Psychiatric Diagnoses Differ Considerably in Their Associations With Alcohol/Drug-Related Problems Among Adolescents. A Norwegian Population-Based Survey Linked With National Patient Registry Data.

Ove Heradstveit,Jens Christoffer Skogen,Jørn Hetland,Robert Stewart,Mari Hysing

doi:10.3389/fpsyg.2019.01003

Abstract

The aim of this study was to examine alcohol/drug use and problems across psychiatric diagnoses and to what extent associations between each psychiatric diagnosis and alcohol/drug use and problems were independent from the potential confounding effects of psychiatric comorbidity, socioeconomic status, sex and age. We used a dataset comprising a linkage between a large population-based and cross-sectional study among Norwegian adolescents (the youth@hordaland conducted in 2012) and national registry-based data on specialist mental health care use during the 4 years prior to the survey (2008 to 2011). The study sample included 16 to 19 year olds who participated in the youth@hordaland survey and consented to the linkage with patient registry data (n = 9,408). Among these, 853 (9%) had received specialist mental health care and comprised the clinical group, while the rest (n = 8,555) comprised the comparison group. The main outcome variables were several self-reported indicators for alcohol/drug use, including any alcohol use, frequent alcohol intoxication, high-level alcohol consumption, and lifetime illicit drug use, as well as one indicator for potential alcohol/drug-related problems: a positive CRAFFT-score. Adolescents receiving specialist mental health care (n = 853) reported more frequently alcohol/drug use and problems compared to adolescents not receiving these services (Cohens d’s ranging from 0.09 to 0.29, all p ≤ 0.01). Anxiety, depression, conduct disorders, eating disorders, ADHD, and trauma-related disorders were all associated with single measures of alcohol/drug use and problems, with odds ratios (ORs) ranging from 1.58 to 4.63, all p < 0.05) in unadjusted models. Trauma-related disorders, depression and conduct disorders were also positively associated with higher scores on a combined indicator of alcohol/drug use and problems (ORs ranging from 1.89 to 3.15, all p < 0.01), even after the full adjustment from psychiatric comorbidity and sociodemographic variables (adjusted odds ratios ranging from 1.61 to 2.79, p < 0.05). These results suggest that alcohol/drug use and problems were slightly more common among adolescents who received specialist mental health care during the past 4 years compared with the general adolescent population, and adolescents with trauma-related disorders, depression and conduct disorders were high-risk groups for alcohol/drug use and problems.

Highlights

Mental health problems are prevalent among children and adolescents, with one in five fulfilling criteria for a psychiatric diagnosis (Canino et al, 2004; Belfer, 2008; Merikangas et al, 2010; Barkmann and Schulte-Markwort, 2012)
We aimed to examine the frequencies of alcohol/drug use and problems among adolescents receiving specialist mental health care compared with a general population of adolescents
The present study is to our knowledge the first to compare a broad range of psychiatric diagnoses and their associations with alcohol/drug use and problems during adolescence, while addressing the role of psychiatric comorbidity

Summary

Introduction

Mental health problems are prevalent among children and adolescents, with one in five fulfilling criteria for a psychiatric diagnosis (Canino et al, 2004; Belfer, 2008; Merikangas et al, 2010; Barkmann and Schulte-Markwort, 2012). Previous studies have demonstrated positive associations between a range of psychiatric diagnoses and adolescent alcohol/drug-related problems. These findings include anxiety (Kedzior and Laeber, 2014; Stapinski et al, 2016), attention-deficit/hyperactivity disorder (ADHD) (Groenman et al, 2013; Zulauf et al, 2014), eating disorders (Castro-Fornieles et al, 2009; Bisetto et al, 2011), post-traumatic stress disorder (PTSD) (Wolitzky-Taylor et al, 2012; Haller and Chassin, 2014), conduct disorders (Khoddam et al, 2016), depression (WolitzkyTaylor et al, 2012; Heron et al, 2013; Edlund et al, 2015), and psychotic disorders (Ferdinand et al, 2005; Addington and Addington, 2007). The majority of previous literature has focused on selected associations between single psychiatric diagnoses and symptoms and alcohol/drug-related problems, and few studies have investigated the full range of common psychiatric diagnoses in a single model

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