Trajectories of resilience over 25 years of individuals who as adolescents consulted for substance misuse and a matched comparison group

Adolescents with substance use problems in outpatient treatment: a one-year prospective follow-up study focusing on mental health and gender differences

Background

Although several studies have found a high incidence of coexisting mental health problems among adolescents with substance use problems, follow-up studies addressing how these conditions change over time are rare. The study will describe and analyze indications of mental health problems and how various risk factors predict outcomes 1 year after initial treatment contact. In addition, gender-specific risk factors are explored.

Methods

A clinical sample of 455 adolescents (29% girls, median age 17 years) answered a structural interview at baseline and were followed up using official records 1 year after initiated treatment. Bivariate associations and logistic regressions were conducted to analyse the links between risk factors at the individual, social, and structural levels as well as links between various mental illness symptoms at treatment start and indications of mental health problems 1 year later were analysed.

Results

The results show that mental health problems among adolescents largely persisted 1 year after start of outpatient care for substance use problems. Forty-two per cent of the sample displayed indications of mental health problems at follow-up, and registrations for both outpatient treatment and psychiatric medication were more common among the girls. Girls also reported more mental illness symptoms at treatment start than boys did, especially anxiety. Depression and suicidal thoughts had predictive values regarding indications of mental health problems and small cumulative effects were found for 6–10 co-occurring risk factors.

Conclusions

Adolescents with depression and suicidal thoughts at treatment start should yield attention among clinicians as these general risk factors could predict indication of mental health problems at 1 year follow-up effectively. Also, patients with more than six co-occurring risk factors seem more vulnerable for continued mental health problems. Generally, girls displayed a greater mental health and psychosocial burden at treatment initiation and were more likely to show indication of mental health problems at follow-up. These results suggests that girls are more likely to get psychiatric out-treatment parallel to, or after, substance abuse treatment. We recommend further investigation of gender differences and gender-specific needs in substance use treatment.

Mortality among young people seeking residential treatment for problematic drug and alcohol use: A data linkage study

BACKGROUND

Young people with problematic alcohol and other drug (AOD) use are often referred to residential treatment. Subsequent mortality rates among this high-risk group is not known. This study estimates mortality rates and determines causes of death amongst young people referred to residential treatment in Sydney, Australia.

DESIGN

Retrospective data linkage study. Data of young people (13-18 years) referred to a residential treatment service 2001-2015 (n = 3256) linked with Australian death registration data, and followed up to 16 years (2001-2016).

METHODS

Mortality rates (CMRs) and standardised mortality ratios (SMRs, age-, gender-, calendar-year-adjusted) calculated using population mortality rates. Causes of death were analysed using ICD-10 codes for AOD-induced, AOD as contributory and non-AOD related causes.

RESULTS

During follow-up of the cohort (28,838 person-years), 63 people died (71.4 % males; 48 % Indigenous; median age at death = 21.9 years; median follow-up = 5.1years), with 76 % dying before aged 25 years. Overall mortality (SMR = 4.91, 95 % CI: 3.8-6.2; CMR = 2.18/1000 person-years, 95 % CI: 1.7-2.8) was significantly higher than age-gender-matched general population, particularly in females (SMR = 9.55; males: SMR = 4.11; RR: 2.3, 95 % CI: 1.3-4.1). SMRs were not significantly different between treatment groups (SMRs>5.5) and non-attend group (SMR = 3.7) (p = 0.359). Two-thirds of deaths involved AOD, with AOD-induced deaths comprising 42 % and AOD as contributory for 22 % deaths. Overdose, mainly opioids (including opiates), suicide, and transport accidents were major causes of deaths.

CONCLUSION

Very high mortality rates, particularly among females, and the high incidence of overdose and suicide emphasise early screening for those at high-risk, targeted and culturally appropriate interventions, and maximised continuing after-care accessible to young people.

Substance use prevalence rates among migrant and native adolescents in Europe: A systematic review

ISSUES

Migrant adolescents show specific risk and protective factors associated with substance use, but the extent to which prevalence rates differ between migrant and native-born youth in Europe remains unclear. The present study aims to provide a comprehensive review of all available substance use prevalence studies on differences in substance use between migrant and native-born adolescents in Europe.

APPROACH

In this systematic review, PubMed, Medline and Pre-Medline, EMBASE and PsycINFO were searched for articles comparing substance use prevalence rates (tobacco, alcohol, illicit drugs) between migrant and native-born adolescents or young adults aged 11 to 29 years in European countries. The Joanna Briggs Institute prevalence critical appraisal tool was used for quality assessment.

KEY FINDINGS

Fifteen studies met the inclusion criteria. The findings unanimously showed lower alcohol use in migrant compared to native-born adolescents, in particular among migrant adolescents from non-European countries and/or with a Muslim background. For tobacco and illicit drug use, findings were mixed.

IMPLICATIONS

The results suggest a healthier behaviour profile among migrants than among native-born adolescents regarding alcohol use. Therefore, it would be beneficial to develop interventions to support migrant communities in maintaining their healthier alcohol use practices upon arrival in the host country.

CONCLUSION

Compared to native-born adolescents, migrant adolescents are less likely to use alcohol. The findings on tobacco and illicit drug use were mixed. A European standard for surveys regarding substance use among adolescents is needed to investigate fluctuations, causes, and consequences of substance use differences between migrants and natives at the European level.

Conceptualizing resilience in adult mental health literature: A systematic review and narrative synthesis

PURPOSE

This review aims to identify how the term 'resilience' is conceptualized across adult mental health research due to ongoing criticism regarding the lack of consistency in its conceptualization.

METHOD

A systematic search, including hand searches of book chapters, was conducted using search terms ('resilien*') AND ('mental illness' OR 'mental health problem'). Papers were excluded if they did not meet the following criteria: written in English, provide a clear conceptualization of resilience, include only adults (aged 18 + ) in the sample, solely focus on individuals with a primary diagnosis of mental illness, and peer-reviewed. Data were extracted on conceptualizations of resilience, demographic, and diagnostic variables of the study population, publication year, and the research design used. Conceptualizations were combined and collapsed into overarching themes and then refined through joint discussion, consultation with a third reviewer, and input from a larger multidisciplinary team.

RESULTS

Thirty-one texts (6 book chapters, 4 reviews, 2 appraisals/critical evaluations, 1 editorial, and 18 research projects) were included. Two broad understandings of resilience were identified: resilience as a process and resilience as a characteristic of an individual. Processes comprise three themes: 'immunity', 'bouncing back', and 'growth', whilst characteristics are captured in two themes 'personal resources' and 'social resources'.

CONCLUSIONS

These findings suggest that resilience can be conceptualized in a clear and meaningful manner in adult mental health research. The five themes reflect distinct ways of using the term resilience. Whilst each one of them may have merit in future research, it appears beneficial to make clear in research which exact conceptualization of resilience has been adopted.

PRACTITIONER POINTS

When considering and reading about 'resilience', one should be aware that there are different concepts of it. The main difference is between resilience as a personal characteristic and resilience as a process. Therapy may address resilience as a personal characteristic by utilizing individual and social resources. The therapeutic process may be understood as resilience in form of bouncing back and personal growth.

Gene-environment interaction of monoamine oxidase A in relation to antisocial behaviour: current and future directions

Since the pioneering finding of Caspi and co-workers in 2002 that exposure to childhood maltreatment predicted later antisocial behaviour (ASB) in male carriers of the low-activity MAOA-uVNTR allele, frequent replication studies have been published. Two meta-analyses, one in 2006 and the other in 2014, confirmed the original findings by Caspi and co-workers. In the present paper, we review the literature, note some methodological aspects of candidate gene–environment interaction (cG×E) studies and suggest some future directions. Our conclusions are as follows. (1) The direction of the effect in a cG×E model may differ according to the positive and negative environmental background of the population. (2) There is a predictor-intersection problem such that when measuring one type of maltreatment in a person, other kinds of maltreatment often co-occur. Other forms of abuse are implicitly considered in statistical models; therefore, it is difficult to draw conclusions about the effects of timing and the severity of different forms of stressful life events in relation to ASB. (3) There is also an outcome-intersection problem because of the major intersection of ASB and other forms of mental health problems. It is likely that the G×E with MAOA is related to a common unmeasured factor. (4) For the G×E model, in which the effect of the gene on the outcome variable is dependent on other predictor variables, theoretically, hypothesis-driven statistical modelling is needed.

Drinking Status Between Ages 50 and 55 for Men From the San Diego Prospective Study Who Developed DSM-IV Alcohol Abuse or Dependence in Prior Follow-Ups

OBJECTIVE

Although alcohol use disorders (AUDs) are prevalent among older individuals, few studies have examined the course and predictors of AUDs from their onset into the person's 50s. This study describes the AUD course from ages 50 to 55 in participants who developed AUDs according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), during the San Diego Prospective Study (SDPS).

METHOD

Among the 397 university students in the SDPS who were followed about every 5 years from age 20 (before AUD onset), 165 developed AUDs, 156 of whom were interviewed at age 55. Age 50-55 outcomes were compared regarding age 20-50 characteristics. Variables that differed significantly across outcome groups were evaluated using binary logistic regression analyses predicting each outcome type.

RESULTS

Between ages 50 and 55, 16% had low-risk drinking, 36% had high-risk drinking, 38% met DSM-5 AUD criteria, and 10% were abstinent. Baseline predictors of outcome at ages 50-55 included earlier low levels of response to alcohol predicting DSM-5 AUDs and abstinence, higher drinking frequency predicting DSM-5 diagnoses and lower predicting low-risk drinking, higher participation in treatment and/or self-help groups predicting abstinence and lower predicting DSM-5 AUDs, later ages of AUD onset predicting high-risk drinking, and cannabis use disorders predicting abstinent outcomes.

CONCLUSIONS

Despite the high functioning of these men, few were abstinent or maintained low-risk drinking during the recent 5 years, and 38% met DSM-5 AUD criteria. The data may be helpful to both clinicians and researchers predicting the future course of AUDs in their older patients and research participants.

Interactive Voice Response with Feedback Intervention in Outpatient Treatment of Substance Use Problems in Adolescents and Young Adults: A Randomized Controlled Trial

PURPOSE

Substance use disorders and problematic substance use are common problems in adolescence and young adulthood. Brief personalized feedback has been suggested for treatment of alcohol and drug problems and poor mental health. This repeated measurement randomized controlled trial examines the effect of an interactive voice response (IVR) system for assessing stress, depression, anxiety and substance use.

METHODS

The IVR system was used twice weekly over 3 months after treatment initiation, with or without addition of a personalized feedback intervention on stress and mental health symptoms. Both IVR assessment only (control group) and IVR assessment including feedback (intervention group) were provided as an add-on to treatment-as-usual procedures (TAU) in outpatient treatment of substance use problems in adolescents and young adults (N = 73).

RESULTS

By using a mixed models approach, differences in change scores were analyzed over the three-month assessment period. Compared to the control group, the intervention group demonstrated significantly greater improvement in the Arnetz and Hasson stress score (AHSS, p = 0.019), the total Symptoms Checklist 8 score (SCL-8D, p = 0.037), the SCL-8D anxiety sub-score (p = 0.017), and on a summarized feedback score (p = 0.026), but not on the depression subscale. There were no differences in global substance use scores between the intervention group (feedback on mental health symptoms) and the control group.

CONCLUSION

In conclusion, IVR may be useful for follow-up and repeated interventions as an add-on to regular treatment, and personalized feedback could potentially improve mental health in adolescents and young adults with problematic substance use.

Stability and predictors of psychopathic traits from mid-adolescence through early adulthood

High levels of psychopathic traits in youth are associated with multiple negative outcomes including substance misuse, aggressive behavior, and criminality. Evidence regarding stability of psychopathic traits is contradictory. No previous study has examined long-term stability of psychopathic traits assessed with validated clinical measures. The present study examined the stability of psychopathic traits from mid-adolescence to early adulthood and explored adolescent factors that predicted psychopathic traits five years later. The sample included 99 women and 81 men who had consulted a clinic for substance misuse in adolescence. At an average age of 16.8 years, the adolescents were assessed using the Psychopathy Checklist: Youth Version (PCL: YV) and five years later using the PCL-Revised (PCL-R). Additionally, extensive clinical assessments of the adolescents and their parents were completed in mid-adolescence. Among both females and males, moderate to high rank-order stability was observed for total PCL and facet scores. Among both females and males, there was a decrease in the mean total PCL score, interpersonal facet score, affective facet score, and lifestyle facet score. However, the great majority of females and males showed no change in psychopathy scores over the five-year period as indicated by the Reliable Change Index. Despite the measures of multiple family and individual factors in adolescence, only aggressive behavior and male sex predicted PCL-R total scores in early adulthood after taking account of PCL:YV scores. Taken together, these results from a sample who engaged in antisocial behavior in adolescence suggest that factors promoting high psychopathy scores act early in life.

Operationalising resilience in longitudinal studies: a systematic review of methodological approaches

Over the life course, we are invariably faced with some form of adversity. The process of positively adapting to adverse events is known as ‘resilience’. Despite the acknowledgement of 2 common components of resilience, that is, adversity and positive adaptation, no consensus operational definition has been agreed. Resilience operationalisations have been reviewed in a cross-sectional context; however, a review of longitudinal methods of operationalising resilience has not been conducted. The present study conducts a systematic review across Scopus and Web of Science capturing studies of ageing that posited operational definitions of resilience in longitudinal studies of ageing. Thirty-six studies met inclusion criteria. Non-acute events, for example, cancer, were the most common form of adversity identified and psychological components, for example, the absence of depression, the most common forms of positive adaptation. Of the included studies, 4 used psychometrically driven methods, that is, repeated administration of established resilience metrics, 9 used definition-driven methods, that is, a priori establishment of resilience components and criteria, and 23 used data-driven methods, that is, techniques that identify resilient individuals using latent variable models. Acknowledging the strengths and limitations of each operationalisation is integral to the appropriate application of these methods to life course and longitudinal resilience research.

Examining the pathways for young people with drug and alcohol dependence: a mixed-method design to examine the role of a treatment programme

INTRODUCTION

Young people with drug and alcohol problems are likely to have poorer health and other psychosocial outcomes than other young people. Residential treatment programmes have been shown to lead to improved health and related outcomes for young people in the short term. There is very little robust research showing longer term outcomes or benefits of such programmes. This paper describes an innovative protocol to examine the longer term outcomes and experiences of young people referred to a residential life management and treatment programme in Australia designed to address alcohol and drug issues in a holistic manner.

METHODS AND ANALYSIS

This is a mixed-methods study that will retrospectively and prospectively examine young people's pathways into and out of a residential life management programme. The study involves 3 components: (1) retrospective data linkage of programme data to health and criminal justice administrative data sets, (2) prospective cohort (using existing programme baseline data and a follow-up survey) and (3) qualitative in-depth interviews with a subsample of the prospective cohort. The study will compare findings among young people who are referred and (a) stay 30 days or more in the programme (including those who go on to continuing care and those who do not); (b) start, but stay fewer than 30 days in the programme; (c) are assessed, but do not start the programme.

ETHICS AND DISSEMINATION

Ethics approval has been sought from several ethics committees including a university ethics committee, state health departments and an Aboriginal-specific ethics committee. The results of the study will be published in peer-reviewed journals, presented at research conferences, disseminated via a report for the general public and through Facebook communications. The study will inform the field more broadly about the value of different methods in evaluating programmes and examining the pathways and trajectories of vulnerable young people.

What is resilience? An Integrative Review of the empirical literature

AIM

To use systematic methods to examine how resilience is defined in empirical research.

BACKGROUND

Resilience is a term that is increasingly being used to describe and explain the complexities of individual and group responses to traumatic and challenging situations. It is now frequently mentioned in relation to many areas of nursing practice, including research. Given the increasing use of the term, it is timely to examine how resilience has been defined in empirical research.

DESIGN

An integrative review of the empirical literature (2000-2015).

DATA SOURCES

Three health-related databases were searched: Medline, PsycINFO and the Cumulative Index for Nursing and Allied Health (CINAHL). Reference and citation tracking was performed on all articles included in the review.

REVIEW METHODS

The methods described by Whittemore and Knafl were used to guide this review. Two reviewers were involved in screening articles for inclusion and in the data extraction process. Data were synthesized using the constant comparative method of analysis.

RESULTS

One hundred articles were included in the final data analysis. The most significant finding of the review was that there is no universal definition of resilience. There were, however, some common themes identified: rising above, adaptation and adjustment, dynamic process, 'ordinary magic' and mental illness as a marker of resilience.

CONCLUSION

Despite the increasing use of the term 'resilience', this review has identified that there is no universal definition of resilience adopted in the research literature. Further research is required to explore this construct in the context of nursing.

Potencial resiliente en familias con adolescentes que consumen y no consumen alcohol

La adolescencia es un periodo crítico para el inicio y desarrollo de las adicciones. Para los padres de familia cada vez son más comunes las adversidades relacionadas con el consumo de alcohol de sus hijos adolescentes y las consecuencias para el desarrollo de estos. El propósito de esta investigación fue establecer si el funcionamiento familiar predice el potencial resiliente de padres con hijos adolescentes que consumen o no consumen alcohol. Participaron de manera voluntaria 140 padres y madres de familia con un hijo adolescente que presentaba un consumo riesgoso de alcohol y 187 padres y madres de familia con un adolescente que no consumía alcohol. Se aplicaron las escalas de Potencial Resiliente (García & García- Méndez, 2013) y Funcionamiento Familiar (García-Méndez, Rivera, Reyes-Lagunes, Díaz-Loving, 2006). Los resultados de las regresiones paso a paso indican que el Potencial Resiliente de los padres y madres de familia es predicho por los factores de Ambiente Familiar Positivo y Mando/Problemas en la Expresión de las Emociones de la Escala de Funcionamiento Familiar.

Epidemiology of substance use disorders

Epidemiological studies of substance use and substance use disorders (SUDs) have provided an abundance of data on the patterns of substance use in nationally representative samples across the world (Degenhardt et al. in PLoS Med 5(7):e141, 2008; Johnston et al. in Monitoring the future national survey results on drug use, 1975-2010, vol I, secondary school students. Institute for Social Research, Ann Arbor, MI, 2011; SAMHSA in Results from the 2010 national survey on drug use and health: summary of national findings, vol NSDUH, series H-41, HHS Publication No. (SMA) 11-4658. Substance Abuse and Mental Health Services Administration, Rockville, 2011). This paper presents a summary of the goals, methods, and recent findings on the epidemiology of substance use and disorders in the general population of adults and adolescents and describes the methods and findings on the genetic epidemiology of drug use disorders. The high 12-month prevalence rates of substance dependence in US adults (about 12 % for alcohol and 2-3 % for illicit drugs) approximate those of other mental disorders as well as chronic physical disorders with major public health impact. New findings from the nationally representative samples of US youth reveal that the lifetime prevalence of alcohol use disorders is approximately 8 % and illicit drug use disorders is 2-3 % (Merikangas et al. in J Am Acad Child Adolesc Psychiatry 49(10):980-989, 2010; Swendsen et al. in Arch Gen Psychiatry 69(4):390-398, 2012; SAMHSA in Results from the 2010 national survey on drug use and health: summary of national findings, vol NSDUH, Series H-41, HHS Publication No. (SMA) 11-4658. Substance Abuse and Mental Health Services Administration, Rockville, 2011). The striking increase in prevalence rates from ages 13 to 18 highlight adolescence as the key period of development of SUDs. The application of genetic epidemiological studies has consistently demonstrated that genetic factors have a major influence on progression of substance use to dependence, whereas environmental factors unique to the individual play an important role in exposure and initial use of substances. Identification of specific susceptibility genes and environmental factors that influence exposure and progression of drug use may enhance our ability to prevent and treat SUDs.

Anxiety disorders among offenders with antisocial personality disorders: a distinct subtype?

OBJECTIVES

about 50% of men with antisocial personality disorder (APD) present a comorbid anxiety disorder. Historically, it was thought that anxiety limited criminal activity and the development of APD, but recent evidence suggests that heightened responsiveness to threat may lead to persistent violent behaviour. Our study aimed to determine the prevalence of APD comorbid with anxiety disorders among offenders and the association of these comorbid disorders with violent offending.

METHOD

a random sample of 495 male penitentiary inmates completed an interview using the Diagnostic Interview Schedule. After excluding men with psychotic disorders, 279 with APD were retained. All authorized access to their criminal records.

RESULTS

two-thirds of the prisoners with APD presented a lifetime anxiety disorder. Among them, one-half had the onset of their anxiety disorder before they were aged 16 years. Among the offenders with APD, those with, compared with those without, anxiety disorders presented significantly more symptoms of APD, were more likely to have begun their criminal careers before they were aged 15 years, to have diagnoses of alcohol and (or) drug abuse and (or) dependence, and to have experienced suicidal ideas and attempts. While there were no differences in the mean number of convictions for violent offences between APD prisoners with and without anxiety disorders, more of those with anxiety disorders had been convicted of serious crimes involving interpersonal violence.

CONCLUSIONS

among men with APD, a substantial subgroup present life-long anxiety disorders. This pattern of comorbidity may reflect a distinct mechanism underlying violent behaviour and signalling the need for specific treatments.