Cordelia J. Fuller

Childhood Depressive Symptoms and Early Onset of Alcohol Use

OBJECTIVES. Few studies have assessed the relationship between depressive symptoms and early onset of alcohol use in children and early adolescents. We aimed to determine whether depressive symptoms in children are associated with subsequent initiation of alcohol use and, if so, whether this association is merely a result of demographic, parental, and/or individual risk factors shared by depression and alcohol use or independent of these shared risk factors. METHODS. Analyses were based on a subsample of 10- to 13-year-old children (N = 1119) from the Boricua Youth Study, a longitudinal study of psychopathology among Puerto Rican children and early adolescents. Children in the study were assessed over 3 waves between 2000 and 2004. In-person structured interviews were conducted with both parents and children. RESULTS. Depressive symptoms and alcohol use shared some significant risk and protective factors, such as parental psychopathology, parenting, child exposure to violence, and antisocial behaviors. After controlling for these factors, the association between depressive symptoms and alcohol use was reduced, but childhood depressive symptoms were still positively associated with subsequent alcohol use initiation. Children with medium or high levels of depressive symptoms were more than twice as likely to use alcohol as those with <2 depressive symptoms. CONCLUSIONS. The finding of the current study that early life depressive symptoms may lead to earlier onset of alcohol use indicates the importance of identifying and treating depressive symptoms in preadolescent children. It also demonstrates the importance of examining shared risk and protective factors for understanding the relationship between depressive symptoms and alcohol use.

The relationship between anxiety disorders and substance use among adolescents in the community: specificity and gender differences.

Using a sample of 781 adolescents (ages 13–17, 52.8% male) from a community survey, this study examined gender differences in the co-occurrence of specific anxiety disorders with substance use in adolescents. The associations between anxiety disorders and substance use differed according to the particular anxiety disorders and forms of substance use being examined, as well as by gender. Social phobia was associated with cigarette smoking among boys only. For girls, social phobia appeared to be negatively associated with drug use. For the other anxiety disorders, the associations with substance use tended to be stronger among girls. These findings highlight the need to improve clinical recognition of the anxiety disorders and to improve treatment access for afflicted adolescents. Future studies based on longitudinal data could further elucidate the relationships among anxiety disorders, gender, and substance use.

Exposure to the World Trade Center Attack and the Use of Cigarettes and Alcohol Among New York City Public High-School Students

We examined exposure to the World Trade Center attack and changes in cigarette smoking and drinking among 2731 New York City public high-school students evaluated 6 months after the attack. Increased drinking was associated with direct exposure to the World Trade Center attack (P < .05). Increased smoking was not directly associated with exposure to the World Trade Center attack but was marginally significantly associated with posttraumatic stress disorder (P= .06). Our findings suggest that targeted substance-use interventions for youths may be warranted after large-scale disasters.

Mental Health Service Use Among Suicidal Adolescents: Findings From a U.S. National Community Survey

OBJECTIVE This study assessed patterns of mental health service use among adolescents who had attempted suicide and examined factors associated with their service use at individual, family, and community levels. METHODS Bivariate and multiple logistic regression analyses were conducted with data from 877 adolescents aged 12-17 who had attempted suicide in the past 12 months and who participated in the 2000 National Household Survey on Drug Abuse. RESULTS Of the 877 adolescents, less than half (45%) reported that they had used mental health services in the past 12 months. Adolescents from racial-ethnic minority groups were less likely than whites to receive inpatient or outpatient mental health treatment, even when the analyses controlled for other demographic, individual, and family and community characteristics. Poor self-perceived health and living in a single-parent family were associated with use of inpatient services. Female gender, higher family income, participation in extracurricular activities, and the presence of symptoms of anxiety or disruptive disorders were associated with use of outpatient services. Use of school-based mental health services was associated only with participation in extracurricular activities. CONCLUSIONS The mental health service needs of suicidal adolescents, especially those from ethnic minority groups and lower-income families, too frequently remain unmet. Larger racial-ethnic disparities were found in use of inpatient and outpatient mental health services than in use of school-based services. Mental health services offered within school settings can reach suicidal adolescents who need services but may experience barriers to standard types of care.

Factors associated with adolescents receiving drug treatment: Findings from the National Household Survey on Drug Abuse

This article examines factors associated with adolescents receiving treatment for drug-related problems. Data on adolescents (aged 12–17) from the 1995 and 1996 National Household Survey on Drug Abuse (NHSDA,N=9133) were used. Information was obtained concerning adolescent drug use, smoking, drinking and related problems, as well as sociodemographics. Many adolescents with drug-related problems did not receive treatment. Among predisposing factors, gender and age were associated with drug treatment. Severity of drug problems and comorbid emotional and health problems also predicted seeking treatment. The results call for an improved service delivery system. Screening for drug problems in primary care settings, at school, and in mental health programs will help in the early identification and treatment of drug use disorders in youth.

Adolescent Substance Use and Other Illegal Behaviors and Racial Disparities in Criminal Justice System Involvement: Findings From a US National Survey

We used data from a national survey to examine arrest rate disparities between African American and White adolescents (aged 12-17 years; n=6725) in relation to drug-related and other illegal behaviors. African American adolescents were less likely than Whites to have engaged in drug use or drug selling, but were more likely to have been arrested. Racial disparities in adolescent arrest appear to result from differential treatment of minority youths and to have long-term negative effects on the lives of affected African American youths.

Alcohol Abuse and Depression in Children and Adolescents

ABSTRACT This study examines gender differences in patterns of the co-occurrence of alcohol abuse and depression in youth. Data were from 1,458 youth (ages 9–17) randomly selected from the community. The child and one parent/guardian in each household were interviewed regarding childhood psychopathology, alcohol and drug use, and a wide array of risk factors. The findings showed that: (1) alcohol abuse/dependence was associated with elevated rates of depression in youth; (2) comorbidity between depression and alcohol use/abuse could be partially explained by shared risk factors; and (3) gender differences were found in the patterns of comorbidity. After controlling for other factors, the relationship between depression and alcohol abuse/dependence was no longer significant for girls, but it remained significant for boys. Among girls, however, cigarette smoking emerged as significantly related to depression. In the prevention of substance abuse and the treatment of depressive and addictive disorders, comorbidity of alcohol abuse and depression should be taken into account. Other clinical and policy implications are also discussed.

Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic.

Abstract Aim The aim of the study was to examine, among hospital employees exposed to an outbreak of severe acute respiratory syndrome (SARS), post-outbreak levels of depressive symptoms and the relationship between those depressive symptom levels and the types of outbreak event exposures experienced. Methods In 2006, randomly selected employees (N = 549) of a hospital in Beijing were surveyed concerning their exposures to the citys 2003 SARS outbreak and the ways in which the outbreak had affected their mental health. Subjects were assessed on sociodemographic factors, on types of exposure to the outbreak, and on symptoms of posttraumatic stress disorder and depression. Results The results of multinomial regression analyses showed that, with other relevant factors controlled for, being single, having been quarantined during the outbreak, having been exposed to other traumatic events before SARS, and perceived SARS-related risk level during the outbreak were found to increase the odds of having a high level of depressive symptoms 3 years later. Altruistic acceptance of risk during the outbreak was found to decrease the odds of high post-outbreak depressive symptom levels. Conclusions Policy makers and mental health professionals working to prepare for potential disease outbreaks should be aware that the experience of being quarantined can, in some cases, lead to long-term adverse mental health consequences.

Alcohol Abuse/Dependence Symptoms Among Hospital Employees Exposed to a SARS Outbreak

AIMS The aim of this study was to examine alcohol abuse/dependence symptoms among hospital employees exposed to a severe acute respiratory syndrome (SARS) outbreak, and the relationship between types of exposure to the SARS outbreak and subsequent alcohol abuse/dependence symptoms. METHODS A survey was conducted among 549 randomly selected hospital employees in Beijing, China, concerning the psychological impact of the 2003 SARS outbreak. Subjects were assessed on sociodemographic factors and types of exposure to the outbreak, and on symptoms of post-traumatic stress (PTS), alcohol abuse/dependence and depression. RESULTS Current alcohol abuse/dependence symptom counts 3 years after the outbreak were positively associated with having been quarantined, or worked in high-risk locations such as SARS wards, during the outbreak. However, having had family members or friends contract, SARS was not related to alcohol abuse/dependence symptom count. Symptoms of PTS and of depression, and having used drinking as a coping method, were also significantly associated with increased alcohol abuse/dependence symptoms. The relationship between outbreak exposure and alcohol abuse/dependence symptom count remained significant even when sociodemographic and other factors were controlled for. When the intrusion, avoidance and hyperarousal PTS symptom clusters were entered into the model, hyperarousal was found to be significantly associated with alcohol abuse/dependence symptoms. CONCLUSIONS Exposure to an outbreak of a severe infectious disease can, like other disaster exposures, lead not only to PTSD but also to other psychiatric conditions, such as alcohol abuse/dependence. The findings will help policy makers and health professionals to better prepare for potential outbreaks of diseases such as SARS or avian flu.