Manhica Hélio, Straatmann Viviane S, Lundin Andreas, Agardh Emilie, Danielsson Anna-Karin
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
BJPsych Open. 2022 Mar 15;8(2):e71. doi: 10.1192/bjo.2022.37.
Poverty in adolescence is associated with later drug use. Few studies have evaluated the role of adolescent psychiatric disorders in this association.
This study aimed to investigate mediation and interaction simultaneously, enabling the disentanglement of the role of adolescent psychiatric disorders in the association between poverty in adolescent and later drug use disorders.
A national cohort study of 634 223 individuals born in 1985-1990, residing in Sweden between the ages of 13 and 18 years, was followed from age 19 years until the first in-patient or out-patient care visit with a diagnosis of drug use disorder. A four-way decomposition method was used to determine the total effect of the association with poverty and possible mediation by and/or interaction with diagnosis of adolescent psychiatric disorders.
The hazard ratios for drug use disorders among those experiencing poverty compared with those 'never in poverty' were 1.40 (95% CI, 1.32-1.63) in females and 1.43 (95% CI, 1.37-1.49) in males, after adjusting for domicile, origin and parental psychiatric disorders. Twenty-four per cent of this association in females, and 13% in males, was explained by interaction with and/or mediation by adolescent psychiatric disorders.
Part of the association between poverty in adolescence and later drug use disorders was due to mediation by and/or interaction with psychiatric disorders. Narrowing socioeconomic inequalities in adolescence might help to reduce the risks of later drug use disorders. Interventions aimed at adolescents with psychiatric disorders might be especially important.
青少年时期的贫困与日后的药物使用有关。很少有研究评估青少年精神障碍在这种关联中的作用。
本研究旨在同时调查中介作用和交互作用，以厘清青少年精神障碍在青少年贫困与日后药物使用障碍之间的关联中所起的作用。
一项全国队列研究，对634223名1985 - 1990年出生、13至18岁居住在瑞典的个体进行跟踪，从19岁开始随访，直至首次因药物使用障碍诊断而进行住院或门诊治疗。采用四向分解法确定与贫困关联的总效应以及青少年精神障碍诊断的中介作用和/或交互作用。
在调整居住地址、出身和父母精神障碍后，经历贫困的女性与“从未贫困”的女性相比，药物使用障碍的风险比为1.40（95%置信区间，1.32 - 1.63），男性为1.43（95%置信区间，1.37 - 1.49）。女性中这一关联的24%，男性中13%可由与青少年精神障碍的交互作用和/或中介作用来解释。
青少年贫困与日后药物使用障碍之间的部分关联归因于与精神障碍的中介作用和/或交互作用。缩小青少年时期的社会经济不平等可能有助于降低日后药物使用障碍的风险。针对患有精神障碍的青少年的干预措施可能尤为重要。
