Shame mediates the relationship between depression and addictive behaviours

Background: Alcohol and gambling problems are common in young adults. Self-medication theory states that young adults with depression drink and/or gamble to escape negative emotions. Research shows that depression is a risk factor for drinking/gambling problems, but more work is needed to examine mediators underlying these associations. One potential mediator is shame. Shame is a self-directed emotion that follows a negative life event and is characterized by intense feelings of inferiority, worthlessness, and embarrassment. Depressed individuals are especially susceptible to shame (and associated emotions). Shame has also been implicated in risk for addiction. Accordingly, we predicted that elevated shame would explain why depression is associated with both alcohol and gambling problems. Methods: A longitudinal design was used to examine this hypothesis. Undergraduates (N = 210) completed self reports of depression at baseline (Time 1) and then completed self-reports of shame, alcohol misuse, gambling problems one month later (Time 2). Results: Results showed that individuals with elevated depression at Time 1 endorsed high levels of shame at Time 2, which in turn predicted more gambling (beta = .038, 95% CI [.010, .087]) and alcohol problems (beta = .249, 95% CI [.123, .435]) at Time 2. We found that increased levels of shame explained the effects of depression on problem drinking and gambling. Conclusions: Study findings improve our understanding of the depressive pathway to addiction by providing evidence for shame as a potential mechanism of this pathway. Impact: Reducing shame can be a target of clinical interventions for young adults with depression and alcohol/gambling problems.