Alcohol Use Trajectories Across Disasters: Associations With Depression and Illness Anxiety

Abstract

Background

Alcohol use often fluctuates following disasters, but individual trajectories and their links to mental health remain poorly understood. This study examined long-term patterns of alcohol use among disaster-exposed adults and their associations with depression and illness anxiety (a preoccupation with having or acquiring a serious illness).

Methods

Data (N = 941) came from five waves (2016–2024) of the Survey of Trauma, Resilience, and Opportunity among Neighborhoods in the Gulf (STRONG), a longitudinal cohort of adults in the U.S. Gulf Coast region. Growth mixture modeling identified latent trajectories of alcohol use across nine years encompassing multiple disasters (Deepwater Horizon oil spill, hurricanes, COVID-19 pandemic). Multinomial regression examined demographic and disaster exposure correlates of trajectory membership. Linear mixed-effects models assessed associations between drinking trajectories and longitudinal changes in depression and illness anxiety.

Results

A four-class model best fit the data: Low Stable (36%), Elevated Stable (47%), Decreasing (11%), and Increasing (7%) drinking trajectories. Elevated Stable drinkers were younger, more educated, and less likely to be female or Black. Disaster exposure differed modestly by class, with only oil spill exposure and COVID-19 disruptions associated with drinking patterns. Over time, depression increased among Elevated Stable and Increasing drinkers, while illness anxiety rose among Elevated Stable and Decreasing drinkers.

Conclusions

Alcohol use and mental health trajectories following disasters are heterogeneous and interrelated. Persistent or increasing drinking was linked to worsening depression, while illness anxiety followed distinct patterns. Tailored prevention and intervention strategies should consider individual drinking trajectories and disaster context.