Felton Julia W, Kofler Michael J, Lopez Cristina M, Saunders Benjamin E, Kilpatrick Dean G
University of Maryland,College Park.
Florida State University.
Dev Psychopathol. 2015 Nov;27(4 Pt 1):1367-83. doi: 10.1017/S0954579414001473.
This study tests competing models of the relation between depression and polysubstance use over the course of adolescence. Participants included a nationwide sample of adolescents (N = 3,604), ages 12 to 17 at study Wave 1, assessed annually for 3 years. Models were tested using cohort-sequential latent growth curve modeling to determine whether depressive symptoms at baseline predicted concurrent and age-related changes in drug use, whether drug use at baseline predicted concurrent and age-related changes in depressive symptoms, and whether initial levels of depression predicted changes in substance use significantly better than vice versa. The results suggest a transactional model such that early polysubstance use promotes early depressive symptoms, which in turn convey elevated risk for increasing polysubstance use over time, which in turn conveys additional risk for future depressive symptoms, even after accounting for gender, ethnicity, and household income. In contrast, early drug use did not portend risk for future depressive symptoms. These findings suggest a complicated pattern of interrelations over time and indicate that many current models of co-occurring polysubstance use and depressive symptoms may not fully account for these associations. Instead, the results suggest a developmental cascade, in which symptoms of one disorder promote symptoms of the other across intrapersonal domains.
本研究检验了青少年时期抑郁症与多种物质使用之间关系的相互竞争模型。参与者包括一个全国性的青少年样本（N = 3604），在研究的第1波中年龄为12至17岁，连续3年每年进行评估。使用队列序列潜在增长曲线模型对模型进行检验，以确定基线时的抑郁症状是否预测了药物使用的同时期变化和与年龄相关的变化，基线时的药物使用是否预测了抑郁症状的同时期变化和与年龄相关的变化，以及抑郁的初始水平是否比反之更能显著预测物质使用的变化。结果表明存在一种相互作用模型，即早期的多种物质使用会引发早期抑郁症状，这反过来又会增加随着时间推移多种物质使用增加的风险，而这反过来又会增加未来出现抑郁症状的额外风险，即使在考虑了性别、种族和家庭收入之后也是如此。相比之下，早期药物使用并未预示未来出现抑郁症状的风险。这些发现表明随着时间推移存在一种复杂的相互关系模式，并表明当前许多关于同时出现的多种物质使用和抑郁症状的模型可能无法完全解释这些关联。相反，结果表明存在一种发展级联，其中一种障碍的症状会在人际领域中促进另一种障碍的症状。
