Research reportThe impact of co-occurring mood and anxiety disorders among substance-abusing youth
Introduction
Epidemiological studies consistently report high rates of comorbid mental health problems amongst adolescents with substance use disorders (SUD) (Armstrong and Costello, 2002, Kandel et al., 1999, Rohde et al., 1996). For example, in a large community sample of over 1500 adolescents (aged 14–18 years) in the United States, Rohde et al. (1996) identified that more than 80% of those with an alcohol use disorder had some form of lifetime psychopathology, with almost half (48%) reporting a history of depression. Similarly, in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, 32% of adolescents (aged 14–17 years) with a current SUD had a co-occurring mood disorder (Kandel et al., 1999).
High rates of comorbid mental health problems have also been reported amongst adolescents within inpatient or residential treatment settings, although figures vary considerably (Bukstein et al., 1992, Grella et al., 2001, Hovens et al., 1994, Stowell and Estroff, 1992). Deykin et al. (1992) reported that approximately 25% of adolescents (mean age 16.5 years) in residential treatment for SUD (n = 223) met lifetime DSM-III-R criteria for major depression. Hovens et al. (1994) reported an even higher rate amongst adolescents (n = 52) hospitalised for substance abuse (mean age 16.5 years), with 85% demonstrating case level psychiatric comorbidity, and 48% reporting dysthymia or other depressive disorders.
Adolescents with SUD and co-occurring mood and anxiety disorders also demonstrate a greater severity of substance use and associated problems (Grella et al., 2001, Riggs et al., 1995, Rowe et al., 2001, Shane et al., 2003). Adolescent drug users with comorbid PTSD describe more interpersonal problems and health complaints (Giaconia et al., 2000), while depressed adolescents with SUD report more academic problems, suicide attempts and impaired role functioning (Lewinsohn et al., 1998). Those with comorbid affective disorders also have a poorer rehabilitation prognosis. Brown et al. (1994) reported that adolescents with emotional problems who were admitted to an inpatient drug treatment program had higher rates of relapse at 2-year follow-up, whilst depressive symptoms at intake were found to predict non-improvement amongst adolescents who completed a drug treatment program (Dobkin et al., 1998).
The majority of clinical studies of young drug users focus on the age range 12 to 18 years, and typically recruit from residential programs (mostly inpatient treatment programs or juvenile detention centres) or inpatient psychiatric services (DeMilio, 1989, Grilo et al., 1995, Hovens et al., 1994, Stowell and Estroff, 1992). Few studies examine comorbidity rates in older adolescence and emerging adulthood, particularly within community treatment settings. Yet, this is the age group at greatest risk of developing comorbid mental health and substance use problems (Kessler et al., 1996, Wittchen et al., 1998). Indeed, utilizing data from the US National Comorbidity Survey, Kessler et al. (1996) reported that the co-occurrence of SUD with mental health disorders was highest amongst those aged 15–24 years. However, the traditional (albeit arbitrary) segregation of ‘child and adolescent’ treatment programs from ‘adult’ services at age 18 often creates difficulties for young people, as neither adolescent nor adult services directly cater for the developmental needs of older adolescents and young adults. In order to determine the treatment needs of young people presenting to services, it is imperative that we better understand the impact of comorbidity in this population.
The current study aimed to address the paucity of data on older adolescents and young adults in community drug treatment, by examining the impact of comorbid mood and anxiety disorders amongst a sample of young drug users (aged 16–22 years). Based upon previous literature, we hypothesised that (1) those with comorbid depressive and anxiety disorders would demonstrate higher levels of psychological dependence and a greater level of poly-drug use; and (2) those with comorbid depressive and anxiety disorders would report more substance-related problems, health risk behaviours and a poorer quality of life.
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Participants
One hundred young people (aged 16 to 22 years) were recruited from two urban youth drug treatment services located in Melbourne, Australia, during the period January 2004 to January 2005. Participants were recruited through flyers advertising the study throughout the two services, as well as information relayed through their respective case workers. Participants were excluded if they were unable to speak and read English, were unable to give informed consent or if they appeared intoxicated,
Sample characteristics
Participants ranged in age from 16 to 22 years (mean age 19.4, SD 1.7), and had spent a mean time of 20.3 months (SD 21.4 months) in treatment. Twelve percent had completed Year 12 (i.e., completed high school), while 54% had completed Year 10. Fifty-three percent of the sample was male. The male and female subjects had similar social and demographic characteristics, however the males as a group were significantly older (mean age 19.8 years, SD 1.4) than the females (mean age 18.9 years, SD
Discussion
This study demonstrated high rates of lifetime (69%) and current (50%) mental health disorders in a sample of older adolescents and young adults attending community youth drug treatment services. Almost half the sample (48.5%) fulfilled criteria for a current mood or anxiety disorder, particularly female participants (60.9%). Rates of MDD and PTSD were particularly high, and were both associated with significant morbidity.
Rates of current (27%) and lifetime (46%) MDD in this sample were higher
Acknowledgements
The study was supported by a grant from the beyondblue Victorian Centre of Excellence in Depression and Related Disorders and the Colonial Foundation. The authors wish to thank the staff and young people at YSAS and DASWest who supported this project.
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