Factors associated with inpatient and outpatient treatment for children and adolescents with serious mental illness.

OBJECTIVE: This study describes the distribution of children and adolescents in psychiatric inpatient and outpatient facilities and identifies factors associated with the selection of individuals into inpatient versus outpatient care. SAMPLE DATA: The data are from a 1986 nationally representative sample surveyed by the National Institute of Mental Health. RESULTS: Results indicate that the vast majority of children and adolescents with psychiatric problems receive outpatient treatment rather than inpatient care. Factors that predict psychiatric hospitalization rather than outpatient care are (1) public or private insurance coverage versus no insurance; (2) previous hospitalization; (3) psychiatric diagnosis of affective or psychotic disorders versus conduct disorders, adjustment disorders, drug and alcohol abuse, and other disorders; and (4) age, with adolescents more likely to be hospitalized than children. CONCLUSIONS: Further research is needed to explore the role of insurance in mental health sorting processes. Moreover, systematic, controlled research is needed to determine how different financing strategies affect mental health outcomes for children and adolescents.

Cessation from cocaine use.

This study explores factors that are related to cessation of cocaine use versus continued use in a non-clinical sample of American adolescents and young adults interviewed at three points in time. At time 3, cocaine stoppers (n = 104) and current users (n = 267) are compared in terms of age and sex, patterns of contemporary and prior drug use, life-style characteristics and a selected group of social learning variables. The data indicate that cocaine stoppers and users have similar patterns of alcohol, marijuana, cigarette, cocaine and other drug use at time 1 and time 2, but that users have higher time 3 frequencies of alcohol, marijuana and other drug use. In addition, those youth who stop are more likely to be married and have children, although the groups do not differ in terms of career/school status. The data lend partial support to a social learning perspective and indicate that differential associations (friends' use) and punishments (negative consequences) are most strongly related to cessation. In addition, users report more dependency symptoms than do stoppers.

Adolescence-limited versus persistent delinquency: extending Moffitt's hypothesis into adulthood.

The authors examined how neuropsychological, personality, and environmental risk factors and their interactions were related to trajectories of delinquent behavior from adolescence to adulthood. Four waves of longitudinal data from 698 male participants, ages 12-18 at Time 1 and ages 25-31 at Time 4, were included in the analyses. Using a growth mixture model approach, 4 trajectories were identified: nondelinquents, adolescence-limited delinquents, adolescence-to-adulthood-persistent delinquents, and escalating delinquents. Five risk factors distinguished escalating from persistent delinquents and 5 also distinguished nondelinquents from the 3 delinquency trajectories. Persistent delinquents scored significantly higher than adolescence-limited delinquents on only one risk factor, disinhibition. Overall, few of the factors that are related to childhood-to-adolescence persistence were associated with persistence in delinquency beyond adolescence.

A longitudinal investigation of alcohol use and aggression in adolescence.

Data from a prospective, longitudinal study of males and females tested at age 12, 15 and 18 years are used to study the relationship between alcohol use and aggression. Prevalence rates for alcohol use are similar for males and females. However, prevalence rates for aggressive behavior and alcohol-related aggression among females are lower than those for males and too low to permit meaningful analysis. Two series of nested structural equation models examine the interrelationships between alcohol use and aggressive behavior over time for all males in the sample and for male alcohol users only. The findings indicate that early aggressive behavior leads to increases in alcohol use and alcohol-related aggression, but that levels of alcohol use are not significantly related to later aggressive behavior. Thus, the data suggest that alcohol-related aggression is engaged in by aggressive people who drink. These data lend support to other research that indicates that early aggressive and antisocial behavior is predictive of later alcohol-related problems.

Becoming married, depression, and alcohol problems among young adults.

This paper examines three questions regarding the relationship between marriage and mental health, specifically depression and alcohol problems. First, does marriage lead to improved mental health compared to never marrying? Second, do any mental health benefits of marriage primarily accrue to men? Third, what qualitative aspects of marriage are related to psychological disorder? We explore these questions in a longitudinal sample of young adults sampled at age 21 and again at age 24. We find no indication that marriage reduces depression. Married people do report fewer alcohol problems than the never-married but this could be due to the selection of less problematic drinkers into marriage. We also fail to find that men receive disproportionate mental health benefits from marriage. Finally, we find that marital conflict is associated with problem drinking for men and depression for women. The results indicate the importance of considering stage in the life cycle and gender-sensitive indicators of psychological disorder in studies of marriage and mental health.

Adolescent drug use, psychological distress, and physical symptoms.

The longitudinal interrelationships among general drug use, psychological distress, and physical symptoms were investigated in a three wave panel study of a community sample of adolescents interviewed when they were 12, 15, and 18 years of age. Results did not provide any support for the hypothesis that adolescents use drugs in general to cope with pre-existing psychological distress and physical symptoms. In contrast, the results supported the hypothesis that general drug use contributes to physical and psychological impairments over time. However, such drug-induced psychological distress and physical symptoms only occurred in later adolescence (from ages 15 to 18), and no evidence of impairments due to general drug use or specific alcohol use was found in early adolescence (from ages 12 to 15). Psychological distress and physical symptoms influenced each other over time, and physical symptoms partially mediated longitudinal changes in psychological distress. However, general drug use did not mediate any longitudinal changes in psychological distress and physical symptoms.

How the negative and positive aspects of partner relationships affect the mental health of young married people.

The relationship between marriage and positive mental health is one of the most established findings in the stress literature. Few studies, however, examine the problematic as well as the supportive impacts of marriage on mental health. This paper uses a cohort of young adults who were sampled at 18, 21, or 24 years of age and resampled seven years later when they were married at 25, 28, or 31. It examines what factors are associated with the quality of marital relationships, the relative impact of and balance between negative and positive partner relationships on mental health, and sex differences in the determinants and outcomes of marital quality. The results indicate that the structural strains of parenthood and financial need and their interaction predict problematic and supportive spousal relationships and the difference in the levels of these two relationships. Problematic relationships with spouses have considerably stronger impacts than supportive relationships on depression. However, the difference between the amounts of supportive and problematic relationships with spouses has a greater impact on mental health than levels of either considered separately. Finally, relational quality has a greater impact on the mental health of wives than husbands. These findings indicate the importance of considering how marriage affects mental health in complex, rather than in straightforward, ways.

Marijuana use, introspectiveness, and mental health.

Conflicting evidence suggests that marijuana use may be associated with either positive or negative mental health. This study explores the possibility that the association of marijuana use with mental health differs among various subgroups of users. Specifically, we investigate the hypothesis that marijuana use and the personality disposition of introspectiveness interact in their effects on psychological well-being. Results support this hypothesis and show that marijuana use is associated significantly with psychological distress for highly introspective individuals. In contrast, marijuana use has no such association for those low on introspectiveness. Additional evidence shows that marijuana use involves primarily self-oriented cognitive and emotional experiences for highly introspective individuals, whereas for those low on introspectiveness it is characterized more often by perceptual distortions and sensorimotor sensations.

The use of multiple outcomes in stress research: a case study of gender differences in responses to marital dissolution.

This study tests the hypothesis that the use of a single outcome variable distorts the mental health consequences of a stressor among different social groups. It uses the example of the impact of marital dissolution on the mental health of men and women to see whether rates of depression and alcohol problems rise disproportionately among women and men, respectively, who experience the same type of stressor. The sample compares 465 married subjects with 127 separated or divorced subjects drawn from a longitudinal study of 25-, 28-, and 31-year-olds. With controls for earlier rates of depression and alcohol problems, as well as for secondary stressors connected with separation and divorce, women undergoing marital dissolution show significantly greater increases in rates of depression compared to men who experience this stressor. Although men report far more alcohol problems than women, rates of these problems do not increase disproportionately among men, compared to women, during marital dissolution. The results indicate that the use of gender-typical mental health outcomes reduce, but do not eliminate,gender differences in the response to marital dissolution. They also indicate the need to use outcomes that typify how each group under study responds to stressful social conditions.

The impact of childhood abuse and neglect on adult mental health: a prospective study.

This paper examines the impact of three types of victimization in childhood--sexual abuse, physical abuse, and neglect--on lifetime measures of mental health among adults. In contrast to research that relies on retrospective recall of childhood victimization, this work uses a prospective sample gathered from records of documented court cases of childhood abuse and neglect in a midwestern city around 1970. These subjects were interviewed about twenty years later. In addition, this research compares outcomes of the 641 members of the abuse and neglect group with a matched control group of 510 persons who did not have documented cases of abuse or neglect. The results indicate that men who were abused and neglected as children have more dysthymia and antisocial personality disorder as adults than matched controls, but they did not have more alcohol problems. Abused and neglected women report more symptoms of dysthymia, antisocial personality disorder, and alcohol problems than controls. After controlling for stressful life events, however, childhood victimization had little direct impact on any lifetime mental health outcome. This research indicates the importance of adopting an approach that places childhood victimization in the context of other life stressors and of prospective changes over the life course.

Psychopathology as a predictor of adolescent drug use trajectories.

The authors examined early psychopathology as a predictor of trajectories of drug use from ages 13-18 years. Six years of annual data were analyzed for 506 boys using a mixed effects polynomial growth curve model. They tested whether distinct measures of psychopathology and behavioral problems (i.e., attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, depression, and violence) assessed in early adolescence could prospectively predict level and change in alcohol and marijuana use. Higher levels of all of the types of psychopathology predicted higher levels of alcohol use, and higher levels of attention-deficit/hyperactivity disorder, conduct disorder, and violence predicted higher levels of marijuana use. Only conduct disorder predicted linear growth in alcohol use, and none of the measures predicted growth in marijuana use. The results suggest that drug use prevention programs should target youths with early symptoms of psychopathology.

Longitudinal stability and dimensional structure of problem drinking in adolescence.

A multivariate analysis of dimensions of problem drinking and their stability across time is conducted through a series of confirmatory factor analyses (as opposed to exploratory factor analyses used in previous studies), using self-report data from a longitudinal sample of adolescents and youth. Analyses are performed separately by age and gender. Results indicate that traditional measures of problem drinking represent at least two distinct dimensions--intensity of use and use-related problems--rather than a unitary construct for adolescent males and females. The results also suggest that dimensions of problem drinking remain relatively stable from 15 to 21 years of age, except that alcohol-related problems are unstable for males from 15 to 18 years of age.

Towards the assessment of adolescent problem drinking.

Longitudinal data were obtained from a nonclinical sample of 1,308 male and female adolescents covering the age range from 12 to 21. Factor analyses of 52 symptoms and/or consequences of alcohol use yielded three problem dimensions. In addition, a unidimensional, 23-item scale (the Rutgers Alcohol Problem Index, RAPI) was constructed with an internal consistency of .92. Correlations between RAPI and alcohol-use intensity were moderately strong for all age groups at each test occasion (ranging from .20 to .57), yet low enough to suggest that identification of problem drinkers requires both types of measures. The results suggest that the RAPI may be a useful tool for the standardized and efficient assessment of problem drinking during adolescence.

An investigation of factors related to intoxicated driving behaviors among youth.

This study assessed the prevalence of driving under the influence of alcohol and marijuana among a sample of 18 and 21 year olds and examined the across-time relationships between intoxicated driving and consumption, risk-taking/impulsive orientation, negative intrapersonal state, stress and use of alcohol and other drugs to cope with problems. Self-report data were collected from 556 men and women, ages 18 and 21, at two points in time. The data indicated that at least a minimum level of drinking and driving, as well as smoking marijuana and driving, is engaged in at least once for the majority of youth. Correlations between eight driving behaviors and consumption variables indicated that frequency of substance use was strongly related to frequency of driving while intoxicated (DWI). Regression analyses revealed that coping use of substances was the strongest predictor of driving under the influence. A path model examining the effect of stress, negative states and risk-taking orientations (T1) on driving under the influence as mediated through coping use (T2) was tested. Results showed that risk-taking orientation was the strongest predictor of DWI, both directly and indirectly (as mediated through coping use). Findings suggest that impaired driving may be part of a global syndrome of risk-taking behavior and is an activity engaged in most often by those who frequently use alcohol and other drugs to cope with problems.

The correspondence between saliva and breath estimates of blood alcohol concentration: advantages and limitations of the saliva method.

Increased awareness of the devastating effects of alcohol misuse on our highways, workplaces and families, as well as on the individual, has resulted in increased social pressure to enforce driving-while-intoxicated laws and to develop educational, prevention and treatment programs. One aspect of this movement is to develop improved sobriety testing to ensure that laws are properly and fairly enforced and that there is compliance with abstinence in treatment. Although sophisticated blood and breath testing devices are available, field tests suggest that saliva alcohol tests based on alcohol-oxidase methodology offer advantages in portability, ease of administration, and cost and time efficiency. We evaluated the validity and reliability of a simple saliva test, based on the enzymatic oxidation of alcohol by alcohol oxidase, for estimating blood alcohol concentration. Ten subjects consumed various doses of alcohol and multiple saliva samples were obtained using alcohol sensitive saliva strips that change color in proportion to the concentration of alcohol. The reflectance values of reacted saliva strips were read by meter and estimates of blood alcohol concentration in the range of 10-90 mg/dl were compared to simultaneous estimates obtained from breath analysis using a Breathalyzer Model 900A. We also examined how alcohol levels changed over time in alcohol reacted saliva strips. The results of regression analysis indicated that the saliva strips and the Breathalyzer gave reasonably close estimates (r = 0.89-.90) of blood alcohol concentration. Correlation coefficents for the values of saliva samples read by meter measured at 10 minutes and at 18 days after collection ranged from .90 to 1.00, showing high test-retest reliability despite storage.(ABSTRACT TRUNCATED AT 250 WORDS)

Predictors of smoking cessation from adolescence into young adulthood.

Although smoking cigarettes is hazardous to health and cessation has positive health benefits, few smokers are able to successfully quit. The purpose of this study was to examine the predictors of smoking cessation in a nonclinical sample of 134 male and 190 female, young adult, regular (daily) smokers within a social learning and maturing-out framework. Four waves of prospective, longitudinal data from a community sample followed from adolescence into young adulthood were analyzed. Logistic regression analyses were used to test the effects of differential associations, definitions, differential reinforcement, and changes in adult role status on smoking cessation in young adulthood. Becoming married to a nonsmoker and decreases in the proportion of friends who smoked were significant predictors of cessation. Current smokers and stoppers did not differ significantly in terms of prior intensity of cigarette use or alcohol abuse/dependence. They also did not differ in terms of psychological characteristics, including depression and prior coping use of cigarettes. Social networks were more important than social roles for predicting cessation in young adulthood. Thus, smoking cessation programs should focus on social learning processes.

Recent development in alcoholism:sociology.

This chapter reviews several domains of sociological research conducted in the field of alcohol studies during the last decade. The domains are organized within the sociostructural, social constructionist, and distribution of consumption theoretical perspectives. Discussions of the current state of the field and definitional and measurement issues are also included. Within the sociostructural perspective, sociocultural theories, social deviance theories, age, gender, ethnic, and occupational group differences, and other related deviant behaviors are examined. Several examples of applications of social constructionist theory are included covering the new temperance movement, the Mothers Against Drunk Driving movement, Alcoholics Anonymous, and the Children of Alcoholics movement. In the section on distribution of consumption models, alcohol availability and drunk driving control policies are discussed. There are several sociopolitical issues that need to be addressed in the next decade and further collaboration across disciplines is warranted.

Longitudinal perspective on alcohol use and aggression during adolescence.

While there is general agreement that alcohol use and aggression are related, few studies have examined this relationship among youth. This chapter reviews the literature on rates of alcohol use, aggression, and alcohol-related aggression among adolescents, as well as the cross-sectional and longitudinal associations among these behaviors. In general, the literature does not provide strong support for a unique association between alcohol use and aggressive behavior during adolescence. The observed relationship between alcohol use and aggression appears to be spurious because both behaviors are predicted by a similar set of individual, family, and environmental factors. Prevention programs that reduce these common risk factors should decrease both behaviors. Interventions with aggressive individuals, especially aggressive individuals who drink heavily, may be most indicated.

Risk taking as a predictor of adolescent sexual activity and use of contraception.

PIP: A hypothesis of high-risk behaviors associated with adolescent sexual activity and lack of contraceptive use was tested in a longitudinal random sample of both male and female youths. The data were part of the Rutgers Health and Human Development Project. 1380 subjects were ascertained by random telephone calling were given self-report questionnaires and personality profiles including the Zuckerman's Sensation Seeking Scale, and Jackson's Personality Research Form in 1979 and 1981. Incidence of sexual activity and use of contraceptives increased with age from age 12-21. Cohort effects were apparent with use of some contraceptive methods. Of the variables indicating risk- taking, disinhibition, impulsivity and experience seeking, there were significant associations between sexual activity and disinhibition and experience seeking, for females. There were no significant associations between these variables and sexual activity in males. Contrary to the hypothesis, there were no relationships between either consistency of birth control use or reliability of the method used and behavioral indicators of risk-taking. Thus this 1st study in the field that included both males and females from the general population, as opposed to college students, found that sexually active adolescents were higher risk-takers than virgins, but no relationship between risk-taking and effectiveness of contraception was observed.^ieng