Substance use patterns and mental health comorbidities in youth with a history of depression or suicidality: Findings from TX-YDSRN.

BACKGROUND: There is a robust relationship between depression and substance use in youth, with higher levels of substance use associated with greater depressive symptomatology. However, previous research has examined individual substances, without consideration of psychiatric comorbidities. Here, we investigate patterns of substance use among depressed and/or suicidal youth within the context of psychiatric comorbidities. METHODS: 945 youth with depression and/or suicidality from the Texas Youth Depression and Suicide Research Network (TX-YDSRN) were assessed for current use of alcohol, nicotine, cannabis, and other drugs and comorbid psychiatric diagnoses. We used latent class analysis to identify patterns of past-year substance use, then examined if demographics or psychiatric disorders predicted class membership. RESULTS: We identified three patterns of substance use: non-use (63.4 %), moderate likelihood of using alcohol, nicotine and cannabis (23.8 %), and high likelihood of using all substances (12.7 %). Compared to non-users, individuals in the moderate and high likelihood classes were more likely to be older. Individuals in the high likelihood class were more likely to have a substance use disorder, ADHD, and higher suicidality scores. LIMITATIONS: We cannot ascertain the causal or temporal ordering of substance use and psychiatric diagnoses due to the cross-sectional nature of the study. CONCLUSIONS: Using a brief, self-report measure of substance use, we identified three classes of substance users differing in probability of past-year use, which were predicted by older age and some psychiatric comorbidities. While research on universal screening of substance use in youth remains limited, we discuss who may benefit from such screening among depressed youth.

Adolescent Sleep Quality and Alcohol Use: An Initial Examination of the Serial Indirect Effects of Anxiety Symptoms and Coping Motives for Alcohol Use.

Background: Insufficient sleep and insomnia are associated with alcohol use as well as anxiety during adolescence and young adulthood. A negative reinforcement path to explain the association between sleep difficulties and alcohol misuse has been proposed. Within this pathway, it is speculated that while sober, insomnia and insufficient sleep lead to increased anxiety as well as anxiolytic responses to alcohol, thereby increasing the risk for both alcohol use and alcohol use problems. No work to date has examined the negative reinforcement path to alcohol use among adolescents who have consumed alcohol. Objectives: The current study aims to address this gap in the literature by examining if sleep quality is related to adolescent alcohol use problems and frequency through serial indirect effects of adolescent anxiety symptoms and coping motives for alcohol use. A total of 147 adolescents between the ages of 13 and 18 years (Mage = 16.31; SD = 0.96) from all geographic regions in the US were recruited using social media platforms (i.e., Facebook and Instagram). Participants who reported having tried alcohol at least once completed self-report measures to examine sleep quality, anxiety symptoms, alcohol use problems, alcohol use frequency, and coping motives for alcohol use. Results: Adolescent sleep quality was found to be associated with higher levels of both alcohol use problems and alcohol use frequency through the serial indirect effect of anxiety symptoms and coping motives for alcohol use. Conclusions: Overall, these findings represent a step towards understanding the complex relationship between sleep quality, alcohol, anxiety, and coping motives among adolescents.

Factors associated with internalizing and externalizing symptoms in a clinical sample of youth with misophonia.

Misophonia is an often chronic condition characterized by strong, unpleasant emotional reactions when exposed to specific auditory or visual triggers. While not currently defined within existing classification systems, and not clearly fitting within the framework of extant psychiatric conditions, misophonia has historically been studied most frequently within the context of obsessive-compulsive and related disorders. Internalizing and externalizing psychiatric symptoms are common in misophonia, but specific factors that confer risk for these symptoms remain unknown. The present cross-sectional study examined whether sensory sensitivity and cognitive emotion regulation facets are associated with co-occurring internalizing and externalizing symptoms in 102 youth with misophonia aged 8-17 years (Nfemales = 69). Participants completed self-report assessments of misophonia severity, sensory sensitivity, cognitive emotion regulation, and emotional-behavioral functioning. In the final model, controlling for all variables, multiple linear regression analyses revealed that sensory sensitivity and age were significant predictors of internalizing symptoms, while sensory sensitivity and the other-blame cognitive emotion regulation facet were significant predictors of externalizing symptoms. Further, findings demonstrated that the positive reappraisal cognitive emotion regulation facet moderated the effect of misophonia severity on internalizing symptoms. Results highlight a strong, consistent relation between sensory sensitivities (beyond sound sensitivity) and psychiatric symptoms in misophonic youth. Further research is necessary to determine mechanisms and clinical variables impacting internalizing and externalizing symptoms within youth with misophonia.

Obsessive-compulsive disorder in youth and young adults with depression: Clinical characteristics of comorbid presentations.

Obsessive-compulsive disorder (OCD), anxiety disorders, and depressive disorders are highly comorbid, and each contribute to significant functional impairment for affected youth. Comorbid anxiety disorders in depressed youth have been associated with greater depressive symptom severity and impairment, but the impact of comorbid OCD in this population remains unclear. Accordingly, the present study examined the differential clinical characteristics of youth with depression and comorbid OCD relative to age/gender matched depressed youth with no such comorbidity and to those with depression and a comorbid (non-OCD) anxiety disorder. A sample of 797 youth and young adults ages 8-20 years who met diagnostic criteria for depression alone, depression with co-occurring OCD or any anxiety disorder were included in the present study. Rates of comorbid anxiety and OCD were very high (60.5% and 15.5%, respectively). Relative to youth with only depression, depressed youth with comorbid OCD or anxiety had greater severity of depression, suicidality, and overall impairment in social, physical, and emotional functioning. These results highlight the contribution of OCD or anxiety comorbidity in more complex clinical presentations for depressed youth.