Participants
Participant recruitment occurred online through paid advertising on a page created on Facebook by the researcher. To qualify for inclusion in this study, participants confirmed they were age 18 years or over and could understand English and meeting the Alcohol Use Disorders Identification Test (AUDIT) [10] criteria with a score of 8 or above indicating hazardous drinking. One hundred and fourteen participants’ data were analysed with 35 males (30.7%), 78 females (68.9%), and one other gender identity (0.9%). Participants ages ranged between 18 and 70 years (M = 33.5, SD = 12.35). Table 1 displays demographic and clinical characteristics of the sample.
Table 1
Demographic and clinical characteristics of sample
| | n | % |
Sex | Male Female Other | 35 78 1 | 17.4 38.8 0.5 |
Marital status | Married/Defacto Never Married Separated/Divorced/Widowed | 28 60 26 | 13.9 29.9 12.9 |
Country of birth | Australia/New Zealand Europe UK Ireland South Africa Canada Iran USA | 27 1 6 24 43 9 1 3 | 13.4 0.5 3 11.9 21.4 4.5 0.5 1.5 |
Occupational status | Full-time Part-time/Casual/Volunteer Unemployed | 52 30 31 | 46 26.5 27.4 |
Education | Secondary/Completed Secondary Bachelor or higher Vocational qualification | 45 38 29 | 40.7 33.6 25.7 |
Religious affiliation | Religious Non-religious Unknown | 51 59 4 | 25.4 29.4 2 |
Psychiatric diagnoses | No diagnosis Depression Comorbid disorders Other | 56 21 31 6 | 49.1 18.4 27.2 5.3 |
Physical diagnoses | Yes | 41 | 20.4 |
Prior hospitalisation for psychiatric diagnoses | Yes | 21 | 10.5 |
Prescribed medication | Yes | 47 | 23.4 |
Non-prescribed drug use | None Marijuana Other | 31 45 38 | 27.2 39.5 33.3 |
Current alcohol treatment | Some treatment | 5 | 2.5 |
Prior alcohol treatment | Some treatment | 21 | 10.4 |
Measures
Demographic questions included age, gender, relationship status, education, occupational status, religious affiliation, psychiatric diagnosis, alcohol treatment history, medical history, and current medication use.
The Alcohol Use Disorders Identification Test – Self-report Version (AUDIT)
The Alcohol Use Disorders Identification Test (AUDIT) is a screening scale that measures hazardous drinking levels with scores ranging from 0 to 4 per question and total scores ranging from 0 to 40 [10].The internal consistency for the AUDIT has been reported as high with a Cronbach’s alpha α = 0.93 (N = 1888) [10].
Depression Anxiety and Stress Scale (DASS 21)
The DASS 21 is a self-report measure with three subscales which measure depression, anxiety and stress [11]. The internal consistency for the DASS 21 has been reported as excellent with high temporal stability. Cronbach’s alpha for the Depression subscale has been reported as α = 0.91, [11]. The DASS-Depression subscale was used in this study.
Ruminative Responses Scale (RRS)
The Ruminative Responses Scale (RRS) is a 22-item scale was used to assess rumination [12]. The internal consistency for the RRS was reported as high with Cronbach’s alpha for the scale α = 0.90 (N = 1328) [12].
Internalised Stigma of Mental Illness Scale (ISMI)
Internalised Stigma of Mental Illness Scale (ISMI) is a 29-item scale that measures self-stigma for individuals with a mental illness. The internal consistency for ISMI was high with Cronbach’s alpha for Alienation subscale α = 0.84, for Stereotype Endorsement subscale α = 0.75, for Discrimination Experience subscale α = 0.82, for Social Withdrawal subscale α = 0.85, and for Stigma Resistance subscale α = 0.53 (N = 758) [13].
Substance Use Stigma Mechanism Scale (SU-SMS) [14]
The Substance Use Stigma Mechanism Scale (SU-SMS) is an 18-item scale which measures internalised-stigma, enacted and anticipated stigma among a substance using population. The internal consistency of the SU-SMS scale has been reported as significant with Cronbach’s alpha α = 0.90 across all the subscales (N = 175) [14]. The internalised-stigma subscale was utilised in this study.
Procedure
Participants accessed the survey via a link that was advertised on Facebook and the researcher’s social media pages. Participants viewed a Participants Information Statement, which included an explanation of the purpose of this study, requirements of participants, researcher’s contact details, and information about confidentiality. Those who selected “I consent to participate in this study” were taken to the survey, which was estimated to take 20 minutes to complete.
Contact details for crisis and mental health support services were provided in the Participant Information Statement and again at the conclusion of the survey. The study was approved b y Western Sydney University Human Research Ethics Committee (HREC Approval Number: H13034).
Data Analyses
Based on the statistical assumptions for the detection of a medium effect size utilising G-power analysis (f2 = 0.05) based upon a 0.90 power level at a significance level of 0.05, a minimum target sample of 173 participants were required for mediation analysis. A frequency analysis revealed that 114 participants met the AUDIT criteria of scoring 8 and above. A one-way between-groups analysis of variance (ANOVA) was conducted to explore the impact of demographic characteristics on scores on depression (DASS 21 depression subscale), internalised stigma (SU-SMS – internalised stigma subscale), self-stigma (ISMI) and rumination (RRS).