participation, participants were debriefed and reminded to
contact the various health services listed on the consent
should they experience any present or future emotional
distress or mental health issues. Study packets were in paper
format and anonymised.
Data Analyses
Descriptive outcomes were reported for the demographic
variables of age, gender, ethnicity, and class year, as well as
for items D5-D9 of the questionnaire and the Brief YAACQ.
For the GAD-7 and PHQ-9 scales, “mild”, “moderate”,
20
and “severe” categories were reported as frequencies and
percentages. For the AUDIT, “hazardous drinking”, “need
for counselling and monitoring”, and “alcohol dependence”
categories were reported as frequencies and percentages.
All statistical analyses were conducted using the
Statistical Package for the Social Sciences (SPSS Windows
version 22.0; IBM Corp, Armonk [NY], US). Separate Chi-
square tests were calculated to determine the associations
between gender and GAD-7 and PHQ-9 categories, while
separate Mann-Whitney rank-sum tests were conducted
to compare GAD-7, PHQ-9, and Brief YAACQ score
medians and general distributions. Finally, correlations
between AUDIT scores and GAD-7, PHQ-9, and Brief
YAACQ scores were calculated using Spearman’s rank
correlation coefficients. For all analyses, p ≤ 0.05 denotes
statistical significance, with no adjustment for the multiple
comparisons.
Results
The study sample (n = 201) was not ethnically diverse as
Caucasians represented 82% of participants, 9% were Black
or African American, 5% were Hispanic or Latino, 2% were
Pacific Islander or Asian, and 2% were “Other” or did not
reply. Except for the freshman class (14.4%) and graduate
students (3.5%), the sample was relatively evenly spread
between sophomore (26.9%), junior (28.4%), and senior
(26.9%) classes.
Regarding the questionnaire about alcohol’s effects
on depressive symptoms, 29.4% of students reported they
had experienced problems with depression before they had
ever started drinking alcohol; 14.9% reported feelings of
depression after they drank; 8.5% felt that drinking made
their feelings of depression worse; and 15.9% felt that
drinking lessened their feelings of depression (Table 1).
Regarding the questionnaire on alcohol’s effects on
anxiety symptoms, 36.3% of students reported they had
experienced anxiety problems before they had ever started
to drink alcohol; 13.4% reported anxiety feelings after they
drank; 8% felt that drinking made their anxiety symptoms
worse; and 18.9% felt that drinking made their anxiety
symptoms better. Socially, 98% of participants stated they
had places on campus to “hang out,” be with friends, and
comfortably attended gatherings where alcohol was not
involved (Table 1).
The validated GAD-7 assessment tool for anxiety
revealed that 45.3% of our student sample had experienced
mild anxiety symptoms, 29.4% with moderate anxiety
symptoms, and 25.4% with severe anxiety (Table 2). The
median GAD-7 score for females was 6 (range, 0-20) and
for males was 5 (range, 0-17); this was not significantly
different, although it trended towards significance (p =
0.08) [Table 3]. No significant association was found
between the GAD-7 and AUDIT scores (r = –0.03, p = 0.68)
[Table 4]. The GAD-7 items that were most often scored
in the moderate and severe range were questions 1, 2, 3,
and 4; these questions deal with nervousness, worrying, and
East Asian Arch Psychiatry 2017, Vol 27, No.1
 College Binge Drinking and Depression

Table 1. Informal drinking questionnaire.

Question No. (%) with
“Yes” response
D5. Have you had any depression problems or feelings before you ever started using alcohol? 59 (29.4)
D6. Do you experience depression feelings when or after you drink? 30 (14.9)
D6a. Do you think that drinking makes your feelings of depression worse? 17 (8.5)
D6b. Do you think that drinking makes your depression feelings better? 32 (15.9)
D7. Have you had any anxiety problems or feelings before you ever started using alcohol? 73 (36.3)
D8. Do you experience anxiety feelings when or after you drink? 27 (13.4)
D8a. Do you think that drinking makes your anxiety feelings worse? 16 (8.0)
D8b. Do you think that drinking makes your anxiety feelings better? 38 (18.9)
D9. Do you have a place to go hang out on campus, parties, or socialising with a group of 197 (98.0)
people that does not involve drinking or where you can be comfortable if you do not drink?

Table 2. GAD-7, PHQ-9, YAACQ, and alcohol audit median scores.

No. (%) of subjects
GAD-7 (level of anxiety and score range)
Mild (1-5) 91 (45.3)
Moderate (6-10) 59 (29.4)
Severe (11-15 51 (25.4)
PHQ-9 (level of depression and score range)
Mild (1-5) 118 (58.7)
Moderate (6-10) 48 (23.9)
Severe (11-15) 35 (17.4)
Median (range) Brief YAACQ score (i.e. for “yes” responses only) [n = 158] 5 (1-19)
AUDIT (alcohol audit and score range)
Hazardous drinking (8-15) 187 (93.0)
Need for counselling and monitoring (16-19) 7 (3.5)
Alcohol dependence (≥ 20) 7 (3.5)
Abbreviations: AUDIT = Alcohol Use Disorders Identification Test; GAD-7 = 7-Item Generalised Anxiety Questionnaire; PHQ-9 =
9-Item Patient Health Questionnaire; YAACQ = Young Adult Alcohol Consequences Questionnaire.

inability to relax. The AUDIT assessment showed that 93% of students

The validated PHQ-9 assessment tool for depression
revealed that 58.7% of our student participants had
experienced mild depressive symptoms, 23.9% with
moderate symptoms, and 17.4% with severe symptoms
(Table 2). The median score for females was 5 (range, 0-24)
and for males was 4 (range, 0-17); this was not significantly
different, although it trended towards significance (p =
0.07) [Table 3]. No significant association between the
PHQ-9 and AUDIT scores was noted (r = 0.09, p = 0.20)
[Table 4]. The PHQ-9 items that were most often scored in
the moderate and severe range were questions 3, 4, and 5;
these questions deal with insomnia or hypersomnia, energy
level, and appetite.
engaged in hazardous drinking (scored 8-15), 3.5% required
monitoring and counselling (scored 16-19), while 3.5%
were categorised as alcohol-dependent (scored ≥ 20) [Table
2]. There was statistically significant difference in AUDIT
scores by gender (median [range], 5 [0-26] in female vs.
8 [0-23] in male; p = 0.01) but such scores did not differ
significantly by class (5 [0-23] in freshmen; 6 [0-25] in
sophomore; 6 [0-18] in junior; 6 [1-26] in senior; p = 0.44)
[Table 5]. Using Spearman’s rank correlation coefficient, a
moderately positive significant correlation (r = 0.61) was
found between YAACQ and AUDIT scores (Table 4). This
is evidence of a greater likelihood of consequences as a
student drinks more.

East Asian Arch Psychiatry 2017, Vol 27, No.1 21

R Nourse, P Adamshick, J Stoltzfus

Table 3. Comparison of GAD-7, YAACQ, and PHQ-9 scores by gender.

Male (n = 51) Female (n = 150) p Value
GAD-7 (anxiety)
Median score (range) 5 (0-17) 6 (0-20) 0.08
Mild 26 65 0.03
Moderate 19 40
Severe 6 45
PHQ-9 (depression)
Median score (range) 4 (0-17) 5 (0-24) 0.07
Mild 35 83 0.23
Moderate 10 38
Severe 6 29
YAACQ
Median score (range) 5 (1-19) 5 (1-16) 0.68
Frequency of responses (in descending order) Q1 (64.7%) Q1 (57.3%)
Q2 (58.8%) Q2 (56.0%)
Q3 (39.2%) Q3 (42.7%)
Q17 (39.2%) Q17 (36.0%)
Q4 (31.4%) Q4 (35.3%)
Q9 (31.4%)
Abbreviations: GAD-7 = 7-Item Generalised Anxiety Questionnaire; PHQ-9 = 9-Item Patient Health Questionnaire; YAACQ = Young
Adult Alcohol Consequences Questionnaire.

Table 4. Association of alcohol audit with YAACQ, GAD-7, and PHQ-9.

Correlation p Value*
AUDIT and YAACQ r = 0.61 (moderate positive correlation) < 0.001
GAD-7 and AUDIT r = –0.03 (very weak inverse correlation) 0.68
PHQ-9 and AUDIT r = 0.09 (very weak positive correlation) 0.20
Abbreviations: AUDIT = Alcohol Use Disorders Identification Test; GAD-7 = 7-Item Generalised Anxiety Questionnaire; PHQ-9 =
9-Item Patient Health Questionnaire; YAACQ = Young Adult Alcohol Consequences Questionnaire.
*
Based on Mann-Whitney rank-sum tests for skewed continuous data, Chi-square tests for categorical data, and Spearman’s rank
correlation coefficients. For all comparisons, p ≤ 0.05 denotes statistical significance, with no adjustment for the multiple testing.

Table 5. AUDIT scores by gender and class.

Male (n = 51) Female (n = 150) p Value
Median score (range) 8 (0-23) 5 (0-26) 0.01
Hazardous drinking 42 145 < 0.001
Counselling and monitoring 6 1
Alcohol dependence 3 4
Freshman Sophomore Junior Senior Year 5 p Value
Median score (range) 5 (0-23) 6 (0-25) 6 (0-18) 6 (1-26) 4 (2-7) 0.44
Hazardous drinking 28 47 55 50 7
Counselling and monitoring 0 4 2 1 0
Alcohol dependence 1 3 0 3 0
Abbreviation: AUDIT = Alcohol Use Disorders Identification Test.

22 East Asian Arch Psychiatry 2017, Vol 27, No.1


The YAACQ showed some variance in responses by
gender. In order of commonality, females most often checked
off question 1 (“I have said or done embarrassing things”,
57.3%), question 2 (“I have had a hangover [headache, sick
stomach] the morning after I had been drinking”, 56%),
question 3 (“I have felt very sick to my stomach or thrown
up after drinking”, 42.7%), question 17 (“I have had less
energy or felt tired because of my drinking”, 36.0%), and
question 4 (“I often have ended up drinking on a night when
I had planned not to drink”, 35.3%). Similarly, males most
often checked off question 1 (64.7%), question 2 (58.8%),
question 3 (39.2%), question 17 (39.2), question 4 (31.4%),
and question 9 (“I have not been able to remember large
stretches of time while drinking heavily”, 31.4%).
Discussion
Despite the application of comprehensive evidence-
based interventions and policies specifically designed to
effectively address and curb the problem of BD among the
college student population, campuses across the United
States continue to struggle with this pestilent issue.4,6,7,9-11
Our study results support this statement as 93% of our
sample engaged in hazardous drinking with 3.5% of students
categorised as in need of counselling / monitoring and 3.5%
satisfied the criteria for alcohol dependence. Overall, the
majority of students were drinking 2 to 4 times a month
(47.3%) and were having 3 to 4 drinks on their typical day
of drinking (36.8%).
Regarding BD, 35.8% of all students reported having
≥ 5 drinks on one occasion less than monthly with 25.4%
stating that they never drink that amount of alcohol on one
occasion. Nonetheless 19.4% of students reported binging
monthly and 19.4% reported binging weekly. Therefore, our
estimated BD rate is 38.8% and mirrors the approximated
national rate of 39% to 44%.1-7 Disturbingly, 13.9% of
our students reported on a monthly basis that they could
not remember what happened the night before due to
drinking; this indicates that the majority of students who
are binging are experiencing memory issues. No recall or
short-term memory ability suggests that students had either
passed out or blacked out and were therefore vulnerable to
harmful events. Similar to previous studies, our results also
indicated a positive relationship between alcohol use and
negative consequences.2,4,6,11-14
While it appears that both males (43.1%) and females
(48.7%) were mostly drinking 2 to 4 times per month,
males were drinking more per week, more per month, and
were also binging more often than females; ergo, our study
agrees with prior research that indicates male students
drink significantly more than female students.4,5,13,15,16,21-24
Additionally, remarkably more male (21.6%) students than
female (11.3%) could not remember what happened the
night before due to drinking, on a monthly basis.
Congruently, colleges are dealing with a student
population who present with serious mental health issues;
furthermore, many students arrive on campus with these
East Asian Arch Psychiatry 2017, Vol 27, No.1
College Binge Drinking and Depression
problems that may or may not be affected by their alcohol
use.24,40-42 Unfortunately, prior research has cited a low rate
of students who recognise or show insight into their alcohol
misuse or mental health problems as well as for students who
obtain professional treatment or counselling.1,4,10,11,18,19,24,27-29
Our sample exhibited questionable insight as 15.9% felt
that drinking helped their depressive symptoms and 18.9%
felt that drinking helped their anxiety symptoms. Due to the
high rates of depression and anxiety that have been reported
on this campus, it does not appear that alcohol use was
helpful for either problem. Rates of depression and anxiety
in our sample may have been somewhat inflated due to the
timing of the study: the end of the spring semester / end of
the college year. Nonetheless recent studies have shown an
increase in anxiety and depression in college students with a
survey reporting that within a 12-month time period, 32.6%
of students reported feeling so depressed that it was hard for
them to function and 54% reported feeling overwhelmed by
anxiety.42
Interestingly, there were significant differences in
responses to the non-validated questionnaire that measured
anxiety and depression versus the validated tools. While
36% of students reported they had experienced anxiety as
per the questionnaire, a total of 54.8% satisfied the criteria
for moderate or severe anxiety as per the GAD-7. Also,
while 29% of students reported they had felt depressed as
per the questionnaire, a total of 41.3% fulfilled the PHQ-9
criteria for moderate or severe depression. These remarkable
differences suggest that students’ casual opinions or
estimations of their anxiety and depression symptoms do
not reflect the real level.
Past studies have identified multiple factors associated
with the initiation and continuation of BD8,10,13,15,20-23;
research has also elucidated the common negative effects
and consequences of drinking on students’ lives.2,4,6,11-14
Identified via the YAACQ, our sample cited problematic
issues in the areas of behavioural changes, hangover
symptoms, regretful and risky / impulsive behaviours, and
passing out or blacking out.
As illustrated by the YAACQ, both female and
males reported their most common drinking consequences
as feelings of embarrassment regarding things they had
said or done, hangover symptoms of headache, vomiting
and stomach upset, drinking on nights when they had not
planned to drink, and feeling more tired / having less energy
due to drinking. Males (31.4%) more often indicated not
remembering large stretches of time (vs. 20.7% in females).
Alarmingly, both males and females reported having taken
foolish risks when drinking (29.4% vs. 22.7%) and having
done impulsive things that were later regretted (29.4% vs.
29.3%).
Interestingly, the answers to 3 YAACQ questions
differed significantly by gender (males vs. females): “I
have passed out from drinking” (21.6% vs. 8.7%), “I have
become very rude, obnoxious or insulting after drinking”
(21.6% vs. 8.0%), and “I have woken up in an unexpected
place after heavy drinking” (17.7% vs. 4.7%).
23
R Nourse, P Adamshick, J Stoltzfus
Discussion
Past research has yielded conflicting results about the
association of BD with depression and anxiety.5,13,16-18,24,30,31
Our results agree with those studies that did not find an
association between BD or hazardous alcohol use and
depression or anxiety.24,29,31 Our student sample may not have
experienced a clinically significant onset or exacerbation of
anxiety or depressive symptoms due to their alcohol use.
Despite this, it is of definite concern that on this campus,
25.4% of students experienced severe anxiety symptoms
and 17.4% experienced severe depressive symptoms; these
numbers indicate that a substantial proportion of students
have endured mental health issues. Additionally, our
statistics were trending towards a gender significance with
females reporting more anxiety and depression than males.
Although some students believe that alcohol can
effectively reduce their emotional discomfort in the form
of anxiety or depressive feelings, our results suggest that
the majority of alcohol use on this campus is more likely to
be linked to students’ perceived positive expectancies and
cultural norms than to self-medication / mood regulation.
Males on this campus are drinking more and suffering
more memory loss than females and should therefore receive
alcohol education sensitive to social and cultural masculine
expectations, pressures, and stereotypes.
Limitations
The main limitation of this study was the small sample
size that comprised mostly Caucasian females and was
not ethnically or gender diverse. Furthermore, the college
setting was a smaller suburban Mid-Atlantic university
so the generalisability of results is limited. Response bias
was a consideration as students may have wanted to be
represented in a positive / academically acceptable manner.
Some abbreviated measurement tools were utilised in order
to reduce the time required for participation and to dissuade
apathetic or rushed responses.
Conclusions
The results of this study have revealed the specific
problematic issues of our student population in the areas of
BD, accompanying dangerous consequences and behaviours
(especially for males), and high rates of depression
and anxiety. Current interventions available to students
will be reviewed and updated. Also, hospital staff —
particularly emergency department and behavioural health
unit clinicians — must be better informed about BD (its
symptoms and contributors) to improve screening methods,
patient education / counselling, and treatment. Hospitals
and their local colleges should work in unison to improve
and promote BD programmes, education / awareness, and
counselling. Research in this specific population should
be ongoing in order to stay current with the alcohol use
trends and mental health issues of emerging adults because
their behaviour, problems, and beliefs are a reflection of
24
our continuously changing society and perceived cultural
norms. Strategies and services utilised by colleges must also
stay current, specific, and adaptable to the needs of students.
Acknowledgements
We would like to thank Ms Sophia Arroyo from St. Luke’s
University Hospital and Mr Ben Watchous from St. Luke’s
University Health Network for their contributions of
recording statistical information.
Declaration
The authors declared no conflicts of interest in this study.
References
1. National Institute on Alcohol Abuse and Alcoholism. College drinking.
Available from: https://www.niaaa.nih.gov/alcohol-health/special-
populations-co-occurring-disorders/college-drinking. Accessed 20 Jun
2015.
2. Wu LT, Pilowsky DJ, Schlenger WE, Hasin D. Alcohol use disorders
and the use of treatment services among college-age young adults.
Psychiatr Serv 2007;58:192-200.
3. U.S. Department of Health and Human Services. Results from the
2013 National Survey on Drug Use and Health: Summary of national
findings. Available from: https://www.samhsa.gov/data/sites/default/
files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf.
Accessed 20 Jun 2015.
4. Graceffo JM, Hayes JA, Chun-Kennedy C, Locke BD. Characteristics
of high-risk college student drinkers expressing high and low levels of
distress. J Coll Counsel 2012;15:262-73.
5. Geisner IM, Mallett K, Kilmer JR. An examination of depressive
symptoms and drinking patterns in first year college students. Issues
Ment Health Nurs 2012;33:280-7.
6. Hensel D, Todd KL, Engs RC. College student’s health, drinking
and smoking patterns: what has changed in 20 years? Coll Stud J
2014;48:378-85.
7. Wechsler H, Lee JE, Kuo M, Seibring M, Nelson TF, Lee H. Trends in
college binge drinking during a period of increased prevention efforts.
Findings from 4 Harvard School of Public Health College Alcohol
Study surveys: 1993-2001. J Am Coll Health 2002;50:203-17.
8. Talbott LL, Wilkinson LL, Moore CG, Usdan SL. The role of injunctive
norms and alcohol use during the first semester of college. J Alcohol
Drug Educ 2014;58:60-81.
9. Martinez JA, Scher KJ, Wood PK. Drinking consequences and
subsequent drinking in college students over 4 years. Psychol Addict
Behav 2014;28:1240-5.
10. Hingson RW. Magnitude and prevention of college drinking and
related problems. Alcohol Res Health 2010;33:45-54.
11. Eshbaugh EM. Factors that predict self-perceived problem drinking
among college students. J Alcohol Drug Educ 2008;52:72-88.
12. White A, Hingson R. The burden of alcohol use: excessive alcohol
consumption and related consequences among college students.
Alcohol Res 2013;35:201-18.
13. Haynes JC, Farrell M, Singleton N, Meltzer H, Araya R, Lewis G, et
al. Alcohol consumption as a risk factor for anxiety and depression:
results from the longitudinal follow-up of the National Psychiatric
Morbidity Survey. Br J Psychiatry 2005;187:544-51.
14. Mouilso ER, Fischer S, Calhoun KS. A prospective study of sexual
assault and alcohol use among first-year college women. Violence Vict
2012:27:78-94.
15. Well S, Flynn A, Tremblay PF, Dumas T, Miller P, Graham K. Linking
masculinity to negative drinking consequences: the mediating roles
of heavy episodic drinking and alcohol expectancies. J Stud Alcohol
East Asian Arch Psychiatry 2017, Vol 27, No.1

Drugs 2014;75:510-9.
16. Pederson DE. Gender differences in college binge drinking: examining
the role of depression and school stress. Soc Sci J 2013;50:521-9.
17. Gonzales VM, Collins RL, Bradizza CM. Solitary and social heavy
drinking, suicidal ideation, and drinking motives in underage college
drinkers. Addict Behav 2009;34:993-9.
18. Czyz EK, Horwitz AG, Eisenberg D, Kramer A, King CA. Self-
reported barriers to professional help seeking among college students
at elevated risk for suicide. J Am Coll Health 2013;61:398-406.
19. Terlecki MA, Buckner JD, Larimer ME, Copeland AL. The role of
social anxiety in a brief alcohol intervention for heavy-drinking
college students. J Cogn Psychother 2011;25:7-21.
20. Norman P, Connor MT, Stride CB. Reasons for binge drinking among
undergraduate students: an application of behavioural reasoning
theory. Br J Health Psychol 2012;17:682-98.
21. McBride NM, Barrett B, Moore KA, Schonfeld L. The role of positive
alcohol expectancies in underage binge drinking among college
students. J Am Coll Health 2014;62:370-9.
22. Park A, Kim J, Gellis LA, Zaso MJ, Maisto SA. Short-term prospective
effects of impulsivity on binge drinking: mediation by positive and
negative drinking consequences. J AM Coll Health 2014;62:517-25.
23. Shin SH, Hong HG, Jeon SM. Personality and alcohol use: the role of
impulsivity. Addict Behav 2012;37:102-7.
24. Cranford JA, Eisenberg D, Serras AM. Substance use behaviors,
mental health problems, and use of mental health services in a
probability sample of college students. Addict Behav 2009;34:134-45.
25. Rospenda KM, Richman JA, Wolff JM, Burke LA. Bullying
victimization among college students: negative consequences for
alcohol use. J Addict Dis 2013;32:325-42.
26. Kieffer KM, Cronin C, Gawet DL. Test and study worry emotionality in
the prediction of college students’ reasons for drinking: an exploratory
investigation. J Alcohol Drug Educ 2006;50:57-81.
27. Clinkingbeard SS, Johnson MA. Perceptions and practices of student
binge drinking: an observational study of residential college students.
J Drug Educ 2013;43:301-19.
28. Eisenberg D, Golberstein E, Gollust SE. Help-seeking and access
to mental health care in a university student population. Med Care
2007;45:594-601.
29. Bergen-Cico D, Possemato K, Cheion S. Examining the efficacy of a
brief mindfulness-based stress reduction (Brief MBSR) program on
East Asian Arch Psychiatry 2017, Vol 27, No.1
College Binge Drinking and Depression
psychological health. J Am Coll Health 2013;61:348-60.
30. Harrell ZA, Slane JD, Klump KL. Predictors of alcohol problems in
college women: the role of depressive symptoms, disordered eating,
and family history of alcoholism. Addict Behav 2009;34:252-7.
31. Currell CK, Jeglic EL. An examination of alcohol and drug use among
urban college students. J Subst Use 2010;15:272-82.
32. Dawson DA, Grant BF, Stinson FS, Chou PS. Psychopathology
associated with drinking and alcohol use disorders in the college and
general adult populations. Drug Alcohol Depend 2005;77:139-50.
33. Hingson RW, Zha W, Weitzman ER. Magnitude of and trends in
alcohol-related mortality and morbidity among U.S. college students
ages 18-24, 1998-2005. J Stud Alcohol Drugs Suppl 2009;(16):12-20.
34. Young A, Grey M, Abbey A, Boyd CJ, McCabe SE. Alcohol-
related sexual assault victimization among adolescents: prevalence,
characteristics, and correlates. J Stud Alcohol Drugs 2008;69:39-48.
35. Perron BE, Grahovac ID, Parrish D. Students for recovery: A novel
way to support students on campus. Psychiatr Serv 2010;61:633.
36. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for
assessing generalized anxiety disorder: the GAD-7. Arch Intern Med
2006;166:1092-7.
37. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and
severity measure. Psychiatr Ann 2002;32:509-15.
38. Saunders JB, Aasland OG, Barbor TF, de la Fuente JR, Grant M.
Development of the Alcohol Use Disorders Identification Test
(AUDIT): WHO collaborative project on early detection of persons
with harmful alcohol consumption. Addiction 1993;88:791-804.
39. Read JP, Kahler CW, Strong DR, Colder CR. Development and
preliminary validation of the young adult alcohol consequences
questionnaire. J Stud Alcohol 2006;67:169-77.
40. Gallagher RP. National Survey of Counseling Center Directors 2008
(Monograph Series No. 8R). Alexandria, VA: The International
Association of Counseling Services, Inc; 2009.
41. Gallagher RP. National Survey of Counseling Center Directors 2009
(Monograph Series No. 8R). Alexandria, VA: The International
Association of Counseling Services, Inc; 2009.
42. American College Health Association National College Health
Assessment Spring 2014 Reference Group Executive Summary.
Available from: http://www.acha-ncha.org/docs/ACHA-NCHA-II_
ReferenceGroup_ExecutiveSummary_Spring2014.pdf. Accessed 1
Aug 2015.
25