Parent, sibling and peer associations with subtypes of psychiatric and substance use disorder comorbidity in offspring
Introduction
Existing studies of risk for psychopathology in the offspring of parents with substance use disorders (SUD) have largely focused on individual disorders (Hartman et al., 2006, Jacob et al., 2003, Xian et al., 2010, Scherrer et al., 2012, Scherrer et al., 2008a, Scherrer et al., 2008b, Marmorstein et al., 2009). While this line of research has identified a wide range of risk factors for specific disorders, we are not aware of previous examinations of the clustering of disorders into subtypes of comorbidity and the familial and environmental characteristics of those subtypes.
Several studies have used latent class analysis (LCA) to characterize the co-occurrence of psychiatric disorders (Kessler et al., 2005). Results from LCA of DSM-IV disorders in adults from the National Comorbidity Survey Replication (NCS-R) suggested there were classes of pure externalizing disorders, pure internalizing disorders and comorbid internalizing and externalizing disorders (Kessler et al., 2005). Subsequent analysis of the NCS and NCS-R data identified classes that could similarly be distinguished by the clustering of internalizing disorders, externalizing disorders, and by the comorbidity of internalizing and externalizing disorders (Vaidyanathan et al., 2011). Overall, the evidence from these and additional reports from other cohorts (Sullivan and Kendler, 1998, Olino et al., 2012, Todorov et al., 2006, Dawson et al., 2010) support several comorbidity subtypes that typically encompass unaffected, internalizing, externalizing, and highly comorbid patterns of SUD and psychiatric disorders.
Parental SUD is associated with increased risk for offspring SUD, externalizing, and internalizing disorders (Dinwiddie and Reich, 1991, Sher, 1991, Chassin et al., 1999, Morgan et al., 2010). It may also confer increased vulnerability for an array of comorbidities which cross externalizing and internalizing domains, and which are characterized by different risk factors and environmental contexts. While offspring studies are designed to examine familial vulnerability to psychopathology, they have not, to our knowledge, investigated other risk factors putatively associated with parental SUDs, such as parenting behaviors and perceived sibling substance use and peer influences, which could be associated with subtypes of offspring comorbidity.
Parenting behavior, sibling and peer influences have been shown to be associated with greater risk of adolescent and young adult alcohol (Barnow et al., 2002) and drug abuse/dependence, both alone (Scherrer et al., 2008a, Scherrer et al., 2008b, Duncan et al., 1996) and comorbid with depression (Martin et al., 2004), anxiety (Lindhout et al., 2009) and conduct disorder (Webster-Stratton and Hammond, 1999). However, the existing literature has not demonstrated that these parenting and peer influences are significantly associated with comorbidity after accounting for familial vulnerability. In addition, the magnitude of familial contributions, parenting and peer influences may vary by patterns of comorbidity. For example, these influences may differ in their association with alcohol abuse/dependence that is comorbid with depression as compared to marijuana abuse/dependence comorbid with conduct disorder.
To address these gaps in the literature, the current study aims to: (1) identify subtypes of comorbidity among alcohol and marijuana abuse/dependence, nicotine dependence, conduct disorder, anxiety disorder and major depressive disorder in adolescents and young adults using latent class analysis, (2) determine if the familial vulnerability associated with parental SUD and internalizing disorders is associated with subtypes of comorbidity, and (3) identify parenting behaviors, early family environmental factors, and perceived sibling and peer influences that are associated with subtypes of comorbidity after accounting for familial vulnerability in an offspring-of-twins design.
Section snippets
Sample
Subjects for the current study were offspring of male twins from the Vietnam Era Twin Registry (VETR; Eisen et al., 1987, Henderson et al., 1990). The VETR comprises male–male twin pairs identified from military discharge files, each of whom served in the military during the Vietnam Era (1965–1975). Twin zygosity, monozygotic (MZ) or dizygotic (DZ), was determined using questionnaires and blood group typing (Eisen et al., 1989). Twin pairs from the VETR were selected for participation in a
Latent class analysis
A 4-class solution provided the best fit to the offspring data based on fit statistics from the Akaike Information Criterion (AIC) and the sample-size-adjusted Bayesian Information Criterion (ABIC), which were lower for the 4 class (AIC = 4322.21, ABIC = 4363.98) than for either the 3 (AIC = 4335.47, ABIC = 4366.42) or the 5-class solutions (AIC = 4325.38, ABIC = 4377.98). The most likely class membership probability was used for class assignment. Fifty-three percent of the sample (n = 443) was assigned to
Discussion
From latent class analyses of 831 offspring aged 12–32, we identified four distinct patterns of substance use and psychiatric disorder that were characterized as (1) unaffected, (2) alcohol abuse/dependence (AUD), (3) comorbid alcohol abuse/dependence, anxiety disorder and major depressive disorder (AUD–MDD–ANX), and (4) comorbid alcohol abuse/dependence, cannabis abuse/dependence, nicotine dependence and conduct disorder (SUD–CD). With the exception of the unaffected class, all patterns of
Role of funding source
This study was supported by NIH Grants AA018146 (McCutcheon) and AA12640, DA14363 (Bucholz) and by the Department of Veterans Affairs Health Services Research and Development Service and the Cooperative Studies Program (Study 992). Dr. Scherrer is also supported by a Career Development Award-2 from the Department of Veterans Affairs Health Services Research and Development Service. Funding sources had no further role in study design; in the collection, analysis and interpretation of data; in
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