Depressive symptoms at the age of 12 years and future heavy alcohol use
Introduction
The impact of earlier depression on later alcohol use is still poorly known. Earlier research has shown that psychiatric symptoms are associated with future alcohol and substance use. For example, Hops, Davis, and Lewin (1999) report that substance use established by ages 14–15 can be predicted by academic and social behavior displayed at ages 7–9. It has also been found that depression and externalizing behavior predict heavy alcohol use 3 years later (Kumpulainen, 2000). Furthermore, Burke, Burke, and Rae (1994) reported that the onset of drug abuse and dependence appears to peak in the age interval of 15 to 19 if there is a preexisting mood or anxiety disorder, and at later ages if there is no such disorder. Some researchers, however, suggest that association with drug-using peers is more predictive than earlier psychiatric disturbances (Swaim, Oetting, Edwards, & Beauvais, 1989). Bauman and Ennett (1994), on the other hand, point out that these correlations between individual and peer drug use may primarily be due to adolescent drug users selecting drug-using friends and projecting their own drug use into their reports regarding peers.
Boyle et al. (1992) point out that treating psychiatric disorders only minimally diminishes future alcohol and substance use. In their study, parents' and teachers' reports were used investigating psychiatric disorders, and only conduct disorder as reported by teachers predicted use of alcohol and hard drugs later. The predictive value of the conduct disorder in their study was rather similar to that of adult reported externalizing behavior in the earlier study with the present sample (Kumpulainen, 2000). However, overall depressive symptoms reported by children themselves proved to be of importance as well in our sample. It is known that childhood depression is difficult for adults to notice, and depressive feelings in particular are more reliably reported by children themselves (Rutter & Tuma, 1988). Earlier studies have also shown that adults more readily report behavioral problems in children who report symptoms defined as depressive (Kumpulainen et al., 1996). Studying depression and dysphoria among children is not, however, an easy task, and measures for finding deviance in this respect still have many limitations. One of the most used ratings scales in identifying depression in children is the Children's Depression Inventory (CDI) developed by Kovacs (1981, 1992). Kovacs (1992) herself writes that the CDI is a reliable and reasonably valid measure for finding depression in children, and it can be used both in epidemiological and clinical settings. However, several different cutoffs (between 13 and 20) for identifying depression have been suggested and used in various samples Edelsohn et al., 1992, Kovacs, 1992, Puura et al., 1998. The cutoff on the CDI to indicate depression and dysphoria is far less solid than the cutoffs on several other measures used in psychiatric research like the Children's Behavior Checklist by Achenbach (1991) and the Rutter Scales Rutter et al., 1970, Rutter, 1967. On the other hand, cutoffs, which define those scoring highest (most commonly those scoring above the 90th percentile of the item distribution) on the scale as disturbed or deviant (overall disturbance/deviance), are frequently used at the present time (see, e.g., Fergusson & Hornwood, 1998, Kumpulainen, 2000, Verhulst & van Wattum, 1993). The CDI includes symptoms related to depressive affect and also to the capacity to work and perform as expected, and different components of depression can be extracted by factorisation. According to Kovacs, there are five primary factors on the CDI, and five factor models have since been commonly used in different studies Kumpulainen et al., 1996, Kumpulainen et al., 1998, Mullins et al., 1995. While childhood depression is not unidimensional, and it may be captured by a number of factors (Kovacs, 1992), it could be hypothesised that certain factors of symptoms are more relevant with regard to later alcohol use.
The aim of this study was to determine the relationships between self-reported depressive and psychosomatic symptoms in early teens and heavy use of alcohol 3 years later, and to discover whether certain aspects of depression are more predictive than others in regard to later heavy alcohol use.
Section snippets
Material and methods
This study was based on a sample gathered in a longitudinal research project which has been ongoing in Kuopio, Finland, since 1989. The original sample was composed of children born in 1981 and alive in 1989, when the first part of the study was carried out (Study 1). These children have subsequently been traced twice, first when they were 12 (Study 2) and then when they were 15 (Study 3). Information concerning the data collection process, sample, and methods has been published earlier
Depression and heavy use of alcohol
Children who scored above the 90th percentile of the CDI in Study 2 were considered to be depressive, as were those who scored above the 90th percentile of the BDI in Study 3. If the child was depressive at both time points, the probability of being a heavy user of alcohol was 3.7-fold (95% CL 2.0–6.6) when compared to other children. The probability of being a heavy user of alcohol at the age of 15 years was also increased, compared to other children, if the child was depressive in either
Discussion
This study is based on information gathered at two time points. Information concerning depressive symptoms and deviance was obtained at the age of 12 years and information concerning alcohol use and depression was obtained 3 years later at the age of 15 years. The sample used is largely representative of the child population born in 1981. The response rate was good, although there was some sample attrition, as there is in all longitudinal studies. It is, however, important to remember that
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