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Transcript of 1 Longitudinal associations between childhood and adolescent emotional problems, behavioral problems...
1
Longitudinal associations between childhood
and adolescent emotional problems,
behavioral problems and substance use
Jouko Miettunen, adjunct professor
University of Oulu, Finland
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Mental health and substance use Emotional and behavioral problems are commonly
associated with substance use in adolescence, but it is
unclear whether substance use causes or is a consequence of
mental health problems
Theories on associations between substance use and mental
health problems can be summarized to three pathways
a common pathway (same risk factors)
substance use causes psychopathology
psychopathology causes substance use (self-medication
hypothesis)
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Emotional and behavioral symptoms
Emotional problems include symptoms or traits
related to depression and anxiety
neurotic, internalising
Behavioral problems cover rule-breaking and
aggressive behavior
antisocial, externalising
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Emotional problems and substance use
Findings on cannabis use as risk factor for depressive and anxious
disorders and symptoms have been inconsistent (Moore et al)
Studies had methodological shortcomings e.g. regarding attempts to
take into account reverse causation and possible intoxication effects.
Emotional symptoms in childhood can even protect from substance use
(e.g., Maggs et al)
Early-onset depressive disorder have been associated with later tobacco
and alcohol use (e.g., Sihvola et al) and vice versa (e.g., Fergusson et al)
Moore et al. Lancet 2007;370:319-28; Maggs et al. Addiction Suppl 2008;103:7-22);Sihvola et al. Addiction 2008;103:2045-53; Fergusson et al. Arch Gen Psychiatry 2009;66:260-6.
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Behavioral problems and substance use
Childhood behavioral disorders have been linked to later alcohol use,
especially among males (e.g., McGue et al)
Substance use have been linked with later behavioural problems (e.g.,
Pernanen, White et al):
Pharmacological effects of intoxication reduce inhibitions which may lead people
to act more daringly and impulsively than they might do while sober.
Prolonged involvement in substance abuse may have developmental effects, such
as increased delinquent peer affiliations
Some drug related criminal activity may be purely utilitarian, for example, when
an unemployed drug addict turns to robbery and theft to support his habit
McGue et al. Alcohol Clin Exp Res 2001;25:1156-65; Pernanen. Alcohol in Human Violence, Guilford Press, 1991; White et al. J Stud Alcohol Suppl 1993;11:62-77.
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Northern Finland 1986 Birth Cohort Population based birth
cohort Individuals born in
Northern Finland July 1985 – June 1986
Original sample:
9,432 (4,865 males) Current sample:
6,348 (3,102 males)
Oulu
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AGE
Youth Self-Report (YSR)
(for previous six months)
-Emotional problems
-Behavioural problems
(covariate)
SELF REPORTS
8 years
REGISTERS
20-23 years15 to 16 years
(outcome, predictor and covariate)
- Regular smoker
- Heavy drinker
-Cannabis use
-Other intoxicant use
SELF REPORTS
TEACHERS AND PARENTS
Rutter scales
(for previous year)
-Emotional problems
-Behavioural problems
(predictor and covariate)
SUBSTANCE
USE
MENTAL
PROBLEMS
Hospital & Criminal Registers
(from age 15 to 16 )-Depressive and neurotic
disorders-Violent and property
offences(outcome)
YEAR1993 - 1994 2005-20082000 - 2001
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Northern Finland 1986 Birth Cohort
Emotional and behavioral data age 8y (Rutter scales)
Emotional subscale (teachers: 4 items / parents: 5 items)
Behavioral subscale (6/4) Items scored 0 to 2 High scorers:
in highest 25% both in parents’ and in teachers’ ratings
Emotional and behavioral data age 15-16y (YSR)
Self reports Emotional (internalising)
subscale (30 items) Behavioral (externalising)
subscale (29 items) Items scored: 0 to 2 High scorers:
highest 10%
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Northern Finland 1986 Birth Cohort
Emotional and behavioral data age 20-23y (registers)
Hospitalisations for emotional disorders (e.g. depression) until 23y
- number of events (n): M/F=40/32
Criminal convictions (property and violent crimes) until 20y
- n=80/40 No/Yes
Substance use data age 15-16y (YSR)
Self reports Regular smoking (ever)
[22/23%] Being drunk 10 times or more
during the past year [17/20%] Tried cannabis (ever) [5/6%] Other substance use (e.g.
medicines for intoxication, sniffing glues or solvents, ecstacy, …) [7/14%]
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Northern Finland 1986 Birth Cohort
Covariates (age 15 to 16)
1. Place of residence (urban vs. rural)
2. Family pattern (intact: no/yes)
3. Parental education (professional/other)
4. Parental psychiatric disorders (hospital registers until 2005)
Final models Logistic regressions (ORs) Predicting substance use with
childhood mental health Adjusted for covariates 1-4
Predicting hospitalisations and crimes with substance use
Adjusted for covariates 1-4 and previous emotional and behavioral problems (age 8 and age 15-16)
Summary of results Both among males and females, behavioral problems at age 8 were
associated (P<0.05) with later smoking and other substance use than
alcohol or cannabis (Adjusted Odds Ratios, OR, between 1.5 and 2.3).
Early emotional problems were not a risk for later substance use,
except being drunk among females (OR 1.4).
Cannabis (OR = 6.7; 95% CI: 2.3 to 19.6) use among females
predicted emotional disorders in the follow-up.
Substance use predicted later criminality in both genders; associations
were stronger among males.
Conclusions
Mental health problems and substance use are strongly
associated in adolescence and early adulthood.
Behavioral problems often both precede and follow substance
abuse, whereas emotional problems may follow adolescent
substance abuse, especially among females.
Males with substance use are at high risk for criminal offences.
These associations were robust even when taking into account
childhood and adolescence mental health problems.
Research group
University of Oulu, Finland
Jouko Miettunen, PhD
Juha Veijola, MD, PhD
Hanna Ebeling, MD, PhD
Irma Moilanen, MD, PhD
Pirjo Mäki, MD, PhD
Anja Taanila, PhD
Sari Törmänen, MD
University of Tampere, Finland
Matti Joukamaa, MD, PhD
University of Cambridge, UK
Peter Jones, FRCPsych
Graham Murray, MRCPsych
Imperial College London, UK
Marjo-Riitta Järvelin, MD, PhD
University of Nebraska, USA
Jukka Savolainen, PhD
www.joukomiettunen.net/presentations