Moderation and mediation in the relationship between mothers' or fathers' serious psychological distress and adolescent substance use: findings from a national sample

Paternal and maternal psychological distress and adolescent health risk behaviors: The role of sensitive periods

INTRODUCTION

Adolescent health risk behaviors are linked to poor physical and mental health outcomes. While past research shows that maternal psychological distress predicts those behaviors, we know less about the role of paternal psychological distress and the role of sensitive periods.

METHODS

Using 11,128 data from families (50.5% female children) from the UK's Millennium Cohort Study, we examined the role of timing of exposure to paternal and maternal psychological distress in engagement in health risk behaviors (smoking, alcohol use, binge drinking, and sexual activity) at age 14. Paternal and maternal psychological distress, measured with the Kessler-6 scale, were assessed at child ages 3, 7, and 11. We performed path analysis, adjusting for key covariates, modeling maternal distress parallel to paternal, and allowing for autoregressive paths.

RESULTS

Paternal distress experienced at age 11 predicted a higher likelihood of smoking at age 14. Maternal distress at age 7 also predicted a higher likelihood of smoking, alcohol use, and binge drinking, but only for boys. Moreover, maternal distress at age 3 was associated with a lower risk for alcohol use. Effects were not replicated in the sensitivity analysis we performed, including only families with resident biological fathers across the study period. Instead, maternal and paternal distress at age 11 raised girls' risk for binge drinking and sexual activity, respectively.

CONCLUSIONS

Parental distress in early childhood does not predict adolescent health risk behaviors. In late childhood, however, both paternal and maternal distress seem to influence the likelihood of engagement in such behaviors.

All in the family: parental substance misuse, harsh parenting, and youth substance misuse among juvenile justice-involved youth

PURPOSE

Research consistently connects parental and youth substance misuse, yet less is known about the mechanisms driving this association among justice-involved youth. We examine whether harsh parenting is an explanatory mechanism for the association between parental substance use and parental mental health and youth substance use disorder in a sample of justice-involved youth.

METHODS

Data were drawn from the Northwestern Juvenile Project, a large-scale longitudinal survey of mental health and substance misuse in a representative sample of youth in juvenile detention. Harsh parenting, child maltreatment, youth alcohol and cannabis use disorder, and parental substance misuse and mental health were assessed among 1,825 detained youth (35.95% female) at baseline, three-year follow-up, and four-year follow-up.

RESULTS

At baseline, over 80% of youth used alcohol and/or cannabis; at the four-year follow-up, 16.35% and 19.69% of the youth were diagnosed with alcohol and cannabis use disorder, respectively. More than 20% of youth reported their parent misused substances and 6.11% reported a parent had a severe mental health need. Black youth experienced significantly fewer types of harsh parenting compared to White youth. Multivariate path analyses revealed harsh parenting mediated the association between parental substance misuse and mental health on youth alcohol and cannabis use disorder. Harsh parenting that does not rise to the level of child maltreatment mediated the association between parental substance misuse and mental health on youth alcohol use disorder; in contrast, child maltreatment did not mediate these associations. Multigroup analyses revealed the effect of harsh parenting on youth alcohol and cannabis use disorder did not vary across sex or race-ethnic subgroups.

CONCLUSIONS

Harsh parenting represents one mechanism for the intergenerational continuity of alcohol and cannabis misuse and should be regularly assessed for and addressed in juvenile justice settings.

Parent's psychopathological profiles and adolescent offspring's substance use disorders

BACKGROUND

Substance use disorders (SUD) represent one of the most important public health problems which has an onset in adolescence. Although substantial data exist on adolescent substance use, studies examining the role of parental psychopathological profiles on adolescent offspring SUD are lacking. Thus, this study aimed to identify parental psychopathological profiles, and to examine the extent to which these profiles are associated with SUD in their offspring.

METHOD

Our analytic sample comprised 5887 adolescents (48.60% boys; M = 15.07 years, SD = 1.46) from the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), whose biological parents responded to the Parent Self-Administered Questionnaire. Parental psychopathological profiles were identified by means of latent class analysis.

RESULTS

Different psychopathological profiles were identified in fathers and mothers. Among fathers, two psychopathological profiles were found: "normative class" (low psychopathological symptoms and drug use) and "high psychopathology class" (high psychopathological symptoms and drug use). Among mothers, three psychopathological profiles were found: "normative class" (low psychopathological symptoms and drug use), "high psychopathology class" (high psychopathological symptoms and drug use), and "suicide class" (low psychopathological symptoms and drug use, but high on suicidal ideation or suicidal attempt). Father's high psychopathology profile was significantly associated with adolescent's illicit drug abuse. Mother's high psychopathology profile was significantly associated with adolescent's nicotine dependence, alcohol or illicit drug abuse.

CONCLUSIONS

Family-based interventions should include skills training in reducing parental SUD and other mental health problems.

Parent Psychological Distress: A Moderator of Behavioral Health Intervention Outcomes among Justice-Involved Adolescents

We examined whether pre-existing parent psychological distress moderated juvenile offenders' substance use, sexual risk, and mental health outcomes in a randomized trial. Forty-seven parent-adolescent dyads received either Family-based Affect Management Intervention (FAMI) for adolescent substance use and HIV prevention or adolescent-only Health Promotion Intervention (HPI). Parents' self-reported distress at baseline significantly moderated adolescents' self-reported marijuana use and alcohol use but not other outcomes at 3 months postintervention, producing crossover interactions. FAMI outperformed HPI when parents reported high-level distress, whereas HPI outperformed FAMI when parents reported low-level distress. This finding that the relative efficacy of interventions depends on the severity of parent psychological distress could inform efforts to match substance-using, justice-involved adolescents with the intervention most likely to benefit them.

The relationship between parental mental illness and/or substance use disorder on adolescent substance use disorder: Results from a nationally representative survey

This study examines the relationship between parental comorbid mental illness and substance use disorder (SUD) and adolescent SUD. Nationally representative parent-child data pooled over six years from the National Survey on Drug Use and Health (NSDUH) was utilized in this study. Multivariable regression analysis was conducted to determine whether adolescents living with parents who have mental health disorders and/or substance use disorder are themselves more likely to have SUD while controlling for potential confounding variables. The results show that comorbid AMI-SUD in mothers is significantly associated with adolescent SUD after controlling for potential confounders. However, comorbid AMI-SUD in fathers is not associated with adolescent SUD when other controls are included in the model. The association of parental comorbid AMI-SUD with adolescent SUD indicates that parental behavioral health treatment may be a preventive measure to protect their children and may function as an important deterrent to adolescent SUD.

A implicação das atitudes parentais no uso de drogas na adolescência

Este estudo transversal quantitativo objetivou analisar a relação entre a percepção do adolescente sobre as atitudes parentais e sua tendência ao uso de substâncias psicoativas. Participaram 487 adolescentes brasileiros. Para análise estatística foi utilizado o Modelo Logístico Multinomial, sobre o qual se aplicou o método Stepwise para seleção de variáveis. O tabaco, o álcool e a maconha foram relacionados com as variáveis de maior influência no uso, abuso ou dependência. Verificou-se que um pai pouco afetivo, aumenta a chance de o filho ser dependente de tabaco (p = 0.001). A mãe sendo pouco afetivatem maior possibilidade de ter um filho dependente do tabaco (p = 0.001). O controle do pai é um fator protetivo para a experimentação do tabaco (p = 0.023) e para a dependência da maconha (p = 0.042). A relação entre o uso de drogas na adolescência e a percepção que o jovem tem das atitudes de seus pais ficou evidenciada.

Variations in parental monitoring and predictions of adolescent prescription opioid and stimulant misuse

OBJECTIVE

This study examined relations between adolescents' family structures, social ties, and drug-related attitudes, and their misuse of prescription opioids and stimulants. Different relationships were anticipated for the substances based on prior research highlighting varying motivations for their use.

METHOD

Based on an earlier model of adolescent substance misuse, two path analytic models were tested using data from 12 to 17 year olds in the 2012 U.S. National Survey on Drug Use and Health (NSDUH: N=17,399).

RESULTS

Female respondents reported higher levels of parental warmth, as did youth from wealthier families. Greater parental monitoring was reported by adolescents from wealthier and intact families. Parental monitoring and warmth predicted adolescents' social ties and individual differences associated with drug use, and both variables predicted prescription opioid and stimulant misuse. Contrary to previous research, for adolescents aged 12 to 14, high levels of parental monitoring, while positively associated with attitudes and social ties, also predicted higher rates of prescription stimulant misuse when combined with low levels of parental warmth. Results were cross-validated with data from the 2011 NSDUH.

CONCLUSIONS

Analyses highlighted the importance of understanding and differentiating the underlying factors associated with adolescent prescription stimulant and opioid misuse, and the role of parental behaviors in prevention.

Economic hardship and adolescent problem drinking: family processes as mediating influences

Alcohol is the most commonly used substance among adolescents in the United States, and adolescent drinking is associated with various health risk behaviors. Given the prevalence and consequences of adolescent drinking, understanding family factors that contribute to adolescent drinking is an important area for research. This study used three waves of data to evaluate a family stress model in which economic hardship is indirectly related to adolescent problem drinking through maternal psychological distress, parenting behaviors, and adolescent externalizing behaviors. Respondents included 300 mothers (71 % Black, 29 % White) and adolescents (51 % male) who were interviewed when adolescents were ages 10, 14, and 16. Structural equation modeling was used to test the hypothesized model and findings supported our hypothesized model. Economic hardship was positively related to maternal psychological distress. Maternal psychological distress was negatively associated with supportive parenting, which in turn was negatively associated with externalizing problems. Externalizing problems were positively associated with problem drinking. In support of our hypothesis regarding indirect effects, economic hardship was indirectly related to problem drinking through maternal psychological distress, parenting behaviors, and adolescent externalizing problems. The findings from this study highlight the role of family processes in adolescent problem drinking.

Alcohol and substance abuse in parentally bereaved youth

OBJECTIVE

Little is known about the role of parental bereavement regarding alcohol and substance abuse. Our aim was to examine whether the incidence of alcohol and substance abuse is higher in parentally bereaved youth and, if so, what might explain this increased incidence.

METHOD

In a longitudinal population-based study conducted between November 2002 and December 2012, the incidence of alcohol and substance abuse or dependence (ASAD) during a period of 5 years was examined (using DSM-IV criteria) in 235 youth whose parents died of suicide, accident, or sudden natural death and 178 demographically similar nonbereaved youth.

RESULTS

In a period that covered 5 years subsequent to the death, bereaved youth had an increased incidence and earlier time to onset of ASAD relative to nonbereaved controls (incident rate ratio = 2.44; 95% CI, 1.17-5.56). Additionally, youth over the age of 13 years (hazard ratio [HR] = 6.68; 95% CI, 3.22-13.89; P < .001), those who developed a disruptive behavior disorder (HR = 7.55; 95% CI, 1.83-31.22; P = .005), and those who had greater functional impairment (HR = 0.93; 95% CI, 0.90-0.95; P < .001) were at increased risk for ASAD. However, after adjusting for the above-noted variables, the relationship between parental bereavement and pathological youth alcohol and substance use was not statistically significant (HR = 1.73; 95% CI, 0.79-3.81; P = .17).

CONCLUSIONS

Bereaved youth are at greater risk for ASAD than their nonbereaved counterparts, especially adolescent boys with disruptive behavior disorders. The effect of bereavement was explained by its overall impact on greater functional impairment in bereaved offspring. Interventions that help to improve offspring functioning and that prevent or attenuate the development of disruptive behavior disorders have the potential to prevent ASAD in bereaved youth.

Substance abuse treatment for adolescents: how are family factors related to substance use change?

Parental involvement in adolescents' substance abuse treatment is highly recommended, even though the mechanisms explaining how this favors youths' recovery are not well understood. The present study examines the association between (1) changes in adolescents' substance use and parenting practices, as measured by adolescent self-disclosure and parental warmth; (2) changes in mothers' mental health and their parenting practices, and (3) parental use of services offered by substance abuse treatment centres, parenting practices and adolescent substance use. In total, 147 adolescents and 69 mothers participated in this study. Participants were assessed upon adolescent admission into treatment, as well as at three- and six-month follow-up. Results show an association between improved maternal mental health and greater parental warmth, as perceived by adolescents. In addition, greater parental use of treatment services was found to be associated with greater adolescent self-disclosure and greater reduction of adolescent substance use. Finally, greater adolescent self-disclosure and parental warmth were both associated with lower adolescent substance use. These findings underscore the need to facilitate parents' access to and involvement in treatment of adolescents. The parent-adolescent relationship and the mental health of parents are essential aspects to consider for interventions.

Do adolescent delinquency and problem drinking share psychosocial risk factors? A literature review

Despite the prevalence and damaging effects of adolescent problem drinking, relative to delinquency, far less research has focused on drinking using an integrated theoretical approach. The aim of the current research was to review existing literature on psychosocial risk factors for delinquency and problem drinking, and explore whether integrating elements of social learning theory with an established psychosocial control theory of delinquency could explain adolescent problem drinking. We reviewed 71 studies published post-1990 with particular focus on articles that empirically researched risk factors for adolescent problem drinking and delinquency in separate and concurrent studies and meta-analytic reviews. We found shared risk factors for adolescent delinquency and problem drinking that are encompassed by an extension of psychosocial control theory. The potential of an extended psychosocial control theory providing a parsimonious theoretical approach to explaining delinquency, problem drinking and other adolescent problem behaviours, along with suggestions for future investigations, is discussed.

Adolescence: a foundation for future health

Adolescence is a life phase in which the opportunities for health are great and future patterns of adult health are established. Health in adolescence is the result of interactions between prenatal and early childhood development and the specific biological and social-role changes that accompany puberty, shaped by social determinants and risk and protective factors that affect the uptake of health-related behaviours. The shape of adolescence is rapidly changing-the age of onset of puberty is decreasing and the age at which mature social roles are achieved is rising. New understandings of the diverse and dynamic effects on adolescent health include insights into the effects of puberty and brain development, together with social media. A focus on adolescence is central to the success of many public health agendas, including the Millennium Development Goals aiming to reduce child and maternal mortality and HIV/AIDS, and the more recent emphases on mental health, injuries, and non-communicable diseases. Greater attention to adolescence is needed within each of these public health domains if global health targets are to be met. Strategies that place the adolescent years centre stage-rather than focusing only on specific health agendas-provide important opportunities to improve health, both in adolescence and later in life.