Dissertations, Theses, and Capstone Projects

Date of Degree

6-2025

Document Type

Doctoral Dissertation

Degree Name

Doctor of Philosophy

Program

Social Welfare

Advisor

Alexis Kuerbis

Committee Members

Rufina Lee

Paul Archibald

Subject Categories

Clinical and Medical Social Work | Mental and Social Health | Psychological Phenomena and Processes | Race and Ethnicity | Social and Behavioral Sciences | Trauma

Keywords

Early Life Adversity, Mental Health, Psychosocial Factors, Behavioral Addictions, Problematic Internet Use, Compulsive Buying Behavior, Race and Ethnicity

Abstract

Behavioral addictions are becoming more common, and individuals who have experienced early-life adversity or who are dealing with mental health conditions may be at greater risk of engaging in addictive behaviors and activities that lead to behavioral addiction as a coping strategy for negative emotions, symptoms, or psychosocial stressors. The purpose of this study was to investigate two behavioral addictions, problematic internet use (PIU) and compulsive buying behavior (CBB), and how they relate to early life adversity, mental health conditions, and sociocultural factors, with a focus on Black and Latiné individuals.

Informed by the Phenomenological Variant of Ecological Systems Theory (PVEST), the Social Determinants of Mental Health and the Maladaptive Consumption Theoretical Model, the research aims of this study were to: 1) explore the prevalence of two behavioral addictions: problematic internet use (PIU) and compulsive buying behavior (CBB); 2) examine early life adversity (ELA) as a predictor of problematic internet use and compulsive buying behavior; 3) test the mediating effect of mental health conditions (anxiety, generalized anxiety, major depressive episode, physical depression, and posttraumatic stress disorder) on the relationship between early life adversity and problematic internet use and compulsive buying behavior; and 4) investigate associated psychosocial factors that moderate the mediated relationship between mental health conditions and problematic internet use and compulsive buying behavior in the context of early life adversity. A quantitative approach was used to conduct secondary data analysis from the Harlem Longitudinal Data Study (HLDS). Among the methods employed were descriptive and correlational analysis, path and mediation analysis, and moderated mediation.

The analytic sample included data from 303 participants. Over half of participants identified as female (66%), identified their race/ethnicity as Latiné (55.4%) or Black/African American (44.6%) and mean age was 45 years old (SD = 1.36). Roughly half of the participants noted their highest education level to be that of a college degree (50.8%) followed by high school/some college (24.8%), and a graduate degree (15.5%). Nearly seventy participants reported exposure to at least one domain of early life adversity (69.9%) and endorsed other adverse experiences such as emotional abuse (57.7%), physical abuse (45.1%), physical neglect (38.3%), emotional neglect (36.7%) and sex abuse (25.7%). Of the 303 participants in this study, 8% reported PIU-related symptoms and about 13% met the criteria for CBB. The results showed that the ELA total score had no effect on CBB, but it had a significant main effect on PIU, increasing PIU by 1% for every unit increase in total ELA. PIU was significantly predicted by ELA subscales, but CBB was unaffected.

After adjusting for early life adversity, the mediation analysis revealed that increases in PIU were associated with four of the five mental health conditions: major depressive episode (3%), RR = 1.03, p =.01, 95% CI: [1.02, 1.06], posttraumatic stress disorder (1%) RR = 1.01, p =.01, 95% CI: [1.00, 1.01], generalized anxiety (9%) (RR = 1.09, p =.01, 95% CI: [1.02, 1.16] and anxiety (4%) RR = 1.04, p =.04, 95% CI: [1.00, 1.07]. Additionally, after adjusting for early life adversity, all five mental health conditions showed associated effects on the relationship between ELA and CBB: anxiety (b = -.14, p = < .001, 95% CI:[ -.21, -.07], generalized anxiety (b = -.13, p = < .03, 95% CI: [-.24, -.01], major depressive episode (b = -.07, p = < .001, 95% CI:[-.12, -.02], physical depression (b =.00, p = < .02, 95% CI: .[00, .00), and posttraumatic stress disorder (b =.01, p = < .001, 95% CI: [.010, .011].

The results of the moderated mediation analysis, which looked at five potential moderators—racist events, neighborhood cohesion, neighborhood disadvantage, affirmation and belonging, and perceived social support—indicated that some of the moderators had statistically significant indirect effects in the relationship between the ELA and PIU or CBB. However, the index of moderated mediation revealed that, in many cases, the indirect effects were not consistently different from zero across all levels of moderator despite having a significant effect on the relationship. In analyzing the relationship between ELA and PIU, perceived social support showed a statistically significant moderated influence on the mediating effects of anxiety (RR = 1.00, p = .01, 95% CI: [1.00, 1.01], major depressive episode (RR = 1.00, p = .01, 95% CI: [1.00, 1.00], and PTSD (RR = 1.00, p = .01, 95% CI: [1.00, 1.00] and neighborhood disadvantage demonstrated a statistically significant negative influence on major depressive episode (RR = 1.00, p = .03, 95% CI: [1.00, 1.00], mediating the relationship of ELA and PIU. Additionally, it was found that perceived social support had statistically significant influence on the moderating effects on both anxiety (b = -.00, p = < .001, 95% CI: [-.01, -.00] and PTSD (b = .00, p = < .001, 95% CI: [.00, .00] in mediating the association between ELA and CBB. Affirmation and belonging showed a significant positive influence on PTSD's (b = -.00, p = < .02, 95% CI: [-.01, -.00] mediating relationship between ELA and CBB.

These findings have noteworthy clinical, policy and research relevance. First and foremost, individuals who experience adversity in their early lives may be more susceptible to mental health issues and behavioral addictions. It is critical therefore to more fully understand risk exposure to adversity and its effects, especially for Black and Latiné individuals who more often report higher early life adverse experiences due to systemic inequalities and/or historical trauma. Second, the findings here suggest strong associations between negative social determinants of mental health such early life adversity and mental health issues and problematic behaviors related to PIU and CBB. Further study on problematic behaviors and possible co-occurring mental health issues is warranted. Third, these findings demonstrate the negative effects of adversity on mental health outcomes as well as the possible correlation between psychosocial factors and mental health outcomes. To better understand the extent of these problems and improve treatment outcomes for individuals impacted, more research is required on PIU, CBB, and the entire spectrum of behavioral addictions, including their classifications and diagnostic standards. Considering the current rapid technological advancements and cultural shifts, these findings underscore the significance of behavioral addictions as a research topic and the need to develop responsive and relevant services and treatments.

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