National Comorbidity Survey Adolescent Supplement Research Articles

Oral contraceptive use and depression among adolescents

PurposeDepression is a prevalent health problem affecting U.S. women. Oral contraceptive pills (OCPs) are commonly used for pregnancy prevention, and evidence is mixed regarding any increased risk for incident depression among users, particularly adolescents. MethodsWe examined the relationship between OCP use and depressive disorders among female adolescents using validated, structured interview assessments in a general population sample of adolescents in the National Comorbidity Survey-Adolescent Supplement. Respondents were 4765 female adolescents with no history of pregnancy who reported current OCP use, lifetime OCP use, and age of OCP initiation. Lifetime and current depressive disorders, including major depressive disorder and depressive episodes, were assessed by lay interviewers. ResultsIn logistic regression models adjusted for a range of confounders, there was no relationship between ever using OCPs and lifetime depressive disorder (OR 1.10, 95% CI 0.88–1.37), nor current use of OCPs and current depressive disorder (OR 0.82, 95% CI 0.50–1.35). Using survival analysis for age-of-onset data, we found that OCP use is not associated with an increased risk of depressive disorders. ConclusionsIn sum, use of OCPs in a general population sample of adolescents did not increase the risk of depressive disorders.

Violent interpersonal trauma predicts aggressive thoughts and behaviors towards self and others: findings from the National Comorbidity Survey-Adolescent Supplement.

The purpose of the current study is to examine the relation between adolescent traumatic event exposure and aggression directed towards the self and others. Theoretical perspectives underscore the particularly pernicious effects of violent traumas intentionally perpetrated by others in terms of negative posttraumatic outcomes. However, a careful comparison of trauma type in relation to aggression has not been done with youth. The current project, therefore, examined differences between youth with a history of violent interpersonal trauma (VIT) compared to those with a non-violent trauma type history in terms of aggressive behavior directed towards others as well as aggressive self-directed thoughts (suicidal ideation). The sample was drawn from the National Comorbidity Survey-Replication and consisted of 1928 adolescents (M = 15.4; SD = 1.47years), each assigned to one of four age- and gender-matched trauma history groups. Consistent with hypotheses, among trauma-exposed youth, those who had experienced or witnessed a VIT (compared to those reporting a non-VIT only) evidenced elevated aggression, even after controlling for a number of theoretically relevant covariates (e.g., gender, age, household income, demographic factors). Results indicate that youth with a history of VIT may be at unique risk for experiencing aggression directed towards others and the self compared to those without this specific trauma history. This is important because trauma type is an easily assessed indicator of potentially elevated risk for these types of deleterious outcomes. Findings are situated in a research agenda aimed at continuing to refine our understanding of the link between interpersonal trauma and aggression.

Association between Exposure to Noise and Sleep and Mental Health Outcomes in a Nationally-Representative Sample of U.S. Adolescents

Background: In 1974, the U.S. Environmental Protection Agency (U.S. EPA) identified an equivalent 24-hour continuous average noise exposure level (LAeq, 24h) of < 55 A-weighted decibels to protect public health with an adequate margin of safety. To date, however, limited U.S.-based research has evaluated the relationship between noise pollution and health. We help fill this gap using data from a nationally-representative sample of U.S. adolescents.Methods: We used a cross-sectional geospatial sound model to estimate noise exposure at the block group level. We dichotomized noise as high (LAeq, 24h ≥ 55 dB) versus low (LAeq, 24h <55 dB). The National Comorbidity Survey Adolescent Supplement, conducted between 2001-2004 and including several self-reported sleep outcomes and DSM-IV disorder diagnoses, provided our study population. We evaluated the association between noise and sleep and mental health using doubly-robust targeted minimum loss-based estimation and propensity score matching to account for potential confounders, including air pollution.Results: The study included 4,508 urban-dwelling adolescents aged 13-18. Controlling for numerous adolescent, household, and environmental covariates, living in a high- versus low-noise census block-group was associated with later bedtimes on both weeknights and weekend nights (risk difference [RD]: 0.41 hours, 95% CI: -0.01, 0.83, and RD: 0.61 hours, 95% CI: 0.38, 0.84, respectively). We found no association with total number of hours slept. Further, we found that living in a high- versus low-noise census block-group was associated with 69% increased odds of an anxiety or depressive disorder (odds ratio [OR]: 1.69, 95% CI: 1.13, 2.25) and 79% increased odds of substance use disorder (OR: 1.79, 95% CI: 0.91, 2.66); we found no similar associations with behavioral disorders.Conclusion: We found evidence that noise exceeding the U.S. EPA threshold may hold adverse sleep and mental health consequences for U.S. adolescents.

Links between bereavement due to sudden death and academic functioning: Results from a nationally representative sample of adolescents.

Bereavement due to sudden loss may disrupt positive adjustment among youth, yet few studies have examined the age at which youth are most likely to first encounter sudden loss, the co-occurrence of sudden loss with other traumatic events, and the independent effects of sudden loss on academic functioning. Data were analyzed from the National Comorbidity Survey-Adolescent Supplement (N = 10,148, Mage = 15.18, 51.1% female). Youth reported on whether they had experienced sudden loss (along with 17 other traumatic events), the age at which they had first experienced sudden loss, and multiple indicators of academic functioning. Sudden loss was the most frequently occurring traumatic event among youth; approximately 30% of adolescents reported at least one sudden loss in their lifetime. Youth were most likely to have first experienced sudden loss during middle adolescence (15 to 16 years of age). Although sudden loss co-occurred with several other traumas, about 10% of youth reported experiencing only sudden loss. After accounting for demographic characteristics and other traumatic events, experiencing sudden loss was associated with lower academic achievement, lower ability to concentrate and learn, less enjoyment of school, lower school belongingness, and lower beliefs that teachers treat youth fairly. Sudden loss is common among adolescents and has important implications for school functioning. Schools may improve academic functioning by adopting routine screening for sudden loss and assessing potential need for bereavement-informed mental health services. (PsycINFO Database Record

Physical Activity and Mental Disorder Among Adolescents in the United States

ObjectiveTo estimate associations between physical activity (PA) and a broad range of lifetime mental disorders among adolescents, and to evaluate whether the context of sports participation impacts these associations. MethodsThe sample included 6,483 13–18 year-olds from the National Comorbidity Survey Adolescent Supplement. Adolescents completed face-to-face psychiatric interviews and a parent provided diagnostic and other family-level information on the participating adolescent by completing a self-administered questionnaire. PA was measured by adolescent self-report and dichotomized to indicate vigorous exercise several times a week. Nineteen psychiatric disorders were assessed using the Diagnostic and Statistical Manual of Mental Disorders criteria. Multiple logistic regression analyses were used to estimate associations of PA with mental disorders, suicidality, and psychological distress. ResultsTwo thirds of adolescents reported being physically active. Active adolescents had significantly lower odds of mood disorder (Odds ratio[OR] = .74, 95% confidence interval [CI]=.58–.94), bipolar II disorder (OR = .54, 95% CI=.30–.99), and general psychological distress (OR = .71, 95% CI=.52–.96) than less/inactive adolescents. In contrast, adolescents who engaged in PA were more likely to have lifetime alcohol use disorder (OR = 1.78, 95% CI = 1.11–2.85), bulimia (OR = 5.84, 95% CI = 2.48–13.79), generalized anxiety disorder (OR = 2.04, 95% CI = 1.16–3.58), and posttraumatic stress disorder (OR = 1.65, 95% CI = 1.07–2.55). The direct associations between PA and alcohol use disorder and bulimia appeared to be specific to adolescents who participated in organized sports. DiscussionAssociations between PA and lifetime mental disorder among adolescents may differ according to both disorder type and the context in which PA occurs. Longitudinal studies that assess the context of PA may be able to explain apparent discrepant associations between PA and mental disorder.

Proximally-occurring life events and the first transition from suicidal ideation to suicide attempt in adolescents

BackgroundInformed by diathesis-stress models of suicide risk, this paper investigated the role of proximally-occurring stressful life events in the first transition from suicidal ideation to suicide attempt in adolescence. Interactions between stressful life events and psychiatric disorders in relation to this progression were also examined. MethodsData are from a subsample (N = 928) of adolescents with lifetime suicidal ideation from the National Comorbidity Survey-Adolescent Supplement. Logistic regression analyses compared adolescents who had transitioned to a first suicide attempt (n = 81) in the year prior to the study to adolescents with suicidal ideation only (n = 847). ResultsMultivariate logistic regressions implicated increased risk for progression from suicidal ideation to a first suicide attempt in the presence of a recent romantic break-up as well as more recent stressful life events. However, among adolescents with suicidal ideation and either a recent romantic break-up or above-average recent stressors, neither a disruptive behavior disorder, mood disorder, nor a substance use disorder intensified the risk for progressing to a first suicide attempt. LimitationsAnalyses are cross-sectional and therefore limit causal inferences. ConclusionsFindings underscore the importance of comprehensive suicide risk evaluations that consider proximally-occurring interpersonal stressors which may influence the first transition from thinking about suicide to acting in adolescence.

The co-occurrence and correlates of anxiety disorders among adolescents with intermittent explosive disorder.

We examined the lifetime prevalence of anxiety disorders (ADs) among adolescents with lifetime intermittent explosive disorder (IED), as well as the impact of co-occurring ADs on anger attack frequency and persistence, additional comorbidity, impairment, and treatment utilization among adolescents with IED. IED was defined by the occurrence of at least three anger attacks that were disproportionate to the provocation within a single year. Data were drawn from the National Comorbidity Survey-Adolescent Supplement (N = 6,140), and diagnoses were based on structured lay-administered interviews. Over half (51.89%) of adolescents with IED had an AD, compared to only 22.88% of adolescents without IED. Compared to adolescents with IED alone, adolescents with IED and comorbid ADs: (a) were more likely to be female; (b) reported greater impairment in work/school, social, and overall functioning; (c) were more likely to receive an additional psychiatric diagnosis, a depressive or drug abuse diagnosis, or diagnoses of three or more additional disorders; and (d) had higher odds of receiving any mental/behavioral health treatment as well as treatment specifically focused on aggression. Adolescents with IED alone and those with comorbid ADs did not differ in the number of years experiencing anger attacks or the highest number of anger attacks in a given year. ADs frequently co-occur with IED and are associated with elevated comorbidity and greater impairment compared to IED alone. Gaining a better understanding of this comorbidity is essential for developing specialized and effective methods to screen and treat comorbid anxiety in adolescents with aggressive behavior problems.

Intellectual disability and mental disorders in a US population representative sample of adolescents.

Most research on the prevalence, distribution, and psychiatric comorbidity of intellectual disability (ID) relies on clinical samples, limiting the generalizability and utility of ID assessment in a legal context. This study assessed ID prevalence in a population-representative sample of US adolescents and examined associations of ID with socio-demographic factors and mental disorders. Data were drawn from the National Comorbidity Survey Adolescent Supplement (N = 6256). ID was defined as: (1) IQ ⩽ 76, measured using the Kaufman Brief Intelligence Test; (2) an adaptive behavior score ⩽76, and (3) age of onset ⩽18 measured using a validated scale. The Composite International Diagnostic Interview assessed 15 lifetime mental disorders. The Sheehan disability scale assessed disorder severity. We used logistic regression models to estimate differences in lifetime disorders for adolescents with and without ID. ID prevalence was 3.2%. Among adolescents with ID, 65.1% met lifetime criteria for a mental disorder. ID status was associated with specific phobia, agoraphobia, and bipolar disorder, but not behavior disorders after adjustment for socio-demographics. Adolescents with ID and mental disorders were significantly more likely to exhibit severe impairment than those without ID. These findings highlight how sample selection and overlap between ID and psychopathology symptoms might bias understanding of the mental health consequences of ID. For example, associations between ID and behavior disorders widely reported in clinical samples were not observed in a population-representative sample after adjustment for socio-demographic confounders. Valid assessment and understanding of these constructs may prove influential in the legal system by influencing treatment referrals and capital punishment decisions.General Scientific SummaryCurrent definitions of intellectual disability (ID) are based on three criteria: formal designation of low intelligence through artificial problem-solving tasks, impairment in one's ability to function in his/her social environment, and early age of onset. In a national population sample of adolescents, the majority of those with ID met criteria for a lifetime mental disorder. Phobias and bipolar disorder, but not behavior disorders, were elevated in adolescents with ID. Findings highlight the need to consider how behavioral problems are conceptualized and classified in people with ID.

Prevalence and Patterning of Mental Disorders Through Adolescence in 3 Cohorts of Black and White Americans.

The tendency for US blacks to report similar or lower rates of mental disorder than whites is well-established. However, whether these disparities are stable across cohorts of black and white Americans is not well understood. In the current study, we examined black-white differences in the lifetime prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, mood, anxiety, impulse control, and substance use disorders and any mental disorders across 3 cohorts of blacks and whites aged 4-18 years. Using merged data from the National Comorbidity Survey Replication (2001-2003) and the National Comorbidity Survey Adolescent Supplement (2001-2004), we observed a change in the black-white patterning of mental disorder between 1957 and 2004. Blacks born during 1957-1969 reported lower rates of anxiety disorders than their white counterparts (odds ratio (OR) = 0.69, 95% confidence interval (CI): 0.52, 0.91); blacks born during 1970-1982 reported no difference in the rates of anxiety disorders relative to whites (OR = 0.97, 95% CI: 0.76, 1.25); and blacks born during 1983-1991 reported higher rates of anxiety disorders than whites (OR = 1.30, 95% CI: 1.18, 1.43). Similar but less distinct trends were observed for mood disorders, impulse control disorders, and any disorders. Our results suggest that the black-white patterning of mental disorder in the United States has changed across cohorts, to the disadvantage of black Americans.

Physical Abuse and Adolescent Sexual Behaviors: Moderating Effects of Mental Health Disorders and Substance Use.

The purpose of the current study was to examine the direct effects of child physical abuse on sexual behaviors and whether mental health problems and substance use moderated the associations between exposure to child physical abuse and sexual behavioral practices among adolescents who participated in the National Comorbidity Survey-Adolescent Supplement (NCS-A). The data show statistically significant relationships between physical abuse and risky sexual behaviors for youth who met the clinical criteria for lifetime Posttraumatic Stress Disorder (PTSD) and reported marijuana use. Data from future studies can inform sexual health practice development with adolescents and emerging adults with a history of physical abuse, marijuana use/abuse and PTSD. These findings underscore the importance of exploring presence of symptoms associated with PTSD and marijuana use as part of a comprehensive biopsychosocial assessment for physically abused adolescents and emerging adults to determine if they are engaging in risky sexual behaviors.

School and Family Correlates of Positive Affect in a Nationally Representative Sample of US Adolescents

Research on psychological wellbeing has received far less attention than mental illness and has created a gap in our understanding of positive mental health. This research is even more sparse among adolescents. The present study examined the correlates of one measure of psychological wellbeing, positive affect, in the adolescent population. Two dimensions of school support (teacher–student relationship and student engagement) and family support (family communication and family closeness) were examined. Because previous studies suggest these correlates may be affected by race and gender, analysis was conducted in the total sample and in disaggregated subpopulations. A nationally representative sample of US adolescents (n = 10,148) from the National Comorbidity Survey—Adolescent Supplement was analyzed in this study. Structural equation models were used for analysis. Latinos reported significantly lower positive affect than Whites. Males reported higher levels of positive affect than females. Blacks and Latinos reported lower perceptions of family communication than Whites and higher school emotional support than Whites. Females reported lower family communication, lower family closeness, and higher school support than males. Analysis revealed that among the total sample, all dimensions of school and family support measured were correlates of positive affect. When the total sample was divided by gender and race there were marked differences in the relationship between school and family support across subpopulations. Males and Whites most closely resembled the total sample while the relationship between dimensions of school and family support were distinct for females and racial ethnic minorities. This study provides an examination of how psychosocial mechanisms operate similarly and differently across adolescent subgroups. In line with other studies, findings provide evidence of differences by race and gender. This study is relevant to social workers because the findings have implications for both assessment and intervention.

The Links Between Social Anxiety Disorder, Insomnia Symptoms, and Alcohol Use Disorders: Findings From a Large Sample of Adolescents in the United States

Social anxiety disorder (SAD) is associated with increased risk of developing an alcohol use disorder (AUD). Most of the current literature has focused on the role of acute stress responding in this relation; however, both SAD and AUDs also are linked to insomnia symptoms (i.e., difficulty falling or staying asleep). As adolescence is a sensitive period for the onset of these disorders, the present study examined if insomnia symptoms might partially account for the SAD-AUD link in a large sample of adolescents. Data from the National Comorbidity Survey–Adolescent Supplement were examined. Participants (N = 10,140) completed interviews to assess past 12-month SAD and AUD diagnostic status as well as insomnia symptoms. Analyses tested whether insomnia symptoms accounted for a significant proportion of the SAD-AUD relation. Results indicated that insomnia symptoms were positively related to both SAD and AUD status, and the relation between SAD and AUD status was significantly reduced when insomnia symptoms were included in the model. Findings remained significant after controlling for the effects of age, gender, posttraumatic stress disorder, major depressive disorder, and other drug dependence status. Experimental examination and intensive longitudinal assessment of these relationships are needed before strong conclusions can be inferred about causality and temporal relationships. The current findings do indicate insomnia may be an important indirect and stigma-free treatment target to address in prevention and treatment efforts for SAD, AUDs, and their co-occurrence.

Targeted Estimation of the Relationship Between Childhood Adversity and Fluid Intelligence in a US Population Sample of Adolescents.

Many studies have shown inverse associations between childhood adversity and intelligence, although most are based on small clinical samples and fail to account for the effects of multiple co-occurring adversities. Using data from the 2001-2004 National Comorbidity Survey Adolescent Supplement, a cross-sectional US population study of adolescents aged 13-18 years (n = 10,073), we examined the associations between 11 childhood adversities and intelligence, using targeted maximum likelihood estimation. Targeted maximum likelihood estimation incorporates machine learning to identify the relationships between exposures and outcomes without overfitting, including interactions and nonlinearity. The nonverbal score from the Kaufman Brief Intelligence Test was used as a standardized measure of fluid reasoning. Childhood adversities were grouped into deprivation and threat types based on recent conceptual models. Adjusted marginal mean differences compared the mean intelligence score if all adolescents experienced each adversity to the mean in the absence of the adversity. The largest associations were observed for deprivation-type experiences, including poverty and low parental education, which were related to reduced intelligence. Although lower in magnitude, threat events related to intelligence included physical abuse and witnessing domestic violence. Violence prevention and poverty-reduction measures would likely improve childhood cognitive outcomes.

Associations among adolescent sleep problems, emotion regulation, and affective disorders: Findings from a nationally representative sample

Sleep problems in youth reliably forecast the development of anxiety and mood disorders, presumably due to increased emotional difficulties. However, precise emotional mechanisms have yet to be delineated. The current study investigated how sleep problems in adolescence are associated with different emotion regulation strategies, and how sleep and psychiatric risk may be indirectly associated via poor emotion regulation. This study utilized data from the National Comorbidity Survey-Adolescent Supplement, a nationally representative sample from the United States (N = 10,148; age range 13–18 years). A diagnostic interview determined if adolescents qualified for a mood or anxiety disorder within the past year. Participants provided reports of their sleep, emotion regulation, and current life stress. Adolescents who reported greater sleep problems were more likely to qualify for a mood or anxiety disorder and generally reported poorer emotion regulation strategy use, even when accounting for demographic characteristics and current stress. Specifically, adolescents with greater sleep problems reported less problem solving, and greater avoidance, suppression, rumination, and acceptance. Sleep problems were indirectly associated with anxiety disorders through greater suppression and rumination, and indirectly associated with mood disorders through greater rumination and lower problem solving. Although cross-sectional, this study extends current research by suggesting that certain emotion regulation strategies may be more difficult for youth struggling with sleep problems, and provides initial evidence that poor emotion regulation may be one factor contributing to sleep-based psychiatric risk. These findings can inform more efficacious intervention efforts.

Activity-specific pathways among duration of organized activity involvement, social support, and adolescent well-being: Findings from a nationally representative sample

Using data from N = 10,148 American youth (Mage = 15.18) who participated in the National Comorbidity Survey Adolescent Supplement, we tested whether duration of involvement in specific organized activities was associated with different sources of social support, and whether these links explained the health-related benefits affiliated with participation. Duration of involvement in certain activities was differentially associated with support from peers, teachers, and other adults, and many of these links partially mediated associations between involvement and well-being. Specifically, greater duration of sports involvement was indirectly associated with higher self-esteem and greater physical activity through greater adult support. Greater duration of club involvement was indirectly associated with greater physical activity through higher adult support and greater duration of music involvement was indirectly associated with lower substance use and greater self-esteem through greater teacher support. Prolonged engagement in specific activities may cultivate certain types of supportive relationships, which may promote adolescent well-being.

Trauma Exposure and Externalizing Disorders in Adolescents: Results From the National Comorbidity Survey Adolescent Supplement

Exposure to violence and other forms of potentially traumatic events (PTEs) are common among youths with externalizing psychopathology. These associations likely reflect both heightened risk for the onset of externalizing problems in youth exposed to PTEs and elevated risk for experiencing PTEs among youth with externalizing disorders. In this study, we disaggregate the associations between exposure to PTEs and externalizing disorder onset in a population-representative sample of adolescents. We analyzed data from 13- to 18-year-old participants in the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A) (N= 6,379). Weighted survival models estimated hazard ratios (HRs) for onset of oppositional defiant disorder (ODD), conduct disorder (CD), and substance use disorders (SUDs) associated with PTEs, and for exposure to PTEs associated with prior-onset externalizing disorders. Multiplicative interaction terms tested for effect modification by sex, race/ethnicity, and household income. All types of PTEs were associated with higher risk for SUD (HRs= 1.29-2.21), whereas only interpersonal violence (HR= 2.49) was associated with onset of CD and only among females. No associations were observed for ODD. Conversely, ODD and CD were associated with elevated risk for later exposure to interpersonal violence and other/nondisclosed events (HRs= 1.45-1.75). Externalizing disorders that typically begin in adolescence, including SUDs and CD, are more likely to emerge in adolescents with prior trauma. ODD onset, in contrast, is unrelated to trauma exposure but is associated with elevated risk of experiencing trauma later in development. CD and interpersonal violence exposure exhibit reciprocal associations. These findings have implications for interventions targeting externalizing and trauma-related psychopathology.

Are there sensitive periods when child maltreatment substantially elevates suicide risk? Results from a nationally representative sample of adolescents.

Although child maltreatment is a well documented risk factor for suicidal behavior, little is known about whether the timing of child maltreatment differentially associates with risk of suicidal ideation, suicide plans, or suicide attempts. The goal of this study was to examine whether a first exposure to physical or sexual abuse during specific developmental periods significantly elevated risk for suicidal behavior in adolescents. Data came from the National Comorbidity Survey Adolescent Supplement, a population-based sample of US adolescents aged 13-18 years old (n = 9,272). Using discrete time survival analysis, we assessed the association between timing of first abuse (early childhood: ages 0-5; middle childhood: ages 6-10; adolescence: ages 11-18) and suicidal ideation, plans, and attempts. Exposure to either physical or sexual abuse increased the odds of reporting suicidal ideation (odds ratio [OR] = 5.06 and OR = 3.56, respectively), plans (OR = 3.63 and OR = 3.58, respectively), and attempts (OR = 5.80 and OR = 4.21, respectively), even after controlling for sociodemographic covariates and psychiatric disorders. However, the timing of physical and sexual abuse exposure was unassociated with suicidal behavior (all p values >.05). Exposure to child maltreatment is strongly associated with risk for adolescent suicidal behaviors, though this association did not vary based on the developmental timing of first exposure. These findings suggest that prevention efforts should be implemented throughout early development and target all children, regardless of when they were first exposed.

The Impact of Pharmacotherapy on Substance Use in Adolescents With Attention-Deficit/Hyperactivity Disorder: Variations Across Subtypes

ABSTRACTObjective: The primary purpose of this study was to investigate the impact of attention-deficit/hyperactivity disorder (ADHD) pharmacotherapy on the risk of substance use within each ADHD subtype. Methods: The study used data from the National Comorbidity Survey-Adolescent supplement, a nationally representative sample of US adolescents (ages 13–18) collected from 6,483 adolescent-parent interviews conducted between 2001 and 2004. ADHD was categorized into three subtypes: ADHD-predominantly hyperactive-impulsive type (ADHD-H); ADHD-predominantly inattentive type (ADHD-I); and ADHD-combined type (ADHD-C) using Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Substance use information was obtained from the adolescents’ interview. The impact of ADHD-pharmacotherapy on substance use was examined using multivariable logistic regression analysis. Results: Among the adolescents with ADHD, ADHD pharmacotherapy significantly associated with reduced risk of substance use (OR = 0.53, 95%CI [0.31–0.90]); with regards to ADHD subtypes, ADHD pharmacotherapy is negatively associated with substance use in adolescents with ADHD-C (OR = 0.53, 95%CI [0.24–0.97]) and those with ADHD-H (OR = 0.23, 95% CI [0.07–0.78]), but it did not have statistically significant effect on risk of substance use in those with ADHD-I subtype (OR = 0.49, 95%CI [0.17–1.39]). Among the group who never received ADHD-pharmacotherapy before the interview, individuals with ADHD-H and ADHD-C had a similar risk of substance use compared to adolescents with ADHD-I (ADHD-C: OR = 1.5, 95%CI [0.77–2.95] and ADHD-H: OR = 2.10, 95%CI [0.87–4.95]). Conclusions: Adolescents with ADHD were equally susceptible to future substance use disregard their ADHD subtypes. Receipt of pharmacotherapy could decrease risk of substance use in adolescents with ADHD-H and ADHD-C, but it may not affect risk of substance use among individuals with ADHD-I.

Sleep Patterns and Mental Health Correlates in US Adolescents

To investigate systematically the associations of sleep patterns with a range of mental disorders and other outcomes among a nationally representative sample of US adolescents. Using the National Comorbidity Survey Adolescent Supplement, a nationally representative cross-sectional survey of 10 123 US adolescents 13-18 years of age, we assessed associations between adolescent-reported sleep patterns (tertiles of weeknight bedtime, weeknight sleep duration, weekend bedtime delay, and weekend oversleep) and past-year mental disorders based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, smoking, injury, suicidality, and perceived mental and physical health, assessed via direct diagnostic interview. The average weeknight bedtime was at 22:37 and sleep duration was 7.72 hours. Average weekend bedtime delay was 1.81 hours and average weekend oversleep was 1.17 hours. Later weeknight bedtime, shorter weeknight sleep duration, greater weekend bedtime delay, and both short and long periods of weekend oversleep were associated with increased odds of mood, anxiety, substance use, and behavioral disorders, as well as suicidality, tobacco smoking, and poor perceived mental and physical health. ORs ranged from 1.27 to 2.15. The only outcomes not associated with any sleep patterns were past-year injury and eating disorder. Suboptimal sleep patterns were associated with an array of mental disorders and other health-related outcomes among adolescents. Abnormal sleep patterns may serve as markers of prodromal or untreated mental disorders among adolescents, and may provide opportunities for prevention and intervention in mental disorders.

Chronology of Onset of Mental Disorders and Physical Diseases in Mental-Physical Comorbidity - A National Representative Survey of Adolescents.

BackgroundThe objective was to estimate temporal associations between mental disorders and physical diseases in adolescents with mental-physical comorbidities.MethodsThis article bases upon weighted data (N = 6483) from the National Comorbidity Survey Adolescent Supplement (participant age: 13–18 years), a nationally representative United States cohort. Onset of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition lifetime mental disorders was assessed with the fully structured World Health Organization Composite International Diagnostic Interview, complemented by parent report. Onset of lifetime medical conditions and doctor-diagnosed diseases was assessed by self-report.ResultsThe most substantial temporal associations with onset of mental disorders preceding onset of physical diseases included those between affective disorders and arthritis (hazard ratio (HR) = 3.36, 95%-confidence interval (CI) = 1.95 to 5.77) and diseases of the digestive system (HR = 3.39, CI = 2.30 to 5.00), between anxiety disorders and skin diseases (HR = 1.53, CI = 1.21 to 1.94), and between substance use disorders and seasonal allergies (HR = 0.33, CI = 0.17 to 0.63). The most substantial temporal associations with physical diseases preceding mental disorders included those between heart diseases and anxiety disorders (HR = 1.89, CI = 1.41 to 2.52), epilepsy and eating disorders (HR = 6.27, CI = 1.58 to 24.96), and heart diseases and any mental disorder (HR = 1.39, CI = 1.11 to 1.74).ConclusionsFindings suggest that mental disorders are antecedent risk factors of certain physical diseases in early life, but also vice versa. Our results expand the relevance of mental disorders beyond mental to physical health care, and vice versa, supporting the concept of a more integrated mental-physical health care approach, and open new starting points for early disease prevention and better treatments, with relevance for various medical disciplines.