Does the Direction of Effects in the Association Between Depressive Symptoms and Health-Risk Behaviors Differ by Behavior? A Longitudinal Study Across the High School Years

doi:10.1016/j.jadohealth.2011.05.016

Journal of Adolescent Health

Volume 50, Issue 2, February 2012, Pages 140-147

https://doi.org/10.1016/j.jadohealth.2011.05.016 Get rights and content

Abstract

Purpose

Adolescence is associated with the onset of depressive symptoms as well as significant increases in health-risk behaviors. Potential explanations for the direction of effects in the association between depressive symptoms and health-risk behaviors include the self-medication/acting out hypothesis (i.e., early depressive symptoms predict increases in risk behaviors over time) and the failure hypothesis (i.e., early participation in health-risk behaviors predicts increases in depressive symptoms over time). The purpose of the present longitudinal study was to assess these competing hypotheses across the high school years, and to examine whether the direction of effects (and therefore the self-medication/acting out and failure hypotheses) may differ depending on the type of risk behavior under consideration.

Methods

The sample consisted of 4,412 adolescents (49% female) who were followed up from grade nine to 12. Adolescents reported on their depressive symptoms and six health-risk behaviors (frequency of alcohol use, amount of alcohol consumed per drinking episode, cigarette smoking, marijuana use, hard drug use, and delinquency). Analyses were conducted with dual trajectory growth curve modeling.

Results

Adolescents who had higher depressive symptoms in grade nine reported faster increases than their peers in smoking, marijuana, and hard drug use across the high school years, supporting the self-medication hypothesis. The failure hypothesis was not supported.

Conclusion

The results are important because they suggest that by targeting depressive symptoms during early adolescence, treatment programs may prevent increases in the frequency of these risk behaviors later in adolescence.

Section snippets

Participants

Students from eight high schools encompassing a school district in Ontario, Canada, were surveyed in each grade of high school. This cohort-sequential study was part of a larger project, and involved 4,412 participants (49% females). The overall participation rate across the longitudinal study ranged from 83% to 86%. Consistent with the broader Canadian population [22], 92.4% of the participants were born in Canada, and the most common ethnic backgrounds reported other than Canadian were

Results

Table 2 outlines the means and standard deviations, and Table 3 outlines the correlations among depressive symptoms and health-risk behaviors. All LGC analyses were conducted using MPlus 6.0 (Muthén & Muthén, Los Angeles, CA) [28]. Depressive symptoms, alcohol frequency, alcohol amount, and marijuana use exhibited acceptable skewness and kurtosis (i.e., skewness: <3, and kurtosis: <10 [29]), and were analyzed using maximum likelihood estimation. Cigarette smoking, hard drug use, and delinquency

Discussion

The present study specifically examined the self-medication/acting out versus failure hypotheses as possible explanations for long-term associations between depressive symptoms and health-risk behaviors, and found support for the self-medication hypothesis only. Higher levels of depressive symptoms in grade nine seem to set the stage for faster increases in cigarette smoking, marijuana use, and hard drug use across the high school years in comparison with adolescents with lower levels of

Acknowledgment

The second author acknowledges funding received from the Social Sciences and Humanities Research Council of Canada.

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Original articleDoes the Direction of Effects in the Association Between Depressive Symptoms and Health-Risk Behaviors Differ by Behavior? A Longitudinal Study Across the High School Years

Abstract

Purpose

Methods

Results

Conclusion

Section snippets

Participants

Results

Discussion

Acknowledgment

J Am Acad Child Adolesc Psychiatry

Soc Sci Med

Epidemiology of depressive mood in adolescents: An empirical study

Arch Gen Psychiatry

Developmental trajectories of co-occurring depressive, eating, antisocial, and substance abuse problems in female adolescents

J Abnorm Psychol

Major depression and cigarette smoking: Results of a 21-year longitudinal study

Psychol Med

Antisocial behavior and depressive symptoms: Longitudinal and concurrent relations

Adolescence

Depressive symptoms and cigarette smoking among middle adolescents: Prospective associations and intrapersonal and interpersonal influences

J Consult Clin Psychol

Drinking to regulate positive and negative emotions: A motivational model of alcohol use

J Pers Soc Psychol

The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence

Am J Psychiatry

Stress and smoking in adolescence: A test of directional hypotheses

Health Psychol

Unmasking masked depression in children and adolescents

Am J Psychiatry

Background characteristics and responses to treatment of two types of institutionalized delinquent boys

Crim Justice Behav

Co-occurrence of conduct problems and depressive symptoms in early adolescent boys: IIA 2-year follow-up at grade 8

Dev Psychopathol

The association of tobacco smoking and depression in adolescence: Evidence from the United States

Subst Use Misuse

A social interactional approach: Antisocial boys, Vol 4

Alcohol involvement and dysphoria: A longitudinal examination of gender differences from late adolescence to adulthood

Psychol Add Behav

Course, co-occurrence, and longitudinal associations of emotional disturbance and delinquency from adolescence to young adulthood: A six-year three-wave study

J Youth Adolesc

Latent growth modeling of the relationship between depressive symptoms and substance use during adolescence

Psychol Add Behav

Problem behavior and psychosocial development: A longitudinal study of youth

Where is the syndrome?Examining co-occurrence among multiple problem behaviors in adolescence

J Consult Clin Psychol

Original article
Does the Direction of Effects in the Association Between Depressive Symptoms and Health-Risk Behaviors Differ by Behavior? A Longitudinal Study Across the High School Years