Comorbidity between depressive disorders and nicotine dependence in a cohort of 16-year-olds

BACKGROUND: There has been growing interest in the associations between cigarette smoking and symptoms of depression. This study documents the comorbidity between depression and nicotine dependence in a birth cohort of 16-year-olds and examines the extent to which comorbidity between depression and nicotine dependence could be explained by risk factors associated with both outcomes. METHODS: Data were gathered during the course of a 16-year longitudinal study of a birth cohort of 947 New Zealand children for (1) depressive disorders and nicotine dependence at age 16 years; and (2) prospectively measured risk factors including family social position, family history of criminality, parental smoking, life events, parental attachment, conduct problems, self-esteem, and affiliations with delinquent peers. RESULTS: There was evidence of moderate to strong comorbidity between depression and nicotine dependence at age 16 years; teenagers with a depressive disorder had odds of nicotine dependence that were 4.6 times those of teenagers without depressive disorder. Analyses using logistic regression and log-linear modeling methods revealed that a substantial component of the comorbidity between depression and nicotine dependence was explained by common or correlated risk factors associated with both outcomes. After adjustment for common or correlated risk factors, the adjusted odds ratio between depression and nicotine dependence was 2.3. CONCLUSIONS: Comorbidities between depression and nicotine dependence seem to be well established by the age of 16 years. Much of this comorbidity can be explained by common or correlated risk factors associated with depression or nicotine dependence.     

Posttraumatic stress disorder and the genetic structure of comorbidity.

This study used structural equation modeling to examine the genetic and environmental architecture of latent dimensions of internalizing and externalizing psychiatric comorbidity and explored structural associations between posttraumatic stress disorder (PTSD) and these dimensions. Data were drawn from the Vietnam Era Twin Registry and included lifetime diagnoses for PTSD and a range of other psychiatric disorders for 3,372 male–male twin pairs. Examination of the phenotypic structure of these disorders revealed that PTSD cross-loaded on both Internalizing and Externalizing common factors. Biometric analyses suggested largely distinct genetic risk factors for the latent internalizing and externalizing comorbidity dimensions, with the total heritability of the Externalizing factor (69%) estimated to be significantly stronger than that for Internalizing (41%). Nonshared environment explained the majority of the remaining variance in the Internalizing (58%) and Externalizing (20%) factors. Shared genetic variance across the 2 dimensions explained 67% of their phenotypic correlation (r = .52). These findings have implications for conceptualizations of the etiology of PTSD and its location in an empirically based nosology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathways linking affective disturbances and physical disorders.

Comorbidity of psychological and physical disorders is substantial. This article presents a broad theoretical framework for identifying factors that contribute to and maintain comorbid conditions. The authors propose heuristic models of how co-occurrences of psychological and physical disorders are developed and maintained. The models specify biological, behavioral, cognitive, and social pathways that may account for comorbidity. Although the authors' discussion of psychological disorders is limited to the role of affective disturbances (subclinical negative moods as well as mood and affective disorders), the pathways they identify are thought to contribute to co-occurrences of other psychological disorders and physical disease as well. The authors emphasize that pathways linking comorbid states are bi-directional and that operative pathways differ depending on the specific affective response, illness behavior, disease, or disease stage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric diagnoses of previous suicide attempters, first-time attempters, and repeat attempters on an adolescent inpatient psychiatry unit

OBJECTIVE: To compare psychiatric diagnoses of hospitalized adolescents who (a) have made previous but no recent suicide attempts, (b) have recently made their first suicide attempt, (c) have recently made a second or subsequent attempt, or (d) have never made an attempt. METHOD: Semistructured psychiatric diagnostic interviews were used to determine psychiatric diagnoses and history of recent and previous suicidal behavior of 269 consecutively admitted adolescents to an inpatient psychiatric facility. Forty-nine previously suicidal youths, 28 first-time attempters, and 33 repeat attempters were compared with 159 nonsuicidal youths in prevalence of Axis I psychiatric disorders and psychiatric comorbidity with affective disorder. RESULTS: Previous attempters and repeat attempters both reported more affective disorders, whereas first-time attempters reported more adjustment disorders than nonsuicidal youths. Previous attempters and nonsuicidal youths reported the most externalizing disorders. CONCLUSIONS: Previous attempters on an inpatient unit have multiple psychiatric problems. Like repeat attempters, they often are depressed, but like nonsuicidal youths, they also exhibit significant externalizing behaviors. Interventions with these adolescents should focus not only on immediate presenting problems, but also on ameliorating their long-term risk of posthospitalization suicidal behavior.     

A process model for assessing adolescent risk for suicide

As the incidence of adolescent suicide within our society continues to rise, it becomes increasingly important for the mental health professional to be able to accurately assess suicide risk in adolescents who seek help. This process model discusses primary risk factors (previous attempt, affective disorders, and hopelessness), secondary risk factors (substance abuse and personality or behavioral disorders), situational risk factors (family functioning, suicide exposure, social support, life stressors, and homosexuality), and their combined implications and significance in determining an adolescent's level or risk for suicide. Use of both empirical data and clinical intuition are integrated to form a working client model that is continuously reassessed in four stages, guiding the mental health professional through a comprehensive assessment process.     

Major depression and phobias: the genetic and environmental sources of comorbidity

In a population based sample of 2163 personally interviewed female twins, substantial comorbidity was observed between DSM-III-R defined major depression (MD) and 4 subtypes of phobia: agoraphobia, social phobia, animal phobia and situational phobia. However, the level of comorbidity of MD with agoraphobia was much greater than that found with the other phobic subtypes. We concluded bivariate twin analyses to decompose the genetic and environmental sources of comorbidity between MD and the phobias. Our results suggest that a modest proportion of the genetic vulnerability to MD also influences the risk for all phobic subtypes, with the possible exception of situational phobias. Furthermore, the magnitude of comorbidity resulting from this shared genetic vulnerability is similar across the phobic subtypes. By contrast, the non-familial environmental experiences which predispose to depression substantially increase the vulnerability to agoraphobia, have a modest impact on the risk for social and situational phobias and no effect on the risk for animal phobias. The increased comorbidity between MD and agoraphobia results, nearly entirely, from individual-specific environmental risk factors for MD which also increase the risk for agoraphobia but not for other phobias.     

Course and outcome in adolescent anorexia nervosa

OBJECTIVE: To investigate course, outcome, and psychiatric comorbidity in adolescent anorexia nervosa by repeated follow-up assessment. METHOD: Thirty-four subjects (88%) of an original sample of 39 inpatients were followed up personally 3 and 7 years after discharge and classified according to DSM-III-R eating disorder categories. Standardized psychometric instruments were used to assess specific eating disorder symptoms, concomitant general psychopathology, and comorbid psychiatric diagnoses. RESULTS: After 7 years, 1 patient (3%) had anorexia nervosa, 4 patients (12%) bulimia nervosa, and 10 patients (29%) eating disorder not otherwise specified (EDNOS). Anxiety disorders (41%) and affective disorders (18%) were the most prevalent comorbid psychiatric disorders. Concomitant general psychopathology was significantly related to the outcome of the eating disorder. CONCLUSIONS: According to our results, the majority of former adolescent anorexic inpatients had shown substantial improvement in their eating disorders symptomatology after 7 years. Patients with persisting eating disorders mostly suffered from restrictive symptoms. The prevalence and distribution of psychiatric comorbidity were similar to those of adult-onset anorexia nervosa. Subjects with a worse outcome of the eating disorder also displayed higher levels of general psychopathology.     

A clinical study of substance dependence patients combined with other psychiatric disorders

The present study was conducted for clarifying the comorbidity of substance dependence and other psychiatric disorders in outpatients of four psychiatric hospitals in May, 1995. The results were as follows; 7.4% (N = 234) of the total 3155 psychiatric outpatients were diagnosed as substance dependence. Among those substance dependence patients, alcohol dependence accounted for 82.5% and the percentage of the other substance dependence were very small, i.e., methamphetamine dependence 6.4%, solvent dependence 1.7%, multiple substance dependence 9.4%, respectively. The percentage of comorbidity of substance dependence and psychiatric disorders was 23.9% (N = 56) of 234 substance dependence patients. The percentage of co-morbid alcohol dependence patients with affective disorder in all affective disorder patients was 5.0%; the percentage of comorbidity of alcohol dependence in neurotic patients 4.1%; the percentage of alcohol dependence comorbidity in schizophrenic patients 0.7%. In many cases, onsets of substance dependence and psychiatric disorders were within 2 years, which suggests the common backgrounds for substance dependence and psychiatric disorders, such as disruption of family and occupational life, stress and individual vulnerability, and substance use for self-medication. The study indicates that the percentages of diagnosed comorbidity of substance dependence and psychiatric disorders are generally smaller in Japan than in the U.S., which may be based on the differences of diagnostic standards between the two countries. Further studies are needed on the comorbidity of substance dependence and psychiatric disorders in other general hospital and psychiatric clinic patients.     

Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology

This article reports the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology. In general, there was a strong association between mood and anxiety disorders as well as conduct and antisocial personality disorder with substance disorders at all sites. The results also suggest that there is a continuum in the magnitude of comorbidity as a function of the spectrum of substance use category (use, problems, dependence), as well as a direct relationship between the number of comorbid disorders and increasing levels of severity of substance use disorders (which was particularly pronounced for drugs). Finally, whereas there was no specific temporal pattern of onset for mood disorders in relation to substance disorders, the onset of anxiety disorders was more likely to precede that of substance disorders in all countries. These results illustrate the contribution of cross-national data to understanding the patterns and risk factors for psychopathology and substance use disorders.     

Do executive and reactive disinhibition mediate the effects of familial substance use disorders on adolescent externalizing outcomes?

The present study examined the potential mediating roles of executive and reactive disinhibition in predicting conduct problems, attention-deficit/hyperactivity disorder (ADHD) symptoms, and substance use among adolescents with and without a family history of substance use disorders. Using data from 247 high-risk adolescents, parents, and grandparents, structural equation modeling indicated that reactive disinhibition, as measured by sensation seeking, mediated the effect of familial drug use disorders on all facets of the adolescent externalizing spectrum. Executive disinhibition, as measured by response disinhibition, spatial short term memory, and “trait” impulsivity, was associated with ADHD symptoms. Moreover, although executive functioning weakness were unrelated to familial substance use disorders, adolescents with familial alcohol use disorders were at risk for “trait” impulsivity marked by a lack of planning. These results illustrate the importance of “unpacking” the broad temperament style of disinhibition and of studying the processes that underlie the commonality among facets of the externalizing spectrum and processes that predict specific externalizing outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders

We evaluated the association between attention deficit hyperactivity disorder (ADHD) and the age of onset of psychoactive substance use disorders (PSUD) in adults with ADHD. We hypothesized that ADHD and psychiatric comorbidity would be risk factors for early onset PSUD. We compared 120 referred adults having a clinical diagnosis of childhood-onset ADHD with 268 non-ADHD adults. All diagnoses were obtained using DSM-III-R based structured psychiatric interviews. We used group comparisons of age at onset and Cox proportional hazard models to examine the development of PSUD over time. ADHD was associated with earlier onset of PSUD independently of psychiatric comorbidity. Conduct and juvenile bipolar disorders conferred a significantly increased risk for early onset PSUD independently of ADHD. Psychiatric disorders commonly emerged before the onset of PSUD in both groups. Persistent ADHD with and without psychiatric comorbidity was associated with adolescent onset PSUD. In addition, comorbidity with conduct and juvenile bipolar disorders predicted very early onset PSUD in both ADHD and non-ADHD individuals. These findings confirm and extend previous findings documenting important associations between PSUD and psychiatric comorbidity including persistent ADHD.     

Multiple chemical sensitivity: a new type of toxicity?]

OBJECTIVE: To compare characteristics and risk factors of suicide in early adolescence (younger than age 15 years) and in late adolescence. The authors examined whether differences in risk factors or resilience might explain the different suicide rates in the two age groups. METHOD: Information about all registered suicides of young people in Norway from 1990 through 1992 was gathered from several professional informants. Children younger than 15 years old who committed suicide (n = 14) were compared with late-adolescent suicides (15 through 19 years) (n = 115) and with controls (n = 889). RESULTS: Younger compared with older adolescent suicides more often hanged themselves (93% versus 35%). Suicidal ideation (7% versus 39%) and precipitating events were described less frequently (29% versus 49%). Older adolescents more often had psychiatric disorders (77% versus 43%). Compared with controls, the risk factors for suicide were affective disorders (young adolescents: odds ratio [OR] = 23.8, 95% confidence interval [CI] = 2.3 to 1,183; older adolescents: OR = 19.6, CI = 10.6 to 38.8); disruptive disorders (young adolescents: OR = 3.4, CI = 0.0 to 340; older adolescents: OR = 6.1, CI = 3.0 to 12.7); and not living with two biological parents (young adolescents: OR = 3.1, CI = 0.6 to 14.7; older adolescents: OR = 2.5, CI = 1.6 to 3.8). CONCLUSION: Children and young adolescents completing suicide were less exposed to known risk factors than older adolescents. The increased suicide risk was similar for both groups when they were compared with community controls. The low suicide incidence in childhood may be related to fewer risk factors, rather than to resilience to risk factors.     

Level of social-cognitive development, adaptive functioning, and DSM-III diagnoses in adolescent offspring of parents with affective disorders: Implications of the development of the capacity for mutuality.

This study examines the relation between the developmental social-cognitive capacity for interpersonal negotiation and both parental-risk and adolescent-outcome variables in 172 adolescents 11 to 19 years of age. The sample was divided into two groups: those at risk because of affective disorder in one or both of their parents and a comparison group whose parents have never experienced affective illness. Adolescents' interpersonal negotiation strategy (INS) levels were negatively associated with the duration of parental affective illness (and with associated lower socioeconomic status and marital discord). INS level significantly predicted adolescents' adaptive social functioning (AFR) even after controlling for age, sex, intelligence, number of adolescent diagnoses, and parental-risk factors. Two additional patterns were found in the risk group: adolescents with both high AFR and high INS, and adolescents who have disturbed functioning despite high INS. These findings are consistent with a risk model in which social-cognitive capacity mediates between parental disorder and adaptive child behavior, and they suggest the importance of assessing children at risk with a developmental measure of relational capacity to complement the more traditional diagnostic and behavioral outcome measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric disorder among American Indian adolescents: prevalence in Northern Plains youth

This article presents data on the prevalence of psychiatric disorders among American Indian adolescents, using DSM-III-R criteria. OBJECTIVE: To generate current prevalence data using a structured diagnostic instrument, the Diagnostic Interview Schedule for Children, Version 2.1C (DISC-2.1C). METHODS: Youths from a Northern Plains tribe who had participated in an earlier study comprised the sample. At reinterview, respondents were between 14 and 16 years of age, when Indian adolescents are thought to be at particularly high risk for manifesting emotional disorders. One hundred nine of the original sample of 251 were still in schools on the reservation. Trained indigenous lay interviewers administered the DISC-2.1C to respondents in a private setting within the school. RESULTS: The findings indicate that rates of some psychiatric problems (e.g., disruptive behavior disorders, substance-related disorders, and their comorbidity) are high among these high school students. CONCLUSIONS: These data, as well as national statistics, suggest that, compared with non-Indian populations, a greater percentage of Northern Plains adolescents manifest significant psychiatric symptoms which warrant treatment.     

Psychiatric hospitalization of adolescents for conduct disorder

OBJECTIVE: The authors' goal was to review current published literature on the psychiatric hospitalization of adolescents with a diagnosis of conduct disorder. METHODS: The English-language literature from 1980 to 1991 cited in the MEDLINE database was searched using the key words conduct disorder, adolescent psychiatric hospitalization, psychiatric hospitalization criteria, adolescent psychiatric inpatient hospitalization, and adolescent psychiatric admissions. RESULTS: A diagnosis of conduct disorder or presenting symptoms and behaviors consistent with that diagnosis are commonly reported for adolescent psychiatric admissions. Estimates of the percentage of admissions to psychiatric inpatient treatment facilities of adolescents with conduct disorder or symptoms consistent with that disorder range from 30 to 70 percent. There are no research-based criteria for hospitalization of adolescents for conduct disorder, and systematic studies of the outcome of psychiatric hospitalization for this group have not been published. Comorbid psychiatric diagnoses and similar behavioral symptoms in conduct disorder and comorbid disorders complicate inpatient treatment of adolescents with conduct disorder. CONCLUSIONS: Studies of the outcome of psychiatric hospitalization of adolescents for conduct disorder are needed to determine the appropriate use of this modality.     

Co-occurrence and contransmission of affective disorders and alcoholism in families

The analysis of patterns of co-occurrence and cotransmission of affective disorders and alcoholism in families may provide clues for understanding the excess comorbidity between these conditions in clinical settings and in the general population. This paper reports the results of a family study of the relatives of patients with bipolar disorder, unipolar depression and alcoholism, and combinations thereof. Excess comorbidity between affective disorders and alcoholism was observed in all groups of relatives. However, the sharing of familial aetiological components was not a major contributor to the excess comorbidity between affective disorders and alcoholism. Unipolar depression and alcoholism segregated independently in families, whereas a modest correlation between familial components of alcoholism and bipolar disorder was observed.     

Parenting self-efficacy and parenting practices over time in Mexican American families.

Drawing on social cognitive theory, this study used a longitudinal cross-lagged panel design and a structural equation modeling approach to evaluate parenting self-efficacy's reciprocal and causal associations with parents' positive control practices over time to predict adolescents' conduct problems. Data were obtained from teachers, mothers, and adolescents in 189 Mexican American families living in the southwest United States. After accounting for contemporaneous reciprocal relationships between parenting self-efficacy (PSE) and positive control, results indicated that parenting self-efficacy predicted future positive control practices rather than the reverse. PSE also showed direct effects on decreased adolescent conduct problems. PSE functioned in an antecedent causal role in relation to parents' positive control practices and adolescents' conduct problems in this sample. These results support the cross-cultural applicability of social cognitive theory to parenting in Mexican American families. An implication is that parenting interventions aimed at preventing adolescent conduct problems need to focus on elevating the PSE of Mexican American parents with low levels of PSE. In addition, future research should seek to specify the most effective strategies for enhancing PSE. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent outcomes for hyperactive children: Perspectives on general and specific patterns of childhood risk for adolescent educational, social, and mental health problems.

Examined significant differences, if any, among adolescent outcomes for hyperactive children and examined early life contributions of biological and psychological characteristics, family environments, social relationships, cognitive and academic status, and school behavior, along with hyperactivity, in explaining each of several outcomes. The Ss were classified on the basis of social system definitions of hyperactivity as well as on the basis of pervasive attention deficit disorder with hyperactivity (ADDH) based on parent and teacher ratings. Outcome measures at ages 17 and 18 included data on educational status, conduct problems, mental health disorders, and substance use. Regardless of the definition used, hyperactive children had significantly poorer educational outcomes and a greater extent of conduct disorders than their age peer controls. Regression analyses supported the inference that early biological factors, as well as the child's early health and temperament, predispose for adolescent mental health outcomes of depression, aggressive and nonaggressive conduct disorders, and hospitalization for psychological treatment. Familial, social, and cognitive factors had greater contributory potential in explaining educational outcomes, substance use, and conduct problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescents' exposure to sexy media does not hasten the initiation of sexual intercourse.

It is widely believed that exposure to sexy content in the mass media leads teenagers to become sexually active. Although most research linking sexy media exposure to adolescents' sexual behavior is cross-sectional, several recent, well-publicized longitudinal studies purport to find a causal connection, which has alarmed the public and prompted criticism of the entertainment industry for its corrupting influence on youth. One problem in research on media effects on sexual activity, however, is that outcomes that are presumed to result from media exposure may actually be due to factors that differentially predispose adolescents to have different degrees of media exposure and are themselves related to sexual activity. We reanalyzed data from one of these longitudinal studies (Brown et al., 2006) using propensity score matching to control for preexisting differences between adolescents with and without high exposure to sexy media. With such controls for differential selection in place, we found no evidence that the initiation of sexual intercourse is hastened by exposure to sexy media. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents

We examine the lifetime comorbidity among anxiety disorders, and between anxiety disorders and other mental disorders, in a large (n = 1,507) community sample of high school students on whom extensive diagnostic data were available. Three diagnostic groups were formed: those with a lifetime anxiety disorder (n = 134); those with a nonanxiety disorder (n = 510); and those who had never met criteria for a mental disorder (n = 863). The intra-anxiety comorbidity rate was relatively low (18.7%), and was strongly associated with being female (92%). The lifetime comorbidity between anxiety and other mental disorders (primarily MDD) was substantial (73.1%) and was not associated with being female.