Institute of Criminology and Legal Policy, University of Helsinki, Finland; Karolinska Institutet, Stockholm, Sweden.
Karolinska Institutet, Stockholm, Sweden.
J Am Acad Child Adolesc Psychiatry. 2021 May;60(5):593-603. doi: 10.1016/j.jaac.2020.06.009. Epub 2020 Jul 1.
The pathways from internalizing psychopathology to substance misuse remain largely unclear. We estimated associations between childhood internalizing problems and subsequent substance misuse in 2 family-based samples. We also investigated sex differences and the role of externalizing comorbidity.
We studied associations of childhood internalizing psychopathology with register-based substance misuse after age 13 years. Sample 1 included all individuals born in Sweden from 1984 to 2000 (N = 1,768,516). Depressive and anxiety disorders were included as register-based International Classification of Diseases Ninth Revision (ICD-9) or Tenth Revision (ICD-10) diagnoses before age 13. Sample 2 was a subsample within the population sample, the Child and Adolescent Twin Study in Sweden (CATSS) twin cohort (n = 12,408; born 1992-1998), with mood and anxiety problems assessed at age 9/12 by parents. In both samples, substance misuse was defined as an ICD-9/10 alcohol/drug use disorder or an alcohol/drug-related criminal conviction until December 2013. To account for familial effects, stratified analyses were conducted within siblings and twin pairs.
In the population sample, both depressive (hazard ratio [HR] = 2.75, 95% CI = 2.36-3.20) and anxiety disorders (HR = 1.52, 95% CI = 1.35-1.73) were associated with substance misuse. Childhood mood problems (HR = 2.28, 95% CI = 1.69-3.08) were associated with substance misuse in the CATSS sample. The associations were partially explained by familial factors, and comorbid externalizing disorders explained the associations in men but not in women.
Childhood mood problems were associated with substance misuse, but familial factors shared by siblings partially explained the associations. The relationship of anxiety with substance misuse was complex and depended on measurement and the type of anxiety disorder. Internalizing problems may be especially important for substance misuse risk in women.
内化心理病理学与物质滥用之间的途径仍很大程度上不清楚。我们在两个基于家庭的样本中估计了儿童期内化问题与随后物质滥用之间的关联。我们还调查了性别差异和外化共病的作用。
我们研究了儿童期内化心理病理学与 13 岁后基于登记的物质滥用之间的关联。样本 1包括 1984 年至 2000 年在瑞典出生的所有人（N=1,768,516）。抑郁和焦虑障碍被包括为基于登记的国际疾病分类第 9 版（ICD-9）或第 10 版（ICD-10）诊断，发生在 13 岁之前。样本 2是瑞典儿童和青少年双胞胎研究（CATSS）双胞胎队列中的人群样本的子样本（n=12,408；生于 1992-1998 年），父母在 9/12 岁时评估情绪和焦虑问题。在两个样本中，物质滥用的定义为 ICD-9/10 酒精/药物使用障碍或酒精/药物相关刑事定罪，直至 2013 年 12 月。为了考虑家族效应，在兄弟姐妹和双胞胎对中进行了分层分析。
在人群样本中，抑郁障碍（危险比[HR] = 2.75，95%CI = 2.36-3.20）和焦虑障碍（HR = 1.52，95%CI = 1.35-1.73）均与物质滥用相关。儿童期情绪问题（HR=2.28，95%CI=1.69-3.08）与 CATSS 样本中的物质滥用相关。家族因素部分解释了这些关联，而共患的外化障碍解释了男性的关联，但不能解释女性的关联。
儿童期情绪问题与物质滥用有关，但兄弟姐妹共有的家族因素部分解释了这些关联。焦虑与物质滥用之间的关系复杂，取决于测量方法和焦虑障碍的类型。内化问题可能对女性的物质滥用风险尤为重要。
