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. 2021 Feb 16;221:108621. doi: 10.1016/j.drugalcdep.2021.108621

What is associated with the increased frequency of heavy episodic drinking during the COVID-19 pandemic? Data from the PAHO regional web-based survey

Juliana Y Valente a, Ivneet Sohi b, Rodrigo Garcia-Cerde c, Maristela G Monteiro b, Zila M Sanchez c,*
PMCID: PMC9759720  PMID: 33636598

Abstract

Background

To estimate the prevalence of changes in the frequency of self-reported heavy episodic drinking (HED) among drinkers in Latin America and Caribbean countries on alcohol consumption during the COVID-19 pandemic, and to assess self-reported factors associated with the increased frequency of HED.

Methods

Data from 12,328 adults who responded to the cross-sectional survey conducted in 33 countries of Latin America and the Caribbean by Pan American Health Organization were used. Logistic regression analyses were performed to estimate the effect of the sociodemographic characteristics, quarantine practices, and anxiety symptoms on the increase in frequency of HED among the 2019 drinkers.

Results

65 % of drinkers in 2019 self-reported HED during the COVID-19 pandemic with 13.8 % of the drinkers reporting an increase in HED compared to a 33.38 % decrease in HED. Multivariable analysis indicated that male gender (aOR 1.29, 95 %CI 1.13; 1.49), higher income (aOR 1.64, 95 %CI 1.35; 1.99) and higher level of quarantine practices (aOR 1.10, 95 %CI 1.04; 1.16) were positively associated with increased frequency of HED; unemployment (aOR 0.78, 95 %CI 0.64; 0.96), student status (aOR 0.53, 95 %CI 0.43; 0.64) and living with children (aOR 0.91, 95 %CI 0.84; 0.99) were negatively associated with increased frequency of HED. A gradient of association was found between generalized anxiety disorder and an increase in HED frequency during the pandemic.

Conclusion

Along with other measures to decrease the spread of COVID-19, it is important to include measures to reduce alcohol consumption and address mental health conditions in the national response to the pandemic.

Keywords: COVID-19, Heavy episodic drinking, Alcohol, Quarantine, Anxiety, Mental health, Binge drinking

1. Introduction

The novel coronavirus, SARS-CoV-2 has brought significant and unprecedented changes to the entire world since first being reported in China in December 2019 (PAHO/WHO, 2020). The scale of the pandemic sparked public health concerns of how facing hardships related to socioeconomic effects, fear of contracting the virus and stressful adaptive challenges in everyday activities would have an impact on the physical and mental health of individuals and entire societies (UNITED NATIONS, 2020).

One of the common methods of coping with anxiety, stress, uncertainty and unpleasant emotions is alcohol use (Brooks et al., 2020; Keyes et al., 2011). There is well-documented evidence suggesting alcohol use can increase during difficult time periods like disasters and pandemics (Brooks et al., 2018; North et al., 2011; World Health Organization, 2020; Wu et al., 2008).

With alcohol consumption levels in the Region of the Americas being higher than the global average, there is significant concern regarding the possibility of changes in alcohol consumption and the potential impacts on individuals as alcohol poses many acute and chronic risks to health (Banks et al., 2019; WHO, 2018). Alcohol consumption weakens the immune system, thus making individuals more susceptible to contracting infectious diseases, including COVID-19 (Testino, 2020). Heavy use of alcohol increases the risk of acute respiratory distress syndrome (ARDS), which is one of the most severe complications of COVID-19 (Simou et al., 2018). Alcohol use increases the risk, frequency and severity of perpetration of interpersonal violence including domestic and sexual violence (Curtis et al., 2019).

Recent online surveys conducted in Argentina, Brazil, Colombia, and Mexico indicate anxiety as one of the most commonly reported mental distress symptoms during the pandemic (Badellino et al., 2020; Goularte et al., 2021; Martínez et al., 2020). However, the impact of the pandemic on alcohol consumption and its association with the mental health status of individuals remains unknown in the Latin American and Caribbean countries (Garcia and Sanchez, 2020; Monteiro et al., 2020; Rehm et al., 2020).

In order to understand the current situation in greater depth, the Pan American Health Organization (PAHO) conducted a regional study focused on alcohol consumption and associated risks during the pandemic in all Latin American and Caribbean countries. The aim of the present study is to estimate the prevalence of changes in the frequency of self-reported heavy episodic drinking (HED) among drinkers in Latin America and Caribbean countries who participated in the PAHO regional survey on self-reported alcohol consumption during the COVID-19 pandemic, and to analyze the self-reported factors associated with the increase in the frequency of self-reported HED, with emphasis on sociodemographic characteristics, quarantine practices, and anxiety symptoms among drinkers.

2. Methods

2.1. Study design and participants

This is a cross-sectional study based on the online survey known as “Alcohol Use during the COVID-19 pandemic in Latin America and the Caribbean” conducted by PAHO. The self-reported questionnaire was widely and repeatedly disseminated through PAHO’s communication platforms including, Facebook, Twitter, the Pan American Network for Alcohol and Public Health (PANNAPH), and other networks such as the Healthy Caribbean Coalition, the Healthy Coalition of Latin America, as well as through PAHO staff and individual contacts. From the 23,058 respondents who accessed the weblink, 12,328 (53.50 %) agreed to participate and answered the online questionnaire, from 22 May to 30 June 2020. To be eligible, participants needed to be aged at least 18 years old, living in one of the 35 Latin American or Caribbean countries or territories, and did not travel out of their country since 15 March 2020. The participants provided electronic consent prior to completing the questionnaire and they were informed that they could withdraw from the survey at any moment without providing any justification. This study was approved by the Ethics Review Committee of PAHO (PAHOERC 0214.01).

2.2. Instrument and variables

To collect the data, we used an online anonymous self-report questionnaire, through Qualtrics software, with 55 questions translated into four languages (English, Spanish, Portuguese, and French) and covering the following: sociodemographic characteristics; COVID-19 related questions, including precautionary measures taken in daily life; anxiety symptoms in the past 14 days; alcohol consumption habits in 2019; and alcohol consumption habits during the COVID-19 pandemic period.

The dependent variable was self-reported change in Heavy Episodic Drinking (HED) during COVID-19 pandemic period in 2020. The data relating to HED were collected through a single question that measured the frequency of the behavior with seven possible responses (ranging from never to everyday). The question was formulated as follows: “How often did you drink five or more standard drinks in one occasion. (One STANDARD drink is equivalent to a can of beer (355 mL), a glass of wine (150 mL), or a shot of distilled spirits (40 mL)”. The same question was asked related to the frequency of HED in 2019 and in the COVID-19 pandemic period in 2020. We constructed de change HED variable from the difference between HED frequency responses in 2019 and 2020. Change in HED was classified as: never reported HED, did not change the HED pattern from 2019, increased frequency of HED and decreased frequency of HED. If the subtraction of frequency in 2020 (during the pandemic) and 2019 was zero, we considered that there was no change in HED, separating those whose subtraction was zero due to reporting no HED in 2019 and in 2020. If it was a positive number, we considered an increase in frequency, and if it was a negative number, it was categorized as a decrease.

The independent variables were self-reported sociodemographic characteristics, quarantine and anxiety symptoms.

Sociodemographic characteristics were considered sex, age, household income (from less than one to more than 20 monthly wages), living area status (urban or rural), working situation (not working, working, student and retired) and living status (living with children until 12 years old and living alone).

The data related to quarantine were collected through one single question measuring the engagement of participants in social distance practices as a consequence of COVID-19 pandemic: 1. avoiding public transport and social gatherings; 2. working/studying from home; 3. home-schooling children/keeping pre-school children home from day care; 4. asked to stay in isolation at home after travel overseas; 5. staying in isolation at home due to own or household members vulnerability to COVID-19; 6. home quarantine (tested positive for COVID-19 and stayed at home); 7. admitted to hospital (tested positive for COVID-19 and 8. admitted to hospital and quarantined to a hotel room). The more options marked the more situations of social distance the subject was involved and stricter was the quarantine (ranging from 0 to 8).

Anxiety symptoms were assessed through a 7-item Generalized Anxiety Disorder Scale (GAD-7) (Ruiz et al., 2011). Participants were asked to rate the severity of seven anxiety symptoms experienced over the past two weeks. The GAD-7 score is calculated by assigning scores of 0, 1, 2, and 3, to the response categories of “not at all,” “several days,” “more than half the days,” and “nearly every day,” respectively, and then adding together the scores for the seven questions. GAD-7 total score for the seven items ranges from 0 to 21. Scores of 5, 10, and 15 represent cut-points for mild, moderate, and severe anxiety, respectively.

2.3. Statistical analysis

Comparisons between the change self-reported HED profiles among drinkers (that is, respondents who have reported drinking in 2019) were performed using chi-square test or ANOVA according to the type of variable. Logistic regression analysis was performed (univariate and multivariate), in which we estimated the effect of the independent variables in the increase of the frequency of HED among the 2019 drinkers. The regressions were performed using STATA cluster option that indicated the non-independence of the participants due to the cluster structure of the data (i.e., participants nested in 33 countries and 2 territories) and subsequently, the standard error was computed, considering the multi-level structure. Inferential estimates are given as adjusted odds ratios (aORs) with their respective 95 %CIs and p-values. Odds ratios were adjusted for all covariates in the model. Stata SE version 16 was used to conduct all analyses with a level of significance set at 5%.

3. Results

The current analytic sample includes 9554 adults who self-reported drinking in 2019. The majority of the participants were women (64 %), with an average of 37.8 years of age, who were working (75.5 %), living in urban areas (91.6 %), with a household income of more than 11 minimum wages per month (31.27 %) and self-reporting mild anxiety symptoms (37.7 %). About 65 % of drinkers in 2019 self-reported HED during the COVID-19 pandemic with 13.8 % of the drinkers reporting an increase and 33.38 % reporting a decrease in self-reported HED frequency (Table 1 ).

Table 1.

Sociodemographic characteristics considering the change in frequency of self-reported HEDb among drinkers participants of the “Alcohol Use during the COVID-19 pandemic in Latin America and the Caribbean” survey, 2020 (N = 9.554).a

Total
 No HEDb
 HED equalb
 Decrease HEDc
 Increase HEDd
 p-value
n = 9.554
 n = 2.942 (34.94 %)
 n = 1.505 (17.87 %)
 n = 2.811 (33.38 %)
 n = 1.162 (13.80 %)
n % n % n % n % n %
Sex <0.001
 Women 5.292 64.00 2.189 41.36 762 14.40 1.660 31.37 681 12.87
 Men 2.977 36.00 695 23.35 716 24.05 1.105 37.11 461 15.49
Age group <0.001
 18 to 29 yo 2.857 29.90 537 22.04 469 19.25 1.154 47.37 276 11.34
 30 to 39 yo 2.919 30.55 823 31.79 520 20.08 841 32.48 405 15.65
 40 to 49 yo 1.934 20.24 732 41.95 284 16.28 440 25.21 289 16.56
 50 to 59 yo 1.200 12.56 516 47.82 172 15.94 258 23.91 133 12.33
 60+ yo 644 6.74 334 58.49 60 10.51 118 20.67 59 10.33
Mean Age (SD) 37.79 ± 12.58 42.06 ± 12.95 36.38 ± 11.37 34.57 ± 11.90 38.33 ± 11.34
Family Income <0.001
 <1 min.wage 1.113 13.45 321 28.84 176 15.81 496 44.56 120 10.79
 1−4 wages 2.546 30.77 788 30.95 514 20.19 949 37.27 295 11.59
 5−10 wages 2.028 24.51 762 37.57 352 17.36 615 30.33 299 14.74
 >11 wages 2.028 31.27 1.000 38.65 448 17.32 703 27.17 436 16.86
Work Situation <0.001
 Not working 1.177 12.32 305 30.53 184 18.42 396 39.64 114 11.41
 Working 7.215 75.52 2.301 36.02 1.174 18.38 1.970 30.84 943 14.76
 Student 850 8.90 185 24.41 120 15.83 384 50.66 69 9.10
 Retired 312 3.27 151 54.91 27 9.82 61 22.18 36 13.09
Living status
 With children 4.721 49.41 1.521 36.88 716 17.36 1.343 32.57 544 13.19 0.003
 Alone 923 9.66 303 36.24 143 17.11 258 30.86 132 15.79 0.158
Living area 0.002
 Urban 7.566 91.56 2.664 35.21 1.352 17.87 2.489 32.90 1.061 14.02
 Rural 697 8.44 203 29.12 136 19.51 269 38.59 89 12.78
Mean Quarantine (SD) 2.10 ± 0.99 2.18 ± 0.95 2.04 ± 0.98 2.12 ± 0.97 2.24 ± 1.03 0.012
GADc <0.001
 Normal 3.314 34.69 1.210 40.84 491 16.57 906 30.58 356 12.01
 Mild 3.598 37.66 1.108 35.05 583 18.44 1.052 33.28 418 13.23
 Moderate 1.491 15.61 366 28.18 252 19.40 484 37.25 197 15.17
 Severe 1.151 12.05 258 25.88 179 17.95 369 37.01 191 19.16
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a

All descriptive models were estimated between those who reported drinking in 2019.

b

HED: Heavy Episodic Drinking.

c

GAD: Generalized Anxiety Disorder Scale.

In the multivariate analysis, the increase in frequency of self-reported HED during the COVID pandemic was positively associated with being a man (aOR 1.29, 95 %CI 1.13; 1.49), with higher income (eg. more than 11 wages aOR 1.64, 95 %CI 1.35; 1.99) and with higher level of self-reported quarantine practices (aOR 1.10, 95 %CI 1.04; 1.16). On the other hand, increase in self-reported HED was inversely associated with, not working (aOR 0.78, 95 %CI 0.64; 0.96), being a student (aOR 0.53, 95 %CI 0.43; 0.64) and living with children (aOR 0.91, 95 %CI 0.84; 0.99). We found a gradient of association between self-reported generalized anxiety disorder symptoms and the increase in frequency of self-reported HED during the pandemic, the more severe the anxiety symptoms the greater the chance of increasing the frequency of self-reported HED (eg. mild aOR 1.18, 95 %CI 1.04; 1.33; moderate aOR 1.43, 95 %CI 1.22; 1.69 and severe aOR 1.99 95 %CI 1.74; 2.27) (Table 2 ).

Table 2.

Univariate and Multivariate Analysisa, b of factors associated with the increase in self-reported Heavy Episodic Drinking (HED) among drinkers participants of the “Alcohol Use during the COVID-19 pandemic in Latin America and the Caribbean” survey. 2020 (N = 8.167).

Univariate Analysis
 Multivariate Analysis
OR 95 % CI p-value aOR 95 % CI p-value
Male 1.24 1.10; 1.40 <0.001 1.29 1.13; 1.49 <0.001



Age 1.00 0.99; 1.01 0.535 0.99 0.99; 100.18 0.156



Area Living
 Urban Ref Ref
 Rural 0.96 0.90; 1.03 0.263 1.00 0.93; 108.158 0.917



Income
 <1 wage Ref Ref
 1−4 wages 1.08 0.86; 1.36 0.488 1.03 0.84; 1.27 0.765
 5−10 wages 1.43 1.14; 1.79 0.002 1.38 1.11; 172.46 0.004
 >11 wages 1.68 1.38; 2.04 <0.001 1.64 1.35; 1.99 <0.001



Work situation
 Working Ref Ref
 Not working 1.34 1.11; 1.63 0.003 0.78 0.64; 0.96 0.018
 Student 0.78 0.60; 1.00 0.051 0.53 0.43; 0.64 <0.001
 Retired 1.17 0.81; 1.68 0.396 0.91 0.75; 1.12 0.388



Living status
 With children 0.90 0.83; 0.98 0.022 0.91 0.84; 0.99 0.040
 Alone 1.02 0.98; 1.04 0.093 1.01 1.00; 1.03 0.092



Quarantine (Score) 1.12 1.06; 1.19 <0.001 1.10 1.04; 1.16 0.001



GADc
 Minor Ref Ref
 Mild 1.11 0.99; 1.26 0.077 1.18 1.04; 1.33 0.010
 Moderate 1.31 1.10; 1.55 0.002 1.43 1.22; 1.69 <0.001
 Severe 1.73 1.53; 1.97 <0.001 1.99 1.74; 2.27 <0.001
Open in a new tab
a

Odds ratios [95 % CI] were derived from logistic regression models predicting increase in self-reported heavy episodic drinking taking as reference the other categories combined (equal/decrease/never heavy episodic drinking).

b

All models were estimated with cluster in country and were performed between those who self-reported drinking in 2019.

c

GAD: Generalized Anxiety Disorder Scale.

4. Discussion

This study provides insight into the pattern of self-reported HED and the self-reported factors associated with an increase in the frequency of self-reported HED during the COVID-19 pandemic among the largest sample of inhabitants Latin American and Caribbean reported to date. The present study suggested that the increase in the frequency of self-reported HED during the first months of the COVID-19 pandemic was associated with being a male, with all levels of self-reported anxiety symptoms, amount of self-reported quarantine strategies practiced, higher income, unemployment, being a student and not living with a child. Among 2019 drinkers, 65 % reported self-reported HED and 33.38 % reported a decrease and 14 % reported an increased frequency of self-reported HED during the first 4 months of the COVID-19 pandemic.

Considering the risks associated with home-drinking (Callinan and MacLean, 2020), including the consumption of higher amounts of alcohol (Foster and Ferguson, 2012) and domestic violence (WHO 2006), this study is focused on the factors associated with the increase in HED self-reporting during the COVID-19 pandemic. However, it is important to highlight that among those who self-reported HED, the majority of the sample reported a decrease in the frequency of HED during the COVID-19 pandemic. These findings are in line with other self-report studies, such as an Australian study that also found that harmful drinking decreased during the pandemic (Callinan et al., 2020) and with an online survey carried out in Asia, Africa and Europe that showed a significantly decrease in binge drinking (Ammar et al., 2020). Studies using more objective measures also found the same trends such as an UK study that reported that households did not buy more alcohol during the pandemic (Anderson et al., 2020) and an Australian study that provided evidence from wastewater analysis suggesting a decrease in population-level weekend alcohol consumption (Bade et al., 2020). However, other self-reported COVID-studies described opposite findings, such as an study conducted in the UK that showed an increase in binge drinking (Niedzwiedz et al., 2020), a Czech study that also found an increase in weekly binge drinking (Winkler et al., 2020) and a study carried out with the US and UK populations that also showed that heavy episodic drinking increased significantly (Daly and Robinson, 2020). These mixed findings may be due to the different measures adopted by national authorities to deal with the spread of COVID pandemic (e.g. lockdown was adopted in many European countries but not in Brazil) as well as different cultural norms related to alcohol consumption.

Higher self-reported quarantine practices and higher levels of self-reported anxiety symptoms were associated with greater risk of increasing self-reported HED during the first months of the pandemic, suggesting that the restrictions on social interaction may have impacted on people emotions. These findings are consistent with previous studies conducted in the United States of America (Rodriguez et al., 2020), Australia (Callinan et al., 2020; Stanton et al., 2020; Tran et al., 2020), and India (Verma and Mishra, 2020) indicating that, potentially, alcohol is used to cope with distress related to the pandemic (de Goeij et al., 2015; Koob and Kreek, 2007), consistent with the self-medication theory (Khantzian, 1997). It is important to highlight that because this is a cross-sectional study, it is not possible to assign the direction of the association. Thus, it is possible that higher self-reported HED could also have led to higher anxiety symptoms.

Although prior research showed that during the pandemic having children at home increases mental distress (Kisely et al., 2020), our results suggest that the presence of children in the home during the pandemic is a protective factor for the increase in self-reported HED, independent of the self-reported anxiety symptoms. Our findings are in line with pre-pandemic evidence indicating that parents are less likely than non-parents to exceed alcohol consumption (Bowden et al., 2019).

This study has some limitations. First, this is a cross-sectional survey and no assumption on causality can be made. Second, the study measures are self-reported and individuals who drink at higher levels may have not participated in the study as well as heavier drinkers may be more likely to complete the survey. Third, considering this is a cross-sectional study asking participants about past exposures, we must consider the possibility of recall bias in the self-reporting measures as well as lack of longitudinal follow-up. Despite the fact that it is very common to use self-report measures to assess alcohol consumption it is important to highlight that they are potentially subject to recall bias and error, in addition to significant underestimated consumption (Greenfield and Kerr, 2008). In addition, we must consider that the title of the survey “Alcohol Use during the COVID-19 pandemic in Latin America and the Caribbean” may have potentially introduced a bias in the study, reducing the probability of the participation of abstainers. Finally, it is a non-probabilistic online sample and it does not represent the general population, which limits the generalizability of the results.

On the other hand, our findings are important for public policies as they show that during the COVID-19 pandemic, people who self-reported anxiety symptoms are more vulnerable to increase self-reported HED, indicating that the need to address mental health issues should be supplemented by restrictions on the availability of alcohol. These findings highlight that preventive public mental health actions should be planned and put into practice in order to reduce the impact on health and wellbeing of the population of Latin America and Caribbean countries. It is important to continue to assess alcohol consumption during the ongoing pandemic and in the post recovery time period, within households and in public settings to ensure a comprehensive response to alcohol problems in these societies.

Role of funding source

Nothing declared.

Contributors

The submitted manuscript has been read and approved by all authors. All authors acknowledge that they have exercised due care in ensuring the integrity of the work. JYV was responsible for the statistical analysis, and also wrote the results, methods and the discussion. IS wrote the introduction. RGC helped with the analysis. MM designed the original study and review the final version of the manuscript. ZS helped in the design of the original study, helped interpreting the results and was responsible for the final approval of the version to be published. None of the original material contained in the manuscript has been submitted for consideration nor will any of it be published elsewhere. Dr Monteiro is a staff of the Pan American Health Organization. The views and positions expressed in the article are only hers and may not necessarily reflect the views or policies of the Organization.

Declaration of Competing Interest

Dr. Monteiro is a staff of the Pan American Health Organization (PAHO) and Ms. Sohi was a temporary consultant of PAHO. The views and positions expressed in the article are those of the authors and do not necessarily reflect the views or policies of the Organization. The other authors state that there is no competing interest to declare.

Acknowledgements

The study received regular PAHO funds to implement technical cooperation activities (PI: Dr Monteiro).

References

  1. Ammar A., Brach M., Trabelsi K., Chtourou H., Boukhris O., Masmoudi L., Bouaziz B., Bentlage E., How D., Ahmed M., Müller P., Müller N., Aloui A., Hammouda O., Paineiras-Domingos L.L., Braakman-Jansen A., Wrede C., Bastoni S., Pernambuco C.S., Mataruna L., Taheri M., Irandoust K., Khacharem A., Bragazzi N.L., Chamari K., Glenn J.M., Bott N.T., Gargouri F., Chaari L., Batatia H., Ali G.M., Abdelkarim O., Jarraya M., El Abed K., Souissi N., Van Gemert-Pijnen L., Riemann B.L., Riemann L., Moalla W., Gómez-Raja J., Epstein M., Sanderman R., Schulz S.V.W., Jerg A., Al-Horani R., Mansi T., Jmail M., Barbosa F., Ferreira-Santos F., Šimunič B., Pišot R., Gaggioli A., Bailey S.J., Steinacker J.M., Driss T., Hoekelmann A. Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19 international online survey. Nutrients. 2020;12:1583. doi: 10.3390/nu12061583. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Anderson P., Llopis E.J., O’Donnell A., Kaner E. Impact of COVID-19 confinement on alcohol purchases in Great Britain: controlled interrupted time-series analysis during the first half of 2020 compared with 2015–2018. Alcohol Alcohol. 2020 doi: 10.1093/alcalc/agaa128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bade R., Simpson B.S., Ghetia M., Nguyen L., White J.M., Gerber C. Changes in alcohol consumption associated with social distancing and self‐isolation policies triggered by COVID‐19 in South Australia: a wastewater analysis study. Addiction. 2020 doi: 10.1111/add.15256. add.15256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Badellino H., Gobbo M.E., Torres E., Aschieri M.E. Early indicators and risk factors associated with mental health problems during COVID-19 quarantine: is there a relationship with the number of confirmed cases and deaths? Int. J. Soc. Psychiatry. 2020 doi: 10.1177/0020764020966020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Banks D.E., Hershberger A.R., Pemberton T., Clifton R.L., Aalsma M.C., Zapolski T.C.B. Poly-use of cannabis and other substances among juvenile-justice involved youth: variations in psychological and substance-related problems by typology. Am. J. Drug Alcohol Abuse. 2019;45:313–322. doi: 10.1080/00952990.2018.1558450. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bowden J.A., Delfabbro P., Room R., Miller C., Wilson C. Parental drinking in Australia: Does the age of children in the home matter? Drug Alcohol Rev. 2019;38:306–315. doi: 10.1111/dar.12875. [DOI] [PubMed] [Google Scholar]
  7. Brooks S.K., Dunn R., Amlôt R., Rubin G.J., Greenberg N. A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak. J. Occup. Environ. Med. 2018 doi: 10.1097/JOM.0000000000001235. [DOI] [PubMed] [Google Scholar]
  8. Brooks S.K., Webster R.K., Smith L.E., Woodland L., Wessely S., Greenberg N., Rubin G.J. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020 doi: 10.1016/S0140-6736(20)30460-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Callinan S., MacLean S. COVID‐19 makes a stronger research focus on home drinking more important than ever. Drug Alcohol Rev. 2020;39:613–615. doi: 10.1111/dar.13125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Callinan S., Smit K., Mojica‐Perez Y., D’Aquino S., Moore D., Kuntsche E. Shifts in alcohol consumption during the COVID‐19 pandemic: early indications from Australia. Addiction. 2020 doi: 10.1111/add.15275. add.15275. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Curtis A., Vandenberg B., Mayshak R., Coomber K., Hyder S., Walker A., Liknaitzky P., Miller P.G. Alcohol use in family, domestic and other violence: findings from a cross‐sectional survey of the Australian population. Drug Alcohol Rev. 2019;38:349–358. doi: 10.1111/dar.12925. [DOI] [PubMed] [Google Scholar]
  12. Daly M., Robinson E. 2020. Problem Drinking Before and During the COVID-19 Crisis in US and UK Adults: Evidence From Two Population-based Longitudinal Studies; pp. 1–31. [DOI] [Google Scholar]
  13. de Goeij M.C.M., Suhrcke M., Toffolutti V., van de Mheen D., Schoenmakers T.M., Kunst A.E. How economic crises affect alcohol consumption and alcohol-related health problems: a realist systematic review. Soc. Sci. Med. 2015;131:131–146. doi: 10.1016/j.socscimed.2015.02.025. [DOI] [PubMed] [Google Scholar]
  14. Foster J.H., Ferguson C.S. Home drinking in the UK: trends and causes. Alcohol Alcohol. 2012;47:355–358. doi: 10.1093/alcalc/ags020. [DOI] [PubMed] [Google Scholar]
  15. Garcia L.P., Sanchez Z.M. Alcohol consumption during the COVID-19 pandemic: a necessary reflection for confronting the situation. Cad. Saude Publica. 2020;36 doi: 10.1590/0102-311X00124520. [DOI] [PubMed] [Google Scholar]
  16. Goularte J.F., Serafim S.D., Colombo R., Hogg B., Caldieraro M.A., Rosa A.R. COVID-19 and mental health in Brazil: psychiatric symptoms in the general population. J. Psychiatr. Res. 2021 doi: 10.1016/j.jpsychires.2020.09.021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Greenfield T.K., Kerr W.C. Alcohol measurement methodology in epidemiology: recent advances and opportunities. Addiction. 2008;103:1082–1099. doi: 10.1111/j.1360-0443.2008.02197.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Keyes K.M., Hatzenbuehler M.L., Hasin D.S. Stressful life experiences, alcohol consumption, and alcohol use disorders: the epidemiologic evidence for four main types of stressors. Psychopharmacology (Berl.) 2011 doi: 10.1007/s00213-011-2236-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Khantzian E.J. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv. Rev. Psychiatry. 1997;4:231–244. doi: 10.3109/10673229709030550. [DOI] [PubMed] [Google Scholar]
  20. Kisely S., Warren N., McMahon L., Dalais C., Henry I., Siskind D. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ. 2020:m1642. doi: 10.1136/bmj.m1642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Koob G., Kreek M.J. Stress, dysregulation of drug reward pathways, and the transition to drug dependence. Am. J. Psychiatry. 2007;164:1149–1159. doi: 10.1176/appi.ajp.2007.05030503. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Martínez L., Valencia I., Trofimoff V. Subjective wellbeing and mental health during the COVID-19 pandemic: data from three population groups in Colombia. Data Br. 2020 doi: 10.1016/j.dib.2020.106287. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Monteiro M.G., Rehm J., Duennbier M. Alcohol policy and coronavirus: an open research Agenda. J. Stud. Alcohol Drugs. 2020 doi: 10.15288/jsad.2020.81.297. [DOI] [PubMed] [Google Scholar]
  24. Niedzwiedz C.L., Green M.J., Benzeval M., Campbell D., Craig P., Demou E., Leyland A., Pearce A., Thomson R., Whitley E., Katikireddi S.V. Mental health and health behaviours before and during the initial phase of the COVID-19 lockdown: longitudinal analyses of the UK Household Longitudinal Study. J. Epidemiol. Community Health. 2020 doi: 10.1136/jech-2020-215060. jech-2020-215060. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. North C.S., Ringwalt C.L., Downs D., Derzon J., Galvin D. Postdisaster course of alcohol use disorders in systematically studied survivors of 10 disasters. Arch. Gen. Psychiatry. 2011 doi: 10.1001/archgenpsychiatry.2010.131. [DOI] [PubMed] [Google Scholar]
  26. PAHO/WHO . 2020. Response to COVID-19 Outbreak in the Region of the Americas: Response Strategy and Donor Appeal: Versión 3. 28 August 2020. [Google Scholar]
  27. Rehm J., Kilian C., Ferreira-Borges C., Jernigan D., Monteiro M., Parry C.D.H., Sanchez Z.M., Manthey J. Alcohol use in times of the COVID 19: implications for monitoring and policy. Drug Alcohol Rev. 2020 doi: 10.1111/dar.13074. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Rodriguez L.M., Litt D.M., Stewart S.H. Drinking to cope with the pandemic: the unique associations of COVID-19-related perceived threat and psychological distress to drinking behaviors in American men and women. Addict. Behav. 2020;110 doi: 10.1016/j.addbeh.2020.106532. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Ruiz M.A., Zamorano E., García-Campayo J., Pardo A., Freire O., Rejas J. Validity of the GAD-7 scale as an outcome measure of disability in patients with generalized anxiety disorders in primary care. J. Affect. Disord. 2011;128:277–286. doi: 10.1016/j.jad.2010.07.010. [DOI] [PubMed] [Google Scholar]
  30. Simou E., Leonardi-Bee J., Britton J. The effect of alcohol consumption on the risk of ARDS. Chest. 2018;154:58–68. doi: 10.1016/j.chest.2017.11.041. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Stanton R., To Q.G., Khalesi S., Williams S.L., Alley S.J., Thwaite T.L., Fenning A.S., Vandelanotte C. Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in australian adults. Int. J. Environ. Res. Public Health. 2020;17:4065. doi: 10.3390/ijerph17114065. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Testino G. Are patients with alcohol use disorders at increased risk for Covid-19 infection? Alcohol Alcohol. 2020;55:344–346. doi: 10.1093/alcalc/agaa037. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Tran T.D., Hammarberg K., Kirkman M., Nguyen H.T.M., Fisher J. Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia. J. Affect. Disord. 2020;277:810–813. doi: 10.1016/j.jad.2020.09.012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. UNITED NATIONS . World Health Organization; Geneva, Swithzerland: 2020. Policy Brief : COVID-19 and the Need for Action on Mental Health EXECUTIVE SUMMARY: COVID-19 and the Need for Action on Mental Health. [Google Scholar]
  35. Verma S., Mishra A. Depression, anxiety, and stress and socio-demographic correlates among general Indian public during COVID-19. Int. J. Soc. Psychiatry. 2020;66:756–762. doi: 10.1177/0020764020934508. [DOI] [PubMed] [Google Scholar]
  36. WHO . WHO; Geneva: 2018. Global Status Report on Alcohol and Health 2018. [Google Scholar]
  37. Winkler P., Formanek T., Mlada K., Kagstrom A., Mohrova Z., Mohr P., Csemy L. Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys. Epidemiol. Psychiatr. Sci. 2020;29:e173. doi: 10.1017/S2045796020000888. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. World Health Organization . World Heal. Organ.; 2020. Alcohol and COVID-19 : What You Need to Know. [Google Scholar]
  39. Wu P., Liu X., Fang Y., Fan B., Fuller C.J., Guan Z., Yao Z., Kong J., Lu J., Litvak I.J. Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol Alcohol. 2008 doi: 10.1093/alcalc/agn073. [DOI] [PMC free article] [PubMed] [Google Scholar]

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