The Roles of Alcohol Availability, Overserving, and Enforcement in Recreational and Social Settings on Alcohol Misuse and Harms: A Comparison of Australia and the United States.

OBJECTIVE: To examine how alcohol availability, overserving, and enforcement in recreational and social settings are related to alcohol misuse and alcohol-impaired driving among young adults in Victoria, Australia and Washington State, United States. METHOD: Longitudinal data came from 1,430 participants in Victoria (n = 757; 52% female) and Washington (n = 673; 53% female), surveyed in 2014 (age 25) and 2018 (age 29) from the International Youth Development Study, a population-based, cross-national study to examine factors influencing substance use. Path modeling tested associations between age 25 perceptions of the alcohol environment, age 25 social alcohol consumption, and age 31 alcohol-related harms. Multiple-group modeling examined differences in parameter estimates across both states. RESULTS: Age 25 perceptions of the alcohol environment (alcohol availability, overservice in evening social venues, legal enforcement) and alcohol consumption in evening social settings were similar between the two states. Higher alcohol availability and perceived tendency of evening social venues to overserve were associated with higher alcohol consumption in these contexts. In turn, higher alcohol consumption in these settings was associated with more problematic alcohol use and an increased likelihood of alcohol-impaired driving 4 years later. Perceived likelihood of legal enforcement in evening social settings was not related to alcohol consumption in these contexts. CONCLUSIONS: The recreational and social settings commonly frequented by young adults can influence drinking behaviors and alcohol-related harms. Reducing alcohol availability and over-servicing in settings where young adults often congregate and socialize could reduce problematic alcohol use and alcohol-impaired driving.

Longitudinal associations between adult-supervised drinking during adolescence and alcohol misuse from ages 25-31 years: A comparison of Australia and the United States.

Prior studies suggest that adult supervised drinking in adolescence predicts greater adolescent alcohol misuse. Long-term follow up data examining how adult supervised drinking during adolescence relates to alcohol misuse in adulthood are lacking. Longitudinal data from the International Youth Development Study tested associations between adult supervised drinking during adolescence (ages 13-16; 2002-2004) and adult alcohol misuse (ages 25-31; 2014, 2018, 2020). Cross-nationally matched samples were compared in Washington State, USA (n = 961) and Victoria, Australia (n = 1,957; total N = 2,918, 55 % female, 83 % White), where adult-supervised adolescent alcohol use was more common. Multilevel analyses adjusted for state, sex, adolescent drinking, parent education, family management, family history of substance use problems, and parent alcohol-related norms. Adult supervised drinking in adolescence (at dinner or parties, on holidays) predicted more adult alcohol misuse (mean Alcohol Use Disorders Identification Test score; b[SE] 0.07[0.03]; p = 0.004) and higher rates of alcohol-impaired driving (Odds Ratio [OR] 1.501, p = 0.034) and riding with an alcohol-impaired driver (OR 1.669, p = 0.005), but not the use of strategies to moderate alcohol intake (e.g., counting drinks). Better family management (monitoring, clear rules) in adolescence predicted less adult alcohol misuse. Associations were similar in the two states. Reducing the frequency of adult supervised drinking and improving family management practices in adolescence may help to decrease alcohol misuse well into adulthood. Findings support the widespread implementation of substance use prevention and family management training programs.

Health and Social Vulnerabilities Among Unstably Housed and Homeless Young Adults During the COVID-19 Pandemic.

The role of housing as a social driver of health is well-established, with stable housing being an important factor in reducing health inequities. During developmentally critical periods such as young adulthood, unstable housing and related social marginalization have profound effects on development and later health, social, and economic wellbeing. This exploratory study analyzed data from a population-based, longitudinal sample of young adults (average age 31 years) from Washington State (n = 755) to compare health and economic impacts of the early days of the COVID-19 pandemic, with a focus on housing status. Descriptive results suggest the pandemic exposed underlying vulnerabilities for young adults experiencing homelessness and housing instability, with an overall widening of inequities related to financial difficulties and increased risk for poor mental health and social isolation. Findings suggest that these vulnerabilities are magnified in the context of public health crises and strengthen the case for population-based studies investigating potential modifiable causes of housing instability to inform prevention and early intervention at the earliest possible point in a young person's development. Studies examining the severity of COVID-related hardships on young adult health and social outcomes are vital for establishing an evidence base for strategic policy action that seeks to prevent a rebound in young adult homelessness and housing instability post-pandemic. These studies would bolster both emergency preparedness responses that account for the unique needs of vulnerable populations and upstream population-level prevention approaches beginning long before the imminent risk for housing instability develops.

Intervention targets for reducing mortality between mid-adolescence and mid-adulthood: a protocol for a machine-learning facilitated systematic umbrella review.

INTRODUCTION: A rise in premature mortality-defined here as death during the most productive years of life, between adolescence and middle adulthood (15-60 years)-is contributing to stalling life expectancy in high-income countries. Causes of mortality vary, but often include substance misuse, suicide, unintentional injury and non-communicable disease. The development of evidence-informed policy frameworks to guide new approaches to prevention require knowledge of early targets for intervention, and interactions between higher level drivers. Here, we aim to: (1) identify systematic reviews with or without meta-analyses focused on intervention targets for premature mortality (in which intervention targets are causes of mortality that can, at least hypothetically, be modified to reduce risk); (2) evaluate the review quality and risk of bias; (3) compare and evaluate each review's, and their relevant primary studies, findings to identify existing evidence gaps. METHODS AND ANALYSIS: In May 2023, we searched electronic databases (MEDLINE, PubMed, Embase, Cochrane Library) for peer-reviewed papers published in the English language in the 12 years from 2012 to 2023 that examined intervention targets for mortality. Screening will narrow these papers to focus on systematic reviews with or without meta-analyses, and their primary papers. Our outcome is death between ages 15 and 60 years; with potential intervention targets measured prior to death. A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) will be used to assess quality and risk of bias within included systematic reviews. Results will be synthesised narratively due to anticipated heterogeneity between reviews and between primary studies contained within included reviews. ETHICS AND DISSEMINATION: This review will synthesise findings from published systematic reviews and meta-analyses, and their primary reviewed studies, meaning ethics committee approval is not required. Our findings will inform cross-cohort consortium development, be published in a peer-reviewed journal, and be presented at national and international conferences. PROSPERO REGISTRATION NUMBER: CRD42022355861.

Immunization Coverage in Young People Experiencing Homelessness and the Impact of a Nurse-led Program.

OBJECTIVES: To identify the proportion of young people experiencing homelessness who are immunized against vaccine-preventable diseases, and to evaluate the impact of a nurse-led immunization program to improve vaccination coverage in this population. METHODS: A retrospective audit of electronic medical records included 400 participants aged 15 to 24 years who had an encounter with the Young People's Health Service, a nurse-led clinic co-located with a specialist youth homelessness service in Melbourne, Australia, between February 2019 and May 2021. RESULTS: Integrating an immunization nurse within a youth specialist homelessness service increased the percentage of young people who were up-to-date with routine vaccinations from 6.0% (n = 24) to 38.8% (n = 155). Intersecting social determinants of health that increased participants' risk of vaccine preventable diseases, and of missing routine vaccines, were common. CONCLUSIONS: Incomplete coverage of routine vaccines is common in young people accessing homelessness services, and this coverage was improved when young people encountered an immunization nurse while accessing support from a specialist youth homelessness service. As a service model, nurse-led community health clinics co-located within homelessness providers can improve vaccination coverage, and therefore health outcomes, of young people experiencing or at risk of homelessness.

Adolescent Predictors of Deliberate Self-Harm Thoughts and Behavior Among Young Adults: A Longitudinal Cross-National Study.

PURPOSE: This study builds upon and extends previous longitudinal research on deliberate self-harm (DSH) among youth by investigating which risk and protective factors during adolescence predict DSH thoughts and behavior in young adulthood. METHODS: Self-report data came from 1,945 participants recruited as state-representative cohorts from Washington State and Victoria, Australia. Participants completed surveys in seventh grade (average age 13 years), as they transitioned through eighth and ninth grades and online at age 25 years. Retention of the original sample at age 25 years was 88%. A range of risk and protective factors in adolescence for DSH thoughts and behavior in young adulthood were examined using multivariable analyses. RESULTS: Across the sample, 9.55% (n = 162) and 2.83% (n = 48) of young adult participants reported DSH thoughts and behaviors, respectively. In the combined risk-protective factor multivariable model for young adulthood DSH thoughts, depressive symptoms in adolescence (adjusted odds ratio [AOR] = 1.05; confidence interval [CI] = 1.00-1.09) increased risk, while higher levels of adolescent adaptive coping strategies (AOR = 0.46; CI = 0.28-0.74), higher levels of adolescent community rewards for prosocial behavior (AOR = 0.73; CI = 0.57-0.93), and living in Washington State decreased risk. In the final multivariable model for DSH behavior in young adulthood, less positive family management strategies during adolescence remained the only significant predictor (AOR = 1.90; CI = 1.01-3.60). DISCUSSION: DSH prevention and intervention programs should not only focus on managing depression and building/enhancing family connections and support but also promote resilience through efforts to promote adaptive coping and connections to adults within one's community who recognize and reward prosocial behavior.

Health of Young Adults Experiencing Social Marginalization and Vulnerability: A Cross-National Longitudinal Study.

People who experience social marginalization and vulnerability have uniquely complex health needs and are at risk of poor health outcomes. Regression analyses using longitudinal data from a cross-national, population-based sample of young adults participating in the International Youth Development Study, tested associations between social marginalization and vulnerabilities and physical health, mental health, and substance use outcomes. Participants from Victoria, Australia, and Washington State in the US were surveyed at ages 25 (2014) and 29 years (2018; N = 1944; 46.7% male). A history of adverse childhood experiences (ACEs), LGBT identity, financial insecurity, and justice system involvement at age 25 predicted poor health outcomes at age 28, including lower perceived health status, risk for chronic illness, depression and anxiety symptoms, and diagnosed mental health/substance use disorders. Tests of model equivalence across states showed that a history of ACEs was more strongly related to health status and serious injury at age 28 and justice system involvement at age 25 was more strongly related to age 28 serious injury in Victoria than in Washington State. Findings strengthen the case for future population-based research identifying life-course interventions and state policies for reducing poor health and improving health equity among members of socially marginalized groups.

Young Adult Development Indicators for Indigenous and Non-Indigenous People: A Cross-National Longitudinal Study.

Worldwide, Indigenous youth face ongoing challenges and inequalities. Increasing our understanding of life course patterns in Indigenous youth will assist the design of strategies and interventions that encourage positive development. This study aimed to increase understanding of resilience and positive development in Indigenous and non-Indigenous youth across Australia and the United States of America. The Australian sample comprised 9680 non-Indigenous and 176 Pacific Islander and Aboriginal and Torres Strait Islander peoples. The USA sample comprised 2258 non-Indigenous and 220 Pacific Islander, Native Hawaiian and Native American/American Indian peoples. Data were used to examine how Indigenous background, volunteering, and community involvement at average age 15 years (Grade 9) predicted five young adult positive development indicators: Year 12 (Grade 12) school completion, tertiary education participation, independent income, paid employment, and intimate relationship formation from age 18 to 28 years. Multilevel regression analyses revealed that while Indigenous youth showed slower increases in positive young adult development over time, when adjusting for socioeconomic disadvantage, there was a reduction in this difference. Moreover, we found that Grade 9 community involvement and volunteering were positively associated with young adult development for Indigenous and non-Indigenous youth. Findings indicate the importance of addressing structural inequalities and increasing adolescent opportunities as feasible strategies to improve positive outcomes for young Indigenous adults.

A population-based study of homelessness, antisocial behaviour and violence victimisation among young adults in Victoria, Australia.

Homeless young adults are at increased risk for contact with the police and are overrepresented in the justice system. This study explored associations between homelessness, antisocial behaviour and violence victimisation using longitudinal panel data gathered through young adulthood. Data were drawn from a state representative population-based sample of young adults from Victoria, Australia participating in the International Youth Development Study (IYDS; n = 2884, 54% female). Participants were surveyed at age 21 years, with follow-up at ages 23 and 25 years. We examined changes in the prevalence of homelessness and tested hypothesised directional relationships between young adult homelessness, antisocial behaviour and violence victimisation using longitudinal cross-lagged panel models. Multiple-group modelling was used to test whether these relationships were moderated by gender. The prevalence of young adult homelessness was highest at age 21 (6.5%), declining at ages 23 (3.9%) and 25 years (2.5%). Results showed that young adult homelessness, antisocial behaviour and victimisation were related cross-sectionally, but not longitudinally. Gender did not significantly moderate these associations. Findings suggest that the state of homelessness is associated with temporary vulnerability to potentially harmful and problematic situations involving antisocial behaviour and victimisation. These situations are likely to heighten risk for contact with the police and direct physical and psychological harm.

Adolescent Antecedents of Young Adult Homelessness: a Cross-national Path Analysis.

Adolescent and young adult health, development, and behavior lay a foundation for future population health. Increasing rates of young adult homelessness mean there is a need for research which generates evidence to support a stronger focus on population-level prevention. Using longitudinal data from a population-based sample of young adults participating in the cross-nationally matched International Youth Development Study, we examined adolescent antecedents of young adult homelessness in Washington State in the USA and in Victoria, Australia. Participants were surveyed using a modified version of the Communities That Care youth survey. Analyses of prospective, longitudinal data from 1945 participants, recruited as state-representative secondary school samples at grade 7 (average age 13, 2002) and longitudinally compared at young adulthood (average age 25, 2014), showed that young adults in Washington State reported higher rates of past year homelessness (5.24%) compared to those in Victoria (3.25%). Path modeling showed less positive family management strategies at age 13 uniquely increased risk for age 25 homelessness. This effect remained after accounting for age 15 antecedents in peer-group, school, and community environments. Friends' drug use, school suspension, academic failure, and low neighborhood attachment at age 15 mediated the association between less positive family management strategies at age 13 and age 25 homelessness. Despite observing some cross-national differences in levels of family, peer-group, school, and community antecedents, we found that these factors equally increased risk for age 25 homelessness in both states, suggesting similar cross-national influences for young adult homelessness. The findings indicate cross-nationally common adolescent antecedents for young adult homelessness that could be targeted by prevention strategies across international settings.

Life-course predictors of homelessness from adolescence into adulthood: A population-based cohort study.

INTRODUCTION: Internationally, the prevalence of young adult homelessness is concerning. Few data on life-course predictors from longitudinal studies exist, limiting our capacity to inform prevention strategies at the population-level. METHODS: Data were drawn from a state representative population-based sample of young adults from Victoria, Australia participating in the International Youth Development Study (IYDS; N = 927, 54% female). Participants were recruited in state-representative secondary school samples at Grade 7 (age 13, 2002), with follow-up in Grades 9 (age 15) and 11 (age 17) and at ages 21, 23 and 25. Using longitudinal path modelling, we conducted a series of analyses testing life-course predictors of young adult homelessness across multiple socializing contexts, and the interrelationships among them. RESULTS: The rate of young adult homelessness was 5.5%. Path modelling showed higher levels of family conflict at ages 13 and 15 uniquely predicted homelessness by age 25. This effect remained after accounting for other risk factors in peer-group (e.g., interactions with antisocial peers), school (e.g., low academic performance), and community contexts (e.g., low neighborhood attachment). Peer drug use and interaction with antisocial peers at age 15 mediated the association between family conflict at age 13 and homelessness by age 25. CONCLUSIONS: Findings point to the vulnerability of early adolescents to family conflict. This vulnerability heightens risk for young adult homelessness. Findings strengthen the case for both primary prevention programs that build healthy relationships between family members from early on in adolescence and for investment in homelessness prevention at key developmental periods.

Longitudinal Consequences of Adolescent Alcohol Use Under Different Policy Contexts in Australia and the United States.

OBJECTIVE: To test the premise that youth alcohol harm minimization policies (compared with abstinence policies) reduce later drinking and harmful consequences of alcohol use in young adulthood, we compared associations among adolescent alcohol use, young adult alcohol consumption, and alcohol-related harms in Victoria, Australia and Washington State, United States. METHOD: Data came from the International Youth Development Study, a longitudinal, cross-national study of the development of substance use. State-representative samples of seventh-grade (age 13) students in Victoria (n = 984, 53% female, 90% White) and Washington (n = 961, 54% female, 73% White) were surveyed in 2002, 2003, 2004, and 2014 (age 25). Participants self-reported alcohol initiation by age 15 and age 25 alcohol consumption (per the Alcohol Use Disorders Identification Test). Path modeling tested associations among age 15 alcohol use, age 25 consumption, and alcohol-related harms at age 25; multiple group modeling tested the equivalence of parameter estimates across states. RESULTS: Age 25 alcohol consumption was lower in Washington versus Victoria and was associated with poor physical and mental health, partner conflict, substance use, criminal behavior, and violence exposure in both states equally. Living in Washington predicted lower levels of multiple alcohol-related harms at age 25 indirectly via lower age 25 alcohol consumption. CONCLUSIONS: Young adults growing up in Victoria reported greater alcohol consumption in young adulthood, which was associated to the same degree with the harms measured regardless of alcohol policy context. Findings support state-level policies that promote alcohol abstinence in adolescence and reduced consumption in young adulthood.

Childhood social environmental and behavioural predictors of early adolescent onset cannabis use.

INTRODUCTION AND AIMS: This study prospectively investigates behavioural and social antecedents of different patterns of adolescent cannabis use, specifically, early adolescent onset cannabis use and late onset occasional use. DESIGN AND METHODS: The sample comprised 852 adolescents (53% female) drawn from the Australian arm of the International Youth Development Study. Data were collected via self-report surveys. Risk and protective factors from a modified version of the Communities That Care youth survey were measured in fifth grade (mean [M] = 10.9 years, SD = 0.4). Frequency of cannabis use was measured at six time-points throughout adolescence (ages 12-19 years). RESULTS: Early adolescent onset cannabis use (10.7% of the sample [n = 91]) was predicted by childhood family-related factors including poor family management, family history of antisocial behaviour and attachment to parents. Cigarette use and drinking until drunk were the strongest predictors of early adolescent onset cannabis use. Cumulative risks associated with community, family, peer/individual environments and early substance use (cigarettes, alcohol) in childhood were predictive of early adolescent onset cannabis use (e.g. relative risk ratio = 2.64; 95% confidence interval 1.40-4.97 for early substance use). Family and early substance use-related cumulative risks were predictive of late adolescent onset occasional cannabis use (n = 231; 27%). Cumulative early substance use risk was the strongest independent predictor of both early adolescent onset and late adolescent onset occasional cannabis use. DISCUSSION AND CONCLUSIONS: Primary prevention efforts should focus on reducing exposure and access to licit substances during late childhood and delaying the onset of use. Prevention and intervention targeted toward the family environment also appears likely to be important in the prevention of early adolescent onset cannabis use.

Prevalence of homelessness and co-occurring problems: A comparison of young adults in Victoria, Australia and Washington State, United States.

Homelessness is associated with various co-occurring health and social problems yet; few contemporary international studies have examined these problems in young adulthood. This descriptive study presents cross-state comparison of the prevalence of young adult homelessness in Washington State, USA and Victoria, Australia using state representative samples from the International Youth Development Study (IYDS; n = 1,945, 53% female). Associations between young adult homelessness and a range of co-occurring problems were examined using a modified version of the Communities That Care youth survey. Results showed significantly higher rates of past year homelessness were reported by young adults in Washington State (5.24% vs. 3.25% in Victoria). Cross-state differences were evident in levels of friends' drug use, antisocial behavior, weekly income and support from peers. Unemployment (Adjusted Odds Ratio [AOR] = 2.67), antisocial behavior (AOR = 3.54) and victimization (AOR = 3.37) were more likely among young adults reporting homelessness in both states. Young adults with higher weekly income were less likely to report homelessness (AOR = .69) in both states. No significant association between mental health problem symptoms, substance use, family conflict or interaction with antisocial peers and homelessness were found in either state. Rates of violent behavior were more strongly related to young adult homelessness in Washington State than Victoria. The current findings suggest that programs that enable young adults to pursue income and employment, reduce antisocial behavior and include services for those who have been victimized, may help to mitigate harm among young adults experiencing homelessness.

Longitudinal Associations Between Early-Mid Adolescent Risk and Protective Factors and Young Adult Homelessness in Australia and the United States.

Homelessness is associated with a range of negative health and behavioral outcomes, yet life-course pathways to homelessness from adolescence to early adulthood are not well-documented. This study asks to what extent do early-mid adolescent risk and protective factors predict young adult homelessness, and whether the predictive nature of these factors is similar in Victoria, Australia, and Washington State in the USA. As part of the International Youth Development Study, adolescents were recruited as state representative secondary school samples at grade 7 (age 13, 2002) and longitudinally compared at average age 25. Higher rates of past year homelessness were reported by Washington State (5.24%), compared to Victorian young adults (3.25%). Although some cross-state differences in levels of adolescent demographic, individual, family, peer group, school, and community predictors were found, cross-state comparisons showed these factors were equally predictive of young adult homelessness in both states. In univariate analyses, most adolescent risk and protective factors were significant predictors. Unique multivariate adolescent predictors associated with young adult homelessness included school suspension (adjusted odds ratio [AOR] = 2.76) and academic failure (AOR = 1.94). No significant unique protective effects were found. Prevention and intervention efforts that support adolescents' academic engagement may help in addressing young adult homelessness. The similar cross-state profile of adolescent predictors suggests that programs seeking to support academic engagement may influence risk for homelessness into young adulthood in both states. The similarity in life-course pathways to homelessness suggests that the USA and Australia can profitably translate prevention and intervention efforts to reduce homelessness while continuing to identify modifiable predictors.

Longitudinal Associations Between the Adolescent Family Environment and Young Adult Substance Use in Australia and the United States.

Introduction: Harmful alcohol and cannabis use are social concerns associated with a range of negative outcomes. Prior research has identified links between disrupted parent-child attachment and child-adolescent substance use. Materials and Methods: This study used cross-national data from the International Youth Development Study (IYDS; Victoria, Australia and Washington State, USA) to investigate the relationship between early adolescent family environment characteristics, mid-adolescent attachment to parents, and young adult harmful alcohol and cannabis use. The moderating role of state on these relationships was also tested. State-representative samples of students in Grade 7 (age 13, 2002) were recruited and followed longitudinally at ages 14, 15, and 25 (n = 1,945, 53% female, 50% in Victoria). Results: Cross-state differences were evident in levels of family management, parent attitudes favorable to drug use, sibling alcohol and cannabis use, attachment to parents, and past year alcohol and cannabis use. Significantly higher rates of problematic alcohol use were reported by young adults in Victoria (25% vs. 14% in Washington State). Young adults in Washington State reported significantly higher rates of problematic cannabis use (14% vs. 10% in Victoria). Path modeling showed that characteristics of positive family environments (e.g., low conflict) in early adolescence were associated with higher attachment to parents and lower alcohol and cannabis use in mid-adolescence. Sibling substance use and more favorable parent attitudes to drug use were associated with past year alcohol and cannabis use in mid-adolescence. Results showed higher attachment to parents in mid-adolescence did not uniquely predict lower problematic alcohol or cannabis use in young adulthood. No significant cross-state differences in this pattern of associations were found. Discussion: The implications of the current findings suggest that prevention and intervention strategies targeted at reducing problematic substance use into young adulthood may benefit from considering the influence of behavioral norms and attitudes in family relationships.

Reciprocal associations between early adolescent antisocial behavior and depressive symptoms: A longitudinal study in Victoria, Australia and Washington State, United States.

PURPOSE: Reciprocal prospective associations between adolescent antisocial behavior and depressive symptoms were examined. METHODS: Seventh grade students (average age 13 years; N=2,314/2,348) were surveyed (T1), and then followed-up 12 (T2) and 24 months (T3) later, using the same methods in Washington State and Victoria, Australia. RESULTS: Negative binomial regressions showed antisocial behavior (T1, T2) did not prospectively predict depressive symptoms (T2, T3). T1 multivariate predictors for T2 depressive symptoms included female gender (incident rate ratio [IRR] = 1.70), prior depressive symptoms (IRR = 1.06), alcohol use (IRR = 1.13), family conflict (IRR = 1.13), antisocial peers (IRR = 1.08) and bullying victimization (IRR = 1.06). Depressive symptoms (T1, T2) did not predict antisocial behavior (T2, T3). T1 multivariate predictors for T2 antisocial behavior included female gender (IRR = .96), age (IRR = .97), prior antisocial behavior (IRR = 1.32), alcohol use (IRR = 1.04), antisocial peers (IRR = 1.11) and academic failure (IRR = 1.03). CONCLUSIONS: Depressive symptoms and antisocial behaviors showed considerable predictive stability in early adolescence but were not reciprocally related. Prevention and intervention strategies in adolescence may benefit by targeting common predictors such as alcohol, peer interactions and early symptoms for depression and antisocial behavior.