Stress, Anxiety, and Change in Alcohol Use During the COVID-19 Pandemic: Findings Among Adult Twin Pairs

Abstract

The novel coronavirus (COVID-19) has impacted the lives of people worldwide since being declared a pandemic on March 11, 2020. Social restrictions aimed at flattening the curve may be associated with an increase in stress and anxiety, which may increase the use of alcohol as a coping mechanism. The objective of this study was to examine if stress and anxiety were associated with changes in alcohol use in a sample of adult twins. Twins allowed us to control for genetic and shared environmental factors that would confound the alcohol - mental health relationship. Twins (N = 3,971; 909 same-sex pairs) from the Washington State Twin Registry (WSTR) completed an online survey examining several health-related behaviors and outcomes and their self-reported changes due to COVID-19. About 14% of the respondents reported an increase in alcohol use. We found an association between both stress and anxiety and increased alcohol use, where twins with higher levels of stress and anxiety were more likely to report an increase in alcohol consumption. The associations were small and confounded by between-family factors and demographic characteristics. However, there was no significant difference in stress or anxiety levels between non-drinkers and those who reported no change in alcohol use. Our findings suggest that individuals' mental health may be associated with changes in alcohol use during the COVID-19 pandemic.

Keywords: alcohol use; anxiety; novel coronavirus; perceived stress; social restriction; twins.

Figure 1

Quasi-causal twin model, controlling for age and sex. A: additive genetic component; C: shared environmental component; E: unique environmental component; b_A and b_C: amount of residual variance of mental health attributable to the genetic and shared environment, respectively; b_p: phenotypic association. Mental health refers to perceived stress or anxiety, in separate models.

Figure 2

Stress and anxiety levels by self-reported change in alcohol use (same-sex twin pairs).

Figure 3

(A) Do not use versus use more, (B) Same use versus use more, (C) Same use versus use less. Average perceived stress levels between twin pairs concordant and discordant in change in alcohol use among same-sex MZ and DZ twin pairs. Error bars denote standard errors.

Figure 4

(A) Do not use versus use more, (B) Same use versus use more, (C) Same use versus use less. Average anxiety levels between twin pairs concordant and discordant in change in alcohol use among same-sex MZ and DZ twin pairs. Error bars denote standard errors.