Maladaptive Coping Strategies Mediate the Relationship Between Depression and Anxiety and Moderate-to-Heavy Alcohol Use in Young South Africans with HIV.

Young South Africans living with HIV experience high rates of depression and anxiety, which may contribute to poor HIV clinical outcomes by leading to moderate-to-heavy alcohol use. This analysis sought to examine whether maladaptive coping strategies mediated the relationship between depression and anxiety and moderate-to-heavy alcohol use in this population. This secondary analysis compared baseline data from two cohorts of young South Africans ages 18-24 from the Cape Town and East London. We performed a series of mediation analyses to determine the relationship among depression and anxiety, maladaptive coping, and moderate-to-heavy alcohol use. We found that higher levels of depressive (OR: 1.140, 95% CI: 1.054-1.234, p = 0.001, d = 0.072), but not anxiety (OR: 1.079, 95% CI: 0.987-1.180, p = 0.096, d = 0.042) was associated with moderate-to-heavy alcohol use. Negative emotion-focused coping was not a mediator of the relationship between depression and alcohol use, but avoidant coping was a significant partial mediator of the relationship between depressive symptoms and alcohol use (Indirect effect = 0.038, 95% CI: 0.010, 0.089). Both negative emotion-focused coping (Indirect effect = 0.049, 95% CI: 0.007, 0.116) and avoidant coping (Indirect effect = 0.046; 95% CI: 0.012, 0.115) were significant partial mediators of the relationship between anxiety symptoms and alcohol use. Our findings that avoidant coping and both avoidant and emotion-focused coping may mediate the relationships between depression and alcohol use and anxiety and alcohol use, respectively, may lend support to future interventions seeking to alter coping strategies as a means of reducing alcohol use among young people living with HIV.