Abstract
ObjectiveEarly onset of alcohol use is associated with an increased risk of substance use disorders (SUD), but few studies have examined associations with other psychiatric disorders. Our aim was to study the association between the age of first alcohol intoxication (AFI) and the risk of psychiatric disorders in a Finnish general population sample. MethodsWe utilized a prospective, general population-based study, the Northern Finland Birth Cohort 1986. In all, 6,290 15–16-year old adolescents answered questions on AFI and were followed up until the age of 33 years for psychiatric disorders (any psychiatric disorder, psychosis, SUD, mood disorders and anxiety disorders) by using nationwide register linkage data. Cox-regression analysis with Hazard Ratios (HR, with 95% confidence intervals (CI)) was used to assess the risk of psychiatric disorders associated with AFI. ResultsStatistically significant associations were observed between AFI and any psychiatric disorder, psychosis, SUDs, and mood disorders. After adjustments for other substance use, family structure, sex and parental psychiatric disorders, AFIs of 13–14 years and ≤12 years were associated with SUD (HR = 5.30; 95%CI 2.38–11.82 and HR = 6.49; 95%CI 2.51–16.80, respectively), while AFI ≤ 12 years was associated with any psychiatric disorder (HR = 1.59; 95%CI 1.26–2.02) and mood disorders (HR = 1.81; 95%CI 1.22–2.68). After further adjustments for Youth Self Report total scores, AFI ≤ 14 was associated with an increased risk of SUD and AFI ≤ 12 with an increased risk of any psychiatric disorder. ConclusionsWe found significant associations between the early age of first alcohol intoxication, later SUD and any psychiatric disorder in a general population sample. This further supports the need for preventive efforts to postpone the first instances of adolescent alcohol intoxication.
Highlights
Alcohol is the most commonly used substance among adolescents in mid- and high-income countries and the most frequent form of very early onset substance use (Kraus et al, 2015; Miech & Johnston, 2018; Toumbourou et al, 2018)
We studied the association of self-reported age of first alcohol intoxication with the risk for each psychiatric outcome group separately using Cox regression analysis with hazard ratios (HR) and 95% confidence intervals
The statistical analyses were performed using SPSS statistical soft ware (IBM SPSS Statistics, version 25; IBM Co., Armonk, New York, USA) with the exception of Aalen – Johansen hazard curves, E-values and examination of cox-proportional hazard assumption that were analyzed using R (R Foundation for Statistical Computing, version 3.6.0; R Core Team., Armonk, Vienna, Austria) packages survival, survminer and Epi. The covariates and their relation to the age of first self-reported alcohol intoxication and onset of any psychiatric disorder are pre sented in Tables 1 and 2
Summary
Alcohol is the most commonly used substance among adolescents in mid- and high-income countries and the most frequent form of very early onset substance use (Kraus et al, 2015; Miech & Johnston, 2018; Toumbourou et al, 2018). The early use of alcohol coincides with a period of neurodevelopmental vulnerability, during which typical maturational processes for the brain and related circuitry of the central nervous system may be disrupted by substance use (Gray & Squeglia, 2018; Hamidullah, Thorpe, Frie, Mccurdy, & Khokhar, 2020) This may increase the later risk of substance use and mental health problems (Gray & Squeglia, 2018; Hamidullah et al, 2020), increasing the burden of disease associated with early use of alcohol (Degenhardt et al, 2018; Griswold et al, 2018). Further more, they reported a crude association between AFI and anxiety and depression, which diminished after adjustments for confounders
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