Miettunen J, Murray G K, Jones P B, Mäki P, Ebeling H, Taanila A, Joukamaa M, Savolainen J, Törmänen S, Järvelin M-R, Veijola J, Moilanen I
Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Finland.
Department of Psychiatry, University of Cambridge and CPFT, UK.
Psychol Med. 2014 Jun;44(8):1727-38. doi: 10.1017/S0033291713002328. Epub 2013 Sep 13.
Emotional and behavioral problems are commonly associated with substance use in adolescence but it is unclear whether substance use precedes or follows mental health problems. The aim was to investigate longitudinal associations between externalizing and internalizing psychopathology and substance use in a prospective population study design.
The sample was the Northern Finland Birth Cohort 1986 Study (NFBC 1986; n = 6349; 3103 males). Externalizing and internalizing mental health problems were assessed at age 8 years (Rutter scales), substance use and externalizing and internalizing problems [Youth Self-Report (YSR)] at age 15-16 years, and hospital diagnoses for internalizing disorders (age 25) and criminal offences (age 20) from nationwide registers in adulthood.
Externalizing problems at age 8 were associated with later substance use. After adjustment for sociodemographic factors, parental alcohol use and psychiatric disorders, and earlier externalizing and internalizing problems, substance use predicted criminality, especially among males, with the highest odds ratio (OR) for cannabis use [adjusted OR 6.2, 95% confidence interval (CI) 3.1-12.7]. Early internalizing problems were not a risk for later substance use. Female adolescent cannabis (OR 3.2, 95% CI 1.4-7.3) and alcohol (OR 2.1, 95% CI 1.1-4.2) use predicted internalizing disorders in adulthood.
Externalizing problems precede adolescent substance use in both genders, whereas, among boys, substance use also precedes criminal offences. Internalizing problems may follow substance use in females. These associations were robust even when taking into account previous mental health problems.
情绪和行为问题在青少年中通常与物质使用有关，但尚不清楚物质使用是先于还是后于心理健康问题出现。本研究旨在通过前瞻性人群研究设计，调查外化和内化精神病理学与物质使用之间的纵向关联。
样本来自1986年芬兰北部出生队列研究（NFBC 1986；n = 6349；3103名男性）。在8岁时使用Rutter量表评估外化和内化心理健康问题，在15 - 16岁时使用青少年自我报告（YSR）评估物质使用以及外化和内化问题，并从成年期全国登记册获取25岁时内化障碍和20岁时刑事犯罪的医院诊断信息。
8岁时的外化问题与后期物质使用相关。在调整社会人口统计学因素、父母酒精使用和精神疾病以及早期外化和内化问题后，物质使用可预测犯罪行为，尤其是在男性中，大麻使用的优势比（OR）最高[调整后的OR为6.2，95%置信区间（CI）为3.1 - 12.7]。早期内化问题并非后期物质使用的风险因素。女性青少年使用大麻（OR 3.2，95% CI 1.4 - 7.3）和酒精（OR 2.1，95% CI 1.1 - 4.2）可预测成年期的内化障碍。
外化问题在两性中均先于青少年物质使用出现，而在男孩中，物质使用也先于刑事犯罪。内化问题可能在女性物质使用之后出现。即使考虑到先前的心理健康问题，这些关联依然稳健。
