Jonathan D. Prince

Delinquency, depression, and substance use disorder among child welfare-involved adolescent females

Although adolescents with delinquency are known to have higher-than-average rates of depression or substance use disorder (SUD), research on the topic is inconsistent. It remains unclear weather depression or SUD leads to delinquency, whether delinquency leads to depression or SUD, or whether there is bi-directionality. Utilizing the National Survey of Child and Adolescent Well-Being (Wave I: 2008-2009; Wave II: 18 months later: N=5872), we used logistic regression to predict depression from delinquency (and vice versa), and SUD from delinquency (and vice versa). After inclusion of control variables, we found that females with minor theft in Wave I were more than 4 times as likely (adjusted odds ratio [aOR]=4.34; 95% CI: 1.10-17.16) as females without minor theft to be depressed in Wave II, and those with public disorder in Wave I were almost 3 times as likely (aOR=2.74; 95% CI: 1.03-7.30) as those without public disorder to have SUD in Wave II. Overall delinquency also predicted depression or SUD, and SUD predicted delinquency. Practitioners could address risk for depression or SUD among child welfare-involved adolescent females by focusing on overall delinquency or on specific types of delinquency (minor theft for depression and public disorder for SUD) and by offering interventions (e.g., cognitive-behavioral psychotherapy) that have been shown to be effective in preventing depression or SUD. In addition, with respect to our finding that SUD predicts delinquency among adolescent females, practitioners can help prevent delinquency by offering interventions (e.g., intensive outpatient treatments) that have well documented effectiveness in addressing SUD.

Risk of Inpatient Stay for Mental Illness Among Individuals With Substance Use Disorders

OBJECTIVE Whereas most studies of inpatient stay for mental illness examine whether substance use is present, this study identified types or combinations of abused substances that most increased hospitalization risk. METHODS Logistic regression of data from the 2007 National Survey of Drug Use and Health (N=37,654) was used to predict past-year hospitalization of individuals with DSM-IV substance use disorders. RESULTS Even after the inclusion of control variables, adults with four types of substance abuse or dependence were more likely to be hospitalized than adults without substance abuse or dependence. High-risk disorders included abuse of or dependence on opioid analgesics (odds ratio [OR]=6.85, p<.001), cocaine (OR=2.65, p<.05), alcohol and cocaine (OR=2.58, p<.05), and alcohol and marijuana (OR=3.10, p<.01). CONCLUSIONS Researchers examining inpatient stays may find it beneficial to look at abuse of specific substances or combinations of substances, and efforts to prevent inpatient stays could target people with high-risk substance use disorders.

Substance Use Disorder and Suicide Attempt Among People Who Report Compromised Health

ABSTRACT Background: Substance use disorder can increase the risk of suicide attempt. However, the relationship between substance use disorder and suicide attempt has yet to be explored among people who report compromised health, even though sick people are more likely to make an attempt. Objectives: Among people who report fair or poor health on the National Survey of Drug Use and Health (2006–2014; N = 502,467), I examined whether people with commonly occurring substance use disorders are more likely to attempt suicide than people without substance use disorders. Methods: Logistic regression was used to predict suicide attempt from presence versus absence of substance use disorder. Results: Among individuals reporting compromised health, those who had DSM-IV alcohol use disorders were 2.72 times (CI = 1.81–4.09, p <.001) as likely as people without SUD to attempt suicide, and people with prescription painkiller use disorders were 2.25 times (CI = 1.04–4.90, p <.05) as likely. Individuals with both alcohol and marijuana use disorders were 2.38 times (CI = 1.25–4.54, p <.01) as likely as people without substance use disorder to make an attempt, and people with both alcohol and cocaine use disorders were 3.15 times (CI = 1.16–8.60, p <.05) as likely. Conclusions/Importance: In order to help prevent suicide attempt among people who report compromised health, treatment programs that specialize in health, mental health, or substance abuse could address the drug-specific disorders that are most highly associated with the likelihood of suicide attempt. More research is needed that may underscore risk associated with other drug-specific disorders, or that substantiate the findings reported herein.

Making connections: Severe mental illness and closeness with other people

ABSTRACT Much has been written about social lives of people with severe mental illness (SMI). Before social lives can flourish, however, people with SMI must first get close to other people. We studied this closeness by holding three hour-long focus groups at Fountain House, a community mental health agency in New York City. We found that closeness between two people with SMI is challenging because someone with depression, for example, may have trouble understanding someone with a different disorder (e.g., schizophrenia). Romantically, closeness is also challenging—SMI is hard to explain to partners. In the workplace, closeness is difficult because SMI can alienate co-workers. It could push them away. In mental health programs, we found that closeness has more of a chance to develop (1) during evening and weekend activities; (2) when activities are planned often enough to prevent isolation; and (3) when staff reach out to people before extended absence causes distance.

Psychiatric Hospitalization Among Adolescents

About one in five adolescents has psychiatric disorders that are serious enough to disrupt normal life functioning. Since youth with such problems may need intensive treatment, hospitalization continues to be an important part of mental health service provision. However, little is known about inpatient care for this population. Existing research has yielded inconsistent findings. There are several examples of this inconsistency. For instance, some investigators 3 suggest that the various psychiatric disorders (e.g., depression, anxiety) are equally likely to result in hospitalization. In other words, when all disorders are taken together, none of them stand out as being especially linked to admission. In short, everyone is at risk. On the contrary, other researchers found that depressed adolescents are more likely than other youth to be hospitalized. Still other researchers point to conduct or oppositional defiant disorder. Taken together, there is a lack of consensus as to which disorders, if any, are more closely linked to hospitalization. Researchers have also examined the relationship between demographic characteristics and psychiatric hospitalization. A better understanding of such characteristics can help identify those adolescents who are most at risk. However, literature on demographic risk is also inconclusive. For instance, some investigators 9 suggest that younger children are more likely than older youth to be hospitalized, but Foster found the reverse to be true. Similarly, Pavkov and colleagues found that African Americans are at heightened risk, but Foster found that Caucasians are more likely to be readmitted. Still other studies 4, 7 found no ethnicity differences. Given these inconsistent findings, this study sought to examine which diagnoses are associated with psychiatric hospitalization and which demographic factors are associated with inpatient stay? More specifically, presence of disruptive behavior disorders (attention deficit, oppositional defiant, or conduct disorders) might be associated with increased hospitalization risk. Because symptoms are often exhibited externally (acted out) in these disorders, they may outwardly signal the need for inpatient stay to a greater extent than disorders that are expressed inwardly (e.g., depression). Or

Nine ways that clubhouses foster interpersonal connection for persons with severe mental illness: Lessons for other types of programs

ABSTRACT We highlighted ways in which clubhouses promote togetherness in order to highlight lessons in togetherness that can be learned by non-clubhouse programs. Using three hour-long focus groups (N = 20), we found that clubhouses promote closeness through work, repeated interaction between members, a non-judgmental environment, evening and weekend activities, social skill enhancement, power equalization between staff and members, sharing of similar experiences, flexibly structured activity, and staff outreach after absence. Other types of mental health programs (e.g., day treatments, certain residential facilities) can grow in these nine ways in order to foster closeness between people and prevent relapse or other adverse consequences.

Willingness to Ask Tor Help Among Persons with Severe Mental illness: Call for Research

There are times when people with severe mental illness (SMI) must be willing to ask for help (e.g., with managing symptoms). But what makes one person ask for help and another decide to go it alone? We used logistic regression to assess willingness to request assistance among 150 people with SMI. Hispanics were more likely (OR 8.51, CI 2.05–35.36, p < .01) than Caucasians to be willing to ask for help, and people with the highest incomes (relative to the lowest) were more likely (OR 7.23, CI 1.76–29.97, p > .01). Individuals with the most social support (relative to the least) were more likely (OR 12.36, CI 3.01–50.85, p < .001) to be willing to request assistance, and people who were willing to ask for help were more likely (OR 2.07, CI 1.01–4.26, p < .05) than less willing individuals to report being happy. More research is needed in order to better understand predisposition to seek aid, and interventions are needed that promote it.

Opioid Analgesic Use Disorders Among Adolescents in the United States

This study examined risk for opioid analgesic use disorders (OAUD) using the 2007 National Survey of Drug Use and Health (N = 17,727 adolescents). Males with poor grades in school (D or F) and females who argued frequently (11 + times past-year) with parents were about 3 times as likely (males: adjusted odds ratio [AOR] = 2.59, CI = 1.06–6.35, p < .05; females: AOR = 3.00, CI = 1.34–6.72, p < .01) as other males and females, respectively, to have opioid analgesic dependence that met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Hispanics were almost twice as likely (AOR = 1.95, CI = 1.05–3.65, p < .05) as Whites to have OAUD than to have alcohol or marijuana use disorders. Findings can inform interventions and future studies.

Call for Research: Detecting Early Vulnerability for Psychiatric Hospitalization

This study delineated the extent to which a broad set of risk factors in youth, a period well suited to primary prevention strategies, influences the likelihood and timing of first lifetime psychiatric hospitalizations. Logistic regression was used to delineate early risk factors for psychiatric hospitalization among Americans in a nationally representative survey (NCS-R, Part II, 2001–2003: N = 5,692). Results suggest that inpatient stay is more common and happens at earlier ages among Americans who report growing up with versus without: (1) depressed parents or caregivers, (2) family members who victimized them, or (3) one of three child mental illnesses (conduct, oppositional defiant, or separation anxiety disorder). In order to prevent inpatient stay, findings call for longitudinal research on early vulnerability for psychiatric hospitalization among families with: (1) depressed parents of children or adolescents, (2) violence against children, and (3) children that have externalizing or separation anxiety disorders.