SPECIAL COMMUNICATION
Relationship Between Depression and Substance Use Disorders in Adolescent Women During the Transition to Adulthood

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ABSTRACT

Objectives

To examine the continuity of substance use disorder (SUD) in adolescent women during the transition to adulthood and to assess psychosocial functioning associated with SUD. Furthermore, to examine concurrent and longitudinal relationships between major depressive disorder (MDD) and SUD during this developmental transition.

Method

One hundred fifty-five women, aged 17 to 19 years, were recruited from 3 high schools and were followed annually for 5 years. Comprehensive diagnostic and psychosocial assessments were performed with standardized instruments. The primary outcome measures included MDD and SUD during follow-up in those with and without a prior history of MDD or SUD, and psychosocial functioning associated with SUD.

Results

The 5-year incidence of SUD was 9.6% and, by the end of follow-up, 18.7% had a lifetime episode. Prior SUD significantly increased the risk for SUD diagnosis during the study. Co-occurrence of MDD and SUD was high during adolescent and early adult years, with episodes of both disorders occurring in close temporal proximity. SUD also predicted MDD over time, but the reverse was not true. After controlling for the effects of MDD on social adjustment, SUD was associated with significant impairment in school functioning.

Conclusions

These results suggest that the risk for new onset and recurrence of SUD is high during the developmental transition to adulthood. SUD during this developmental period is associated with significant school-related problems. The findings also suggest that SUD and MDD frequently co-occur during the post-high school transition in women. Given the significant psychosocial dysfunction associated with these illnesses, early detection of these problems and effective intervention are crucial.

Section snippets

Sample

Participants were recruited from the senior classes of 3 local public high schools, chosen to be demographically representative of Los Angeles County high schools with respect to ethnicity, proportion graduating, and proportion attending college after graduation (Los Angeles County Office of Education, 1991). During the spring semester, research staff entered 12th grade classrooms at each school and distributed screening questionnaires to all female students present. Five-hundred thirteen women

Prevalence of SUD During the 5 Years After High School Graduation

Of 150 women providing follow-up information, 21 (14%) reported SUD during follow-up. Of these, 13 had a first episode of SUD, yielding a first incidence rate of 9.6% over 5 years. The RCSAST measure yielded a prevalence rate of 13.6% for significant substance-related problems at 5 years after graduation. Risk for SUD occurred throughout the follow-up period. After accounting for differential follow-up interval within the sample, by the end of first year the probability of SUD diagnosis was

DISCUSSION

The study examined the continuity of SUD in adolescent women during the post-high school transition. Moreover, cross-sectional and longitudinal reciprocal relationships between depression and SUD were examined using both categorical and dimensional measures. There was a strong continuity of SUD from adolescent to early adult years. Depression and SUD were related concurrently. Furthermore, SUD increased the risk for MDD over 5 years, but the reverse was not true. SUD was associated with

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    This research was supported in part by the William T. Grant Foundation (Dr. Hammen) and NIMH Scientist Development Award MH01419 (Dr. Rao).

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