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Internalizing symptoms and conduct problems: Redundant, incremental, or interactive risk factors for adolescent substance use during the first year of high school?

ABSTRACT: AIM:The complex interplay of externalizing and internalizing problems in substance use risk is not well understood. This study tested whether the relationship of conduct problems and several internalizing disorders with future substance use is redundant, incremental, or interactive in adolescents. METHODS:Two semiannual waves of data from the Happiness and Health Study were used, which included 3383 adolescents (M age=14.1years old; 53% females) in Los Angeles who were beginning high school at baseline. Logistic regression models tested the likelihood of past six-month alcohol, tobacco, marijuana, and any substance use at follow-up conditional on baseline conduct problems, symptoms of one of several internalizing disorders (i.e., Social Phobia and Major Depressive, Generalized Anxiety, Panic, and Obsessive-Compulsive Disorder), and their interaction adjusting for baseline use and other covariates. FINDINGS:Conduct problems were a robust and consistent risk factor of each substance use outcome at follow-up. When adjusting for the internalizing-conduct comorbidity, depressive symptoms were the only internalizing problem whose risk for alcohol, tobacco, and any substance use was incremental to conduct problems. With the exception of social phobia, antagonistic interactive relationships between each internalizing disorder and conduct problems were found when predicting any substance use; internalizing symptoms was a more robust risk factor for substance use in teens with low (vs. high) conduct problems. CONCLUSIONS:Although internalizing and externalizing problems both generally increase risk of substance use, a closer look reveals important nuances in these risk pathways, particularly among teens with comorbid externalizing and internalizing problems.

SUBMITTER: Khoddam R

PROVIDER: S-EPMC5140846 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Internalizing symptoms and conduct problems: Redundant, incremental, or interactive risk factors for adolescent substance use during the first year of high school?

Khoddam Rubin R Jackson Nicholas J NJ Leventhal Adam M AM

Drug and alcohol dependence 20161017

<h4>Aim</h4>The complex interplay of externalizing and internalizing problems in substance use risk is not well understood. This study tested whether the relationship of conduct problems and several internalizing disorders with future substance use is redundant, incremental, or interactive in adolescents.<h4>Methods</h4>Two semiannual waves of data from the Happiness and Health Study were used, which included 3383 adolescents (M age=14.1years old; 53% females) in Los Angeles who were beginning h ...[more]

PMID: 27771536

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Project description:BackgroundSymptoms of anxiety and depression are common mental health problems in children and are often referred to as internalizing symptoms. Youth with such symptoms are at greater risk for poor academic achievement, school non-completion, and future mental health problems, all of which, lead to public health consequences and costs to society. The aim of the current study was to investigate associations between young school children's internalizing symptoms and school functioning, as assessed separately by the teachers and the children.MethodsThis study is a cross-sectional study including children (N = 750. 58% girls) from the ages of 8-12 years with elevated levels of self-reported symptoms of anxiety (MASC-C) and/or depression (SMFQ). Teachers reported the academic achievement, school adaptation (TRF) and internalizing symptoms (BPM-T) of the children. Associations were analyzed using linear regression analyses.ResultsBoth teacher-reported internalizing symptoms and children's self-reported depressive symptoms were associated with poor academic achievement and school adaptation, while self-reported symptoms of anxiety were not. Symptoms of depression as assessed by the children were associated with teacher-rated internalizing symptoms, while self-reported symptoms of anxiety were not.ConclusionWe found negative associations between school functioning and internalizing symptoms, as assessed by both the teachers and the children. The dual findings strengthen the validity of these relationships. Thus, prevention of depressive and anxiety symptoms in children may lead to positive changes in school domains such as academic achievement and school adaptation. We also identified a negative association between teacher-rated internalizing symptoms and children's self-report of depressive symptoms, indicating that teachers may have difficulties recognizing children with these symptoms.Trial registrationClinical Trials NCT02340637, Registered on June 12, 2014, Retrospectively registered.

Project description:BACKGROUND:The increasing prevalence of psychological health problems among adolescent girls is alarming. Knowledge of beneficial effects of physical activity on psychological health is widespread. Dance is a popular form of exercise that could be a protective factor in preventing and treating symptoms of depression. The aim of this study was to assess the cost-effectiveness of a dance intervention in addition to usual school health services for adolescent girls with internalizing problems, compared with usual school health services alone. METHODS:A cost-utility analysis from a societal perspective based on a randomized controlled intervention trial was performed. The setting was a city in central Sweden with a population of 130 000. A total of 112 adolescent girls, 13-18 years old, with internalizing problems participated in the study. They were randomly assigned to intervention (n?=?59) or control (n?=?53) group. The intervention comprised dance twice weekly during eight months in addition to usual school health services. Costs for the stakeholder of the intervention, treatment effect and healthcare costs were considered. Gained quality-adjusted life-years (QALYs) were used to measure the effects. Quality of life was measured with the Health Utility Index Mark 3. Cost-effectiveness ratios were based on the changes in QALYs and net costs for the intervention group compared with the control group. Likelihood of cost-effectiveness was calculated. RESULTS:At 20 months, quality of life had increased by 0.08 units more in the intervention group than in the control group (P?=?.04), translating to 0.10 gained QALYs. The incremental cost-effectiveness ratio was USD $3,830 per QALY and the likelihood of cost-effectiveness was 95%. CONCLUSIONS:Intervention with dance twice weekly in addition to usual school health services may be considered cost-effective compared with usual school health services alone, for adolescent girls with internalizing problems. TRIAL REGISTRATION:Name of the trial registry: "Influencing Adolescent Girls' With Creative Dance Twice Weekly" TRIAL REGISTRATION NUMBER:NCT01523561.

Project description:Background and aimsThere is a documented link between common psychiatric disorders and substance use in adolescent males. This study addressed two key questions: (1) is there a within-person association between an increase in psychiatric problems and an increase in substance use among adolescent males and (2) are there sensitive periods during male adolescence when such associations are more evident?DesignAnalysis of longitudinal data collected annually on boys selected randomly from schools based on a comprehensive public school enrollment list from the Pittsburgh Board of Education.SettingRecruitment occurred in public schools in Pittsburgh, Pennsylvania, USA.ParticipantsA total of 503 boys assessed at ages 13-19 years, average cooperation rate = 92.1%.MeasurementsDiagnostic and Statistical Manual (DSM)-oriented affective, anxiety and conduct disorder problems were measured with items from the caregiver, teacher and youth version of the Achenbach scales. Scales were converted to t-scores using age- and gender-based national norms and combined by taking the average across informants. Alcohol and marijuana use were assessed semi-annually by a 16-item Substance Use Scale adapted from the National Youth Survey.FindingsWhen male adolescents experienced a 1-unit increase in their conduct problems t-score, their rate of marijuana use subsequently increased by 1.03 [95% confidence interval (CI) = 1.01, 1.05], and alcohol quantity increased by 1.01 (95% CI = 1.0002, 1.02). When adolescents experienced a 1-unit increase in their average quantity of alcohol use, their anxiety problems t-score subsequently increased by 0.12 (95% CI = 0.05, 0.19). These associations were strongest in early and late adolescence.ConclusionsWhen adolescent boys experience an increase in conduct disorder problems, they are more likely to exhibit a subsequent escalation in substance use. As adolescent boys increase their intensity of alcohol use, they become more likely to develop subsequent anxiety problems. Developmental turning points such as early and late adolescence appear to be particularly sensitive periods for boys to develop comorbid patterns of psychiatric problems and substance use.

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Internalizing symptoms and conduct problems: Redundant, incremental, or interactive risk factors for adolescent substance use during the first year of high school?

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Internalizing symptoms and conduct problems: Redundant, incremental, or interactive risk factors for adolescent substance use during the first year of high school?

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