Abstract
BACKGROUND: Excessive discounting of future rewards [delay discounting (DD)] may be a transdiagnostic process and treatment target underlying behavioral health outcomes, including trauma, depression, anxiety, and problematic substance use. However, multiple health behaviors and barriers are also related to these outcomes, including social media usage, adverse childhood experiences (ACEs), sleep quality, healthcare access, housing status, and exercise. To extend research examining DD as transdiagnostic process, we recruited a large, heterogenous sample to examine the association between DD, problematic substance use, and mental health outcomes while controlling for certain health behaviors and health barriers. METHOD: In a cross-sectional online survey of 3992 US residents, we administered validated measures of PTSD, depression, anxiety, and problematic alcohol, stimulant, and opioid use. Using linear or ordinal logistic models, scores for each outcome were regressed onto DD while controlling for demographics, health behaviors, and health barriers. RESULTS: Including only DD and demographics, DD was associated with each outcome at low effect sizes (ƒ(2) = .013, OR range = 1.08-1.16). Except for opioid ASSIST scores, these relationships held when controlling for social media usage, sleep, housing status, healthcare access, ACEs, physical exercise, and demographic variables (ƒ(2) = .002, OR range = 1.03-1.12), increasing confidence that DD concurrently and directly relates to four of these five clinical outcomes. DISCUSSION: These findings support the conceptualization of DD as a transdiagnostic process underlying certain psychopathologies and suggest targeting DD in co-occurring substance use disorder and/or mental health treatments may result in clinically significant outcomes.