{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:40:04Z","timestamp":1760146804489,"version":"build-2065373602"},"reference-count":52,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,9]],"date-time":"2024-12-09T00:00:00Z","timestamp":1733702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Family members who live with relatives with serious mental illness face unique mental health risks, which become worse with alcohol use and without social support. Research has highlighted the damaging effects of harmful substance use among people who feel like they do not matter to others, but few studies have assessed links between mattering and alcohol use within marginalized populations. In the present study, a sample of family members who reside with a relative with mental illness completed an online survey. Using the AUDIT alcohol screening measure, participants were classified into a No\u2013Low Risk Alcohol Use (n = 52) or a Hazardous Drinking (n = 28) group. Hazardous alcohol use was alarmingly high, reaching triple the rate of the general population and categorized at the most severe level of harm. Those who drank hazardously felt like they mattered less to others (p &lt; 0.001), felt like they mattered less to their relative with mental illness (p = 0.035), had greater anti-mattering (e.g., they felt invisible and unheard) (p = 0.008), experienced more hopelessness (p &lt; 0.001), felt less supported by significant others (p = 0.003), endorsed having more problems with mental health services (p = 0.017), had higher stigma (p &lt; 0.001), and had lower psychological well-being (p &lt; 0.001). Findings highlight under-recognized public health risks, implications for public health initiatives, and the need for tailored interventions that boost mattering and reduce harmful alcohol use in this vulnerable family member population.<\/jats:p>","DOI":"10.3390\/ijerph21121637","type":"journal-article","created":{"date-parts":[[2024,12,9]],"date-time":"2024-12-09T06:16:14Z","timestamp":1733724974000},"page":"1637","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["What\u2019s the Matter? Alcohol Use Risk Among Relatives of People with Mental Illness"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6926-1506","authenticated-orcid":false,"given":"Suzanne A.","family":"McKeag","sequence":"first","affiliation":[{"name":"Department of Psychology, York University, Toronto, ON M3J 1P3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gordon L.","family":"Flett","sequence":"additional","affiliation":[{"name":"Department of Psychology, York University, Toronto, ON M3J 1P3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6409-6238","authenticated-orcid":false,"given":"Joel O.","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Department of Psychology, York University, Toronto, ON M3J 1P3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.1017\/S2045796023000756","article-title":"Changing trends in the global burden of mental disorders from 1990 to 2019 and predicted levels in 25 years","volume":"32","author":"Wu","year":"2023","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"244","DOI":"10.52711\/2454-2660.2022.00057","article-title":"A Study to assess the Psychosocial problems and coping strategies of significant family members of mentally ill patients admitted at MHI (COE), SCBMCH, Cuttack","volume":"10","author":"Behera","year":"2022","journal-title":"Int. J. Nurs. Educ. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1080\/080394800427555","article-title":"The burden of relatives of psychiatric patients: Comparisons between parents, spouses, and grown-up children of voluntarily and compulsorily admitted psychiatric patients","volume":"54","author":"Hansson","year":"2000","journal-title":"Nord. J. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"85","DOI":"10.5093\/clysa2024a14","article-title":"Psychological intervention on health, self-esteem, and coping in siblings of patients with severe mental disorders","volume":"35","author":"Roldan","year":"2024","journal-title":"Cl\u00ednica Salud"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.2147\/PRBM.S320126","article-title":"Psychometric properties of the Multidimensional Scale of Perceived Social Support (MSPSS) among family caregivers of people with schizophrenia in China","volume":"14","author":"Wang","year":"2021","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1007\/s00127-016-1256-x","article-title":"Stigma by association and family burden among family members of people with mental illness: The mediating role of coping","volume":"51","author":"Pryor","year":"2016","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/s001270050301","article-title":"The psychological wellbeing of family members of individuals with schizophrenia","volume":"36","author":"Martens","year":"2001","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.apnu.2011.03.008","article-title":"Global Perspective of Burden of Family Caregivers for Persons With Schizophrenia","volume":"25","author":"Chan","year":"2011","journal-title":"Arch. Psychiatr. Nurs."},{"key":"ref_9","first-page":"35","article-title":"The burden experienced by relatives of those with a severe mental illness\u2014Differences between those living with and those living apart from the patient","volume":"3","year":"2007","journal-title":"J. Psychiatr. Intensive Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1080\/15332985.2011.575712","article-title":"Well being, depressive symptoms, and burden among parent and sibling caregivers of persons with severe and persistent mental illness","volume":"9","author":"Chen","year":"2011","journal-title":"Soc. Work. Ment. Health"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Goldberg, J.O., McKeag, S.A., Rose, A.L., Lumsden-Ruegg, H., and Flett, G.L. (2023). Too close for comfort: Stigma by association in family members who live with relatives with mental illness. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20065209"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/S0140-6736(05)17870-2","article-title":"Alcohol and public health","volume":"365","author":"Room","year":"2005","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1037\/h0095388","article-title":"Coping skills, strengths, and needs as perceived by adult offspring and siblings of people with mental illness: A retrospective study","volume":"20","author":"Kinsella","year":"1996","journal-title":"Psychiatr. Rehabil. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1177\/0020764019840061","article-title":"What is related to the well-being of the siblings of patients with schizophrenia: An evaluation within the Lazarus and Folkman\u2019s Transactional Stress and Coping Model","volume":"65","author":"Karanci","year":"2019","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1606\/1044-3894.3628","article-title":"Support needs of family caregivers of people who experience mental illness and the role of mental health services","volume":"88","author":"Shankar","year":"2007","journal-title":"Fam. Soc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2655","DOI":"10.1111\/fare.13024","article-title":"The experience of growing up with a sibling who has depression from emerging adults\u2019 perspectives","volume":"73","author":"Levkovich","year":"2024","journal-title":"Fam. Relat."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s10567-020-00331-3","article-title":"Non-psychopathology related outcomes among siblings of individuals with mental illness: A systematic review","volume":"24","author":"Shivers","year":"2021","journal-title":"Clin. Child Fam. Psychol. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"23333936231162230","DOI":"10.1177\/23333936231162230","article-title":"Filling the void: The role of adult siblings caring for a brother or sister with severe mental illness","volume":"10","author":"Kalhovde","year":"2023","journal-title":"Glob. Qual. Nurs. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"294","DOI":"10.3109\/01612840.2014.971385","article-title":"Childhood parental mental illness: Living with fear and mistrust","volume":"36","author":"Murphy","year":"2015","journal-title":"Issues Ment. Health Nurs."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1177\/00207640221109171","article-title":"\u2018I feel hopeless\u2019: Exploring the psychosocial impacts of caring for mentally ill relatives in Cambodia","volume":"69","author":"Phoeun","year":"2023","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1002\/hpja.296","article-title":"An online cross-sectional survey of the health risk behaviours among informal caregivers","volume":"31","author":"Wynne","year":"2020","journal-title":"Health Promot. J. Aust."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/0306-4603(94)90042-6","article-title":"Adult children of alcoholic or mentally ill parents: Alcohol consumption and psychological distress in a tri-ethnic community study","volume":"19","author":"Neff","year":"1994","journal-title":"Addict. Behav."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1176\/appi.psychotherapy.2009.63.4.305","article-title":"The well sibling: Challenges and possibilities","volume":"63","author":"Abrams","year":"2009","journal-title":"Am. J. Psychother."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Elliott, G.C. (2009). Family Matters: The Importance of Mattering to Family in Adolescence, Wiley-Blackwell.","DOI":"10.1002\/9781444305784"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Flett, G.L., Casale, S., Stoakes, A., Nepon, T., and Su, C. (2023). Mattering, substance use, and addictive behaviors: Review, analysis, and implications for treatment and prevention. J. Ethn. Subst. Abus., 1\u201334.","DOI":"10.1080\/15332640.2023.2218283"},{"key":"ref_26","first-page":"163","article-title":"Mattering: Inferred significance and mental health among adolescents","volume":"2","author":"Rosenberg","year":"1981","journal-title":"Res. Community Ment. Health"},{"key":"ref_27","first-page":"5","article-title":"Marginality and mattering: Key issues in building community","volume":"48","author":"Schlossberg","year":"1989","journal-title":"New Dir. Stud. Serv."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1002\/ajcp.12368","article-title":"Mattering at the intersection of psychology, philosophy, and politics","volume":"65","author":"Prilleltensky","year":"2020","journal-title":"Am. J. Community Psychol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1006\/jado.2001.0384","article-title":"Do I matter? Construct validation of adolescents\u2019 perceived mattering to parents and friends","volume":"24","author":"Marshall","year":"2001","journal-title":"J. Adolesc."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Flett, G.L. (2018). The Psychology of Mattering: Understanding the Human Need to Be Significant, Elsevier Academic Press.","DOI":"10.1016\/B978-0-12-809415-0.00003-7"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1177\/07342829211055342","article-title":"The utility of brief mattering subscales for adolescents: Associations with learning motivations, achievement, executive function, hope, loneliness, and risk behavior","volume":"40","author":"Somers","year":"2022","journal-title":"J. Psychoeduc. Assess."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"43","DOI":"10.3109\/16066359.2012.685120","article-title":"Present orientation, future orientation and alcohol use in Northern Irish adolescents","volume":"21","author":"McKay","year":"2013","journal-title":"Addict. Res. Theory"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1177\/0743558403258860","article-title":"Relationships between future orientation, impulsive sensation seeking, and risk behavior among adjudicated adolescents","volume":"19","author":"Robbins","year":"2004","journal-title":"J. Adolesc. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2443","DOI":"10.1007\/s11469-020-00339-4","article-title":"Aging and feeling valued versus expendable during the COVID-19 pandemic and beyond: A review and commentary of why mattering is fundamental to the health and well-being of older adults","volume":"19","author":"Flett","year":"2021","journal-title":"Int. J. Ment. Health Addict."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","article-title":"Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II","volume":"88","author":"Saunders","year":"1993","journal-title":"Addiction"},{"key":"ref_36","unstructured":"Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B., and Monteiro, M.G. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care, World Health Organization. [2nd ed.]. Available online: https:\/\/iris.who.int\/handle\/10665\/67205."},{"key":"ref_37","unstructured":"Marcus, F.M., and Rosenberg, M. (1987, January 2). Mattering: Its measurement and significance in everyday life. Proceedings of the 57th Annual Eastern Sociological Society Meeting, Boston, MA, USA."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/07342829211050544","article-title":"The Anti-Mattering Scale: Development, psychometric properties, and associations with well-being and distress measures in adolescents and emerging adults","volume":"40","author":"Flett","year":"2022","journal-title":"J. Psychoeduc. Assess."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1037\/h0037562","article-title":"The measurement of pessimism: The Hopelessness Scale","volume":"42","author":"Beck","year":"1974","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.comppsych.2018.07.003","article-title":"The development and validation of the Brief Experience of Caregiving Inventory (BECI)","volume":"86","author":"Farrelly","year":"2018","journal-title":"Compr. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/1477-7525-4-76","article-title":"Psychometric evaluation and predictive validity of Ryff\u2019s psychological well-being items in a UK birth cohort sample of women","volume":"4","author":"Abbott","year":"2006","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1207\/s15327752jpa5201_2","article-title":"The multidimensional scale of perceived social support","volume":"52","author":"Zimet","year":"1988","journal-title":"J. Personal. Assess."},{"key":"ref_43","unstructured":"R Core Team (2022). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.r-project.org\/."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1176\/ajp.147.2.190","article-title":"Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients","volume":"147","author":"Beck","year":"1990","journal-title":"Am. J. Psychiatry"},{"key":"ref_45","unstructured":"Statistics Canada (2024, August 21). Canadian Alcohol and Drugs Survey, 2019 [Dataset]. Statistics Canada Open License, Available online: https:\/\/www.canada.ca\/en\/health-canada\/services\/canadian-alcohol-drugs-survey\/2019-summary\/detailed-tables.html."},{"key":"ref_46","unstructured":"Statistics Canada (2024, August 21). Canadian Addiction Survey, 2004 [Dataset]. Statistics Canada Open License, Available online: https:\/\/www.ccsa.ca\/sites\/default\/files\/2019-04\/ccsa-004804-2004.pdf."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1192\/bjp.2018.27","article-title":"Depression and hopelessness as risk factors for suicide ideation, attempts and death: Meta-analysis of longitudinal studies","volume":"212","author":"Ribeiro","year":"2018","journal-title":"Br. J. Psychiatry"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1097\/NMD.0000000000000189","article-title":"Coping with stigma by association and family burden among family members of people with mental illness","volume":"202","author":"Stutterheim","year":"2014","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Appleton, A., James, R., and Larsen, J. (2018). The association between mental wellbeing, levels of harmful drinking, and drinking motivations: A cross-sectional study of the UK adult population. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15071333"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1007\/s00127-016-1222-7","article-title":"Wellbeing, mental health knowledge and caregiving experiences of siblings of people with psychosis, compared to their peers and parents: An exploratory study","volume":"51","author":"Sin","year":"2016","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1037\/0033-2909.130.2.304","article-title":"Preventing substance abuse in American Indian and Alaska Native Youth: Promising strategies for healthier communities","volume":"130","author":"Hawkins","year":"2004","journal-title":"Psychol. Bull."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Haighton, C., Kidd, J., O\u2019Donnell, A., Wilson, G., McCabe, K., and Ling, J. (2018). \u201cI take my tablets with the whiskey\u201d: A qualitative study of alcohol and medication use in mid to later life. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0205956"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/12\/1637\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:50:06Z","timestamp":1760115006000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/12\/1637"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,9]]},"references-count":52,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["ijerph21121637"],"URL":"https:\/\/doi.org\/10.3390\/ijerph21121637","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2024,12,9]]}}}