Patterns, predictors, and outcome of the trajectories of depressive symptoms from adolescence to adulthood.

BACKGROUND: The long-term trajectory of depressive symptoms has a heterogeneous pattern. Identifying factors associated with different trajectories and outcomes may have important theoretical and clinical implications. This study explored patterns of depressive symptom trajectory from adolescence to adulthood, and their relationship with subsequent psychiatric disorders. METHOD: A sample of 816 participants (58.8% girls; M = 16.58 years old at baseline, SD = 1.21) from a large community sample were interviewed four times during adolescence and adulthood. Depressive symptoms were also assessed. Symptom trajectory identification was based on latent class mixed modeling. Logistic regression was used for predicting emotional and drug use disorder over age 30. RESULTS: Three trajectories of depressive symptoms were identified: "decreasing symptom" (decreasing trajectory of symptoms; 15.1% of participants), "increasing symptom" (initially decreasing pattern of symptoms and then increasing; 6.1% of participants), and "normative symptom" (consistently low symptom levels; 78.8% of participants). Predictors of the increasing symptom trajectory were high level of loneliness and state anxiety, presence of an emotional disorder, and low involvement in physical exercise at baseline. This trajectory membership predicted the development of anxiety disorders over age 30. Predictors of the decreasing symptom class were being female and high level of worry at baseline. CONCLUSIONS: Long-term trajectories of depressive symptoms are heterogeneous, with each trajectory having different predictors and are associated with different outcomes during adulthood.

The number of biological parents with alcohol use disorder histories and risk to offspring through age 30.

OBJECTIVE: We investigated associations between the number of parents with histories of alcohol use disorder (AUD) and several offspring (proband) variables through age 30: occurrence of AUD and, separately, alcohol dependence; onset age of the initial AUD episode; time to recovery from the first AUD episode; number of distinct AUD episodes; and cumulative duration of AUD across episodes. METHODS: Offspring data were collected during four assessment waves of a longitudinal epidemiological study of psychiatric disorders with a regionally representative sample. The reference sample included 730 offspring with diagnostic data from at least one parent. Offspring were assessed with semi-structured diagnostic interviews between mid-adolescence and young adulthood and parents were assessed when offspring were approximately 24 years of age. RESULTS: As the number of parents with AUD increased, offspring risk for AUD and alcohol dependence also increased. Latent growth model results indicated that offspring AUD risk trajectories increase in severity as a function of the number of parents with AUD. This pattern of results was not observed for other AUD course-related features in offspring (i.e., number of distinct episodes; months required for recovery from initial episode; cumulative duration across episodes). CONCLUSIONS: The number of parents with a history of AUD is associated with overall offspring risk for AUD and alcohol dependence and elevated AUD risk trajectories through age 30. The number of parents with AUD may be a more relevant risk factor for onset-related characteristics of AUD in offspring than for its longitudinal course.

Is the Assessment of Personality Comparable in Persons Who Have and Have Not Experienced Depressive, Anxiety, and Substance Use Disorders? An Examination of Measurement Invariance.

Numerous studies have focused on characterizing personality differences between individuals with and without psychopathology. For drawing valid conclusions for these comparisons, the personality instruments used must demonstrate psychometric equivalence. However, we are unaware of any studies that examine measurement invariance in personality across individuals with and without psychopathology. This study conducted tests of measurement invariance for positive emotionality, negative emotionality, and disinhibition across individuals with and without histories of depressive, anxiety, and substance use disorders. We found consistent evidence that positive emotionality, negative emotionality, and disinhibition were assessed equivalently across all comparisons with each demonstrating strict invariance. Overall, results suggest that comparisons of personality measures between diagnostic groups satisfy the assumption of measurement invariance and these scales represent the same psychological constructs. Thus, mean-level comparisons across these groups are valid tests.

Clinical features associated with an increased risk for alcohol use disorders among family members.

This study evaluated the risk for alcohol use disorders (AUDs) among first-degree relatives depending on whether a specific family member (proband) had an AUD history. For probands with AUD histories, we also evaluated whether certain clinical features were associated with higher rates of AUDs in family members as a means for identifying markers that signify a more familial form of AUD. The proband sample was recruited from high schools in Western Oregon communities at Age 16 and followed longitudinally until Age 30. Structured psychiatric histories of 2,414 first-degree relatives of 732 probands were ascertained when the proband was Age 24. For the full sample, a significant association was observed between proband AUD history and the density (proportion) of first-degree relatives with AUD histories. Univariate analyses indicated that several clinical features among probands with AUD histories were significantly associated with AUD family density. In multivariate analyses, proband AUD episode recurrence and anxiety disorder history features emerged as trend-level or statistically significant unique predictors of AUD family density. One of these features, AUD episode recurrence, demonstrated a significant association with AUD family density once other forms of psychopathology among first-degree relatives were controlled. No evidence of gender moderation of effects was observed. Findings overall indicate that the familial risk for AUDs is related to probands' AUD history status and clinical features they exhibit. (PsycINFO Database Record

The impact of pre- and perinatal factors on psychopathology in adulthood.

BACKGROUND: There is considerable evidence that pre- and post-natal factors are associated with a wide range of psychopathology in offspring during childhood and adolescence. OBJECTIVE: The main aims of the present study were to examine the associations between pre- and perinatal factors and psychopathology in offspring during adulthood, and to explore whether family factors (i.e., family cohesion, mother's social support, and father's social support) mediate these relationships. METHOD: Information on pre- and perinatal events was collected from biological mothers of the participants (N = 315) when they were between 14 and 18 years who were then followed up until they reached age 30. RESULTS: Maternal obstetric history and illness during first year were significant predictors of offspring anxiety disorder. Maternal emotional health predicted offspring affective disorder. Difficult delivery and breast feeding predicted disruptive disorder. The relationship between maternal obstetric history/emotional health and anxiety/affective disorder was no longer significant after controlling for family cohesion. LIMITATIONS: The information was based on maternal recall when their offspring were between 14 and 18 years which may be subjected to recall bias. CONCLUSION: The association between pre- and postnatal factors and psychopathology of offspring during adulthood is mediated by familial factors.

Incidence, recurrence and comorbidity of anxiety disorders in four major developmental stages.

BACKGROUND: Anxiety disorders are common in childhood, adolescence, and adulthood, and frequently comorbid with other mental disorders. OBJECTIVE: The main aim of the present study was to examine the incidence, recurrence and comorbidity rates of anxiety disorders across four developmental periods, namely, during childhood (5 - 12.9 years), adolescence (13 - 17.9 years), emerging adulthood (18 - 23.9 years), and adulthood (24 - 30 years). METHOD: Eight hundred and sixteen participants from a large community sample were interviewed twice during adolescence, at age 24, and at age 30. They completed self-report measures of psychosocial functioning and semi-structured diagnostic interviews during adolescence and adulthood. RESULTS: The result showed first incidence of anxiety disorders to be significantly higher in childhood and adulthood than in adolescence and emerging adulthood. Female gender was associated with first incidence, but not with recurrence. Significant comorbidity was found between anxiety disorders and major depressive disorder (MDD) across the four developmental periods. The comorbidity between anxiety and substance use disorders (SUD) was significant in childhood, emerging adulthood and adulthood, but not in adolescence. The presence of anxiety disorders during childhood and adolescence significantly increased the probability of having an anxiety disorder during emerging adulthood. LIMITATIONS: The participants are ethically and geographically homogenous. CONCLUSION: Incidence and recurrence rates of anxiety disorders differed across four diverse developmental periods. The magnitude of comorbidity between anxiety disorders and MDD was comparable across periods.

No Reliable Evidence That Emotional Disorders Are Proximal Antecedents, Concomitants, or Short-Term Consequences of First Episode Alcohol Use Disorders in a Representative Community Sample.

OBJECTIVE: Emotional disorders and alcohol use disorders (AUDs) frequently demonstrate significant 12-month and lifetime comorbid associations. This comorbidity has been incorporated into influential theories of addiction processes that posit direct or indirect causal associations between these disorder categories. There is currently no consensus, however, about the sequencing of these disorders. In this research, longitudinal data from a regionally representative community sample were used to evaluate whether emotional disorders constitute a proximal antecedent, concomitant, or short-term consequence of first episode (or index) AUDs. METHOD: Participants were 131 persons with index AUD episodes lasting 12 months or more and 131 matched controls. For each participant with an AUD, the presence or absence of an emotional disorder was coded for three time intervals: (a) the 12 months preceding full syndrome AUD episode onset; (b) the last 12 months of the AUD episode; and (c) the 12 months following complete symptom AUD episode offset. These intervals, referenced to participant age, were matched to those of control participants, and emotional disorder rate comparisons subsequently performed both within and between groups. RESULTS: Findings indicated an absence of significant within- or between-subject differences in emotional disorder rates, suggesting that the association between AUDs and emotional disorders is neither directional nor systematic. There was also no indication that the length of the AUD episode increased risk for an emotional disorder in the year following AUD offset. CONCLUSIONS: Overall, this research suggests that emotional disorders are generally independent events in relation to the index AUD episode.

Trajectories of cannabis use disorder: risk factors, clinical characteristics and outcomes.

AIMS: To estimate cannabis use disorder (CUD) trajectory classes from ages 14 to 30 years and compare classes on clinical characteristics, risk factors and psychosocial outcomes. DESIGN: Four waves (T1-T4) of data from an epidemiological study of psychopathology among a regionally representative sample. Trajectory classes described risk for CUD as a function of age. The number of classes was determined by model fit. SETTING: Participants were selected randomly from nine high schools in western Oregon, USA. PARTICIPANTS: The sample included 816 participants [age at T1 mean = 16.6, standard deviation (SD) = 1.2; 44% male; 8% non-white]. MEASUREMENTS: Participants completed diagnostic interviews, Child Trauma Questionnaire, Social Adjustment Scale and items adapted from the Wisconsin Manual for Assessing Psychotic-Like Experiences. FINDINGS: There were three CUD trajectory classes (Lo-Mendell-Rubin likelihood ratio test < 0.001): (1) persistent increasing risk; (2) maturing out, with increasing risk then decreasing risk; and (3) stable low risk. The persistent increasing class had later initial CUD onsets (η2  = 0.16, P < 0.001) and greater cumulative CUD durations (η2  = 0.26, P < 0.001). Male sex [odds ratio (OR) = 2.57, P = 0.018], externalizing disorders between ages 24 and 30 years (OR = 2.64, P < 0.001) and psychotic experiences during early adulthood (Cohen's d = 0.44, P = 0.016) discriminated between the persistent increasing and the maturing-out classes. CONCLUSIONS: Evidence suggests three distinguishable types of trajectory for development of cannabis use disorder starting in early teens: (1) persistent increasing risk; (2) maturing out, with increasing risk then decreasing risk; and (3) stable low risk.

Internalizing and externalizing disorders as predictors of alcohol use disorder onset during three developmental periods.

BACKGROUND: The developmental pathways associated with an enhanced risk for future alcohol use disorders (AUDs) continue to be a topic of both interest and debate. In this research, internalizing and externalizing disorders were evaluated as prospective predictors of the index AUD episode onset, separately within three developmental periods: early-to-middle adolescence (age 13.0-17.9), late adolescence (18.0-20.9), and early adulthood (21.0-30.0). METHODS: Participants (N=816) were initially randomly selected from nine high schools in western Oregon and subsequently interviewed on four separate occasions between ages 16 and 30, during which current and past AUDs were assessed as well as a full range of psychiatric disorders associated with internalizing and externalizing psychopathology domains. RESULTS: In adjusted analyses for each of the three developmental periods investigated, externalizing domain psychopathology from the most proximal adjoining developmental period predicted AUD onset. Distal externalizing psychopathology also predicted AUD onset among early adult onset cases. Proximal or distal internalizing psychopathology, in comparison, was not found to be a significant predictor of AUD onset in adjusted analyses for any of the developmental periods examined. CONCLUSIONS: Findings overall suggest that externalizing developmental histories are robust predictors of AUD onset within the age range during which index episodes are most likely to occur, and that gender does not moderate this association.

Questioning kindling: An analysis of cycle acceleration in unipolar depression.

The kindling hypothesis for depression predicts that with more recurrences, the interval between successive recurrences decreases. Studies with unipolar and bipolar samples generally have been consistent with this premise. However, previous research is subject to a statistical artifact. Slater's fallacy maintains that these intermorbid intervals appear to decrease because highly recurrent individuals with consistently shorter intervals become a larger proportion of the remaining sample with each recurrence. Correcting for this bias, research on bipolar disorder no longer evidences such an effect. We predicted similar results for unipolar depression when correcting for this bias, and proposed an alternative model: individuals who are highly recurrent have consistently shorter intermorbid periods, even following the very first lifetime episode. As predicted, correcting for Slater's fallacy removed the appearance of decreasing intermorbid intervals. Further, highly recurrent individuals exhibited shorter intermorbid intervals in general, and for the very first interval, supporting the alternative model.

Association of comorbid psychopathology with the duration of cannabis use disorders.

Risk factors for the development of cannabis use disorders (CUDs) have been well-researched. Comparatively little is known, however, about factors associated with the persistence of CUDs over time. This research explored whether the temporal sequencing of comorbid psychiatric disorders in relation to the onset of the index CUD episode were associated with the length of this episode. Four comprehensive diagnostic assessments were conducted between ages 16 and 30 with a large and regionally representative community sample (n = 816), among which 173 persons were diagnosed with a lifetime CUD. In separate unadjusted analyses, any internalizing disorder and any mood disorder with onset prior to that of the index CUD episode were each significantly and negatively associated with CUD duration. These effects, however, were reduced to trend level in adjusted analyses that controlled for putative confounders. Following the onset of the index CUD episode, the subsequent occurrence of any Axis I disorder, internalizing disorder, externalizing disorder, or other substance use disorder during the index CUD episode was significantly and positively associated with the duration of that episode in both unadjusted and adjusted analyses. These findings collectively suggest that the presence of internalizing-spectrum disorders prior to the onset of the index CUD episode affords some modest protection against protracted episodes, whereas the emergence of broad-spectrum psychopathology within the index CUD episode, most notably noncannabis substance use disorders, is associated with greater disorder persistence. The relevance of these findings for various motivational models of cannabis addiction is discussed.

Internalizing and externalizing psychopathology as predictors of cannabis use disorder onset during adolescence and early adulthood.

Risk-related liabilities associated with the development of cannabis use disorders (CUDs) during adolescence and early adulthood are thought to be established well before the emergence of the index episode. In this study, internalizing and externalizing psychopathology from earlier developmental periods were evaluated as risk factors for CUDs during adolescence and early adulthood. Participants (N = 816) completed 4 diagnostic assessments between the ages 16 and 30, during which current and past CUDs were assessed as well as a full range of psychiatric disorders associated with internalizing and externalizing psychopathology domains. In unadjusted and adjusted time-to-event analyses, externalizing but not internalizing psychopathology from proximal developmental periods predicted subsequent CUD onset. A large proportion of adolescent and early adult cases, however, did not manifest any externalizing or internalizing psychopathology during developmental periods before CUD onset. Findings are consistent with the emerging view that externalizing disorders from proximal developmental periods are robust risk factors for CUDs. Although the identification of externalizing liabilities may aid in the identification of individuals at risk for embarking on developmental pathways that culminate in CUDs, such liabilities are an incomplete indication of overall risk.

Parental transmission of risk for cannabis use disorders to offspring.

AIMS: We investigated the risk of cannabis use disorder (CUD) among probands as a function of parental psychopathology and explored parent-offspring gender concordance as a mechanism of parental CUD transmission to offspring. DESIGN: Four waves of data collection from a longitudinal epidemiological study of psychopathology among a regionally representative sample. SETTING: Participants were selected randomly from western Oregon, USA, and were initially assessed during mid-adolescence. PARTICIPANTS: The reference sample included 719 probands and their biological mothers and fathers. MEASUREMENTS: CUD episodes among probands were assessed with semistructured diagnostic interviews between mid-adolescence and young adulthood. Life-time psychiatric disorders among parents of probands were assessed when probands were approximately 24 years of age. FINDINGS: There was an increased risk for CUD onset among probands with parental histories of CUD [hazard ratio (HR) = 1.93, 95% confidence interval (CI) = 1.30-2.88], hard drug use disorders (HR = 1.96, 95% CI = 1.32-2.90) or antisocial personality disorder (HR = 1.73, 95% CI = 1.06-2.82). A significant parent-offspring gender concordance effect indicated that females with a maternal CUD history were at higher risk for CUD onset compared with females without a maternal CUD (HR = 3.10, 95% CI = 1.52-6.34). Maternal CUD was not associated with CUD onset among males (P = 0.570), nor was there evidence for parent-offspring gender concordance effects for paternal CUD-specific transmission (P = 0.114). CONCLUSIONS: Parental histories of antisocial personality and illicit substance use disorders are associated with increased risk for cannabis use disorder onset in offspring, especially among females with maternal cannabis use disorder histories.

Comorbidity and temporal relations of alcohol and cannabis use disorders from youth through adulthood.

BACKGROUND: Alcohol and cannabis are among the most widely used and abused drugs in industrialized societies. Investigations of patterns in comorbidity and temporal sequencing between alcohol use disorders (AUDs) and cannabis use disorders (CUDs) from childhood to adulthood are important for understanding the etiologies of these disorders. METHODS: The sample comprised 816 individuals (59% male, 89% white). Dichotomous measures indicated whether or not a participant was in an AUD or CUD episode during three developmental periods-youth (childhood through adolescence), early adulthood, and adulthood. Structural equation modeling was used to determine relations between AUDs and CUDs across the three developmental periods, and to test for gender differences. RESULTS: Concurrent associations between AUD and CUD were significant. Both AUD and CUD in previous developmental periods significantly predicted the same substance disorders in subsequent periods. Cross-lagged paths from youth AUD to young adult CUD and youth CUD to young adult AUD were both significant. However, only the cross-lagged path from youth CUD to adult AUD was significant. The cross-lagged paths from young adult AUD to adult CUD and young adult CUD to adult AUD were both nonsignificant. Males and females were mostly similar with only three differences found between genders. CONCLUSIONS: Comorbidity of AUDs and CUDs was evident from youth through adulthood but the strength of the relationship lessened in adulthood. Temporal sequencing influences of AUDs and CUDs on each other were similar in youth and adulthood but not young adulthood. Same substance stability was greatest in adulthood.

Adolescent suicide attempts and adult adjustment.

BACKGROUND: Adolescent suicide attempts are disproportionally prevalent and frequently of low severity, raising questions regarding their long-term prognostic implications. In this study, we examined whether adolescent attempts were associated with impairments related to suicidality, psychopathology, and psychosocial functioning in adulthood (objective 1) and whether these impairments were better accounted for by concurrent adolescent confounders (objective 2). METHOD: Eight hundred and sixteen adolescents were assessed using interviews and questionnaires at four time points from adolescence to adulthood. We examined whether lifetime suicide attempts in adolescence (by T2, mean age 17) predicted adult outcomes (by T4, mean age 30) using linear and logistic regressions in unadjusted models (objective 1) and adjusting for sociodemographic background, adolescent psychopathology, and family risk factors (objective 2). RESULTS: In unadjusted analyses, adolescent suicide attempts predicted poorer adjustment on all outcomes, except those related to social role status. After adjustment, adolescent attempts remained predictive of axis I and II psychopathology (anxiety disorder, antisocial and borderline personality disorder symptoms), global and social adjustment, risky sex, and psychiatric treatment utilization. However, adolescent attempts no longer predicted most adult outcomes, notably suicide attempts and major depressive disorder. Secondary analyses indicated that associations did not differ by sex and attempt characteristics (intent, lethality, recurrence). CONCLUSIONS: Adolescent suicide attempters are at high risk of protracted and wide-ranging impairments, regardless of the characteristics of their attempt. Although attempts specifically predict (and possibly influence) several outcomes, results suggest that most impairments reflect the confounding contributions of other individual and family problems or vulnerabilites in adolescent attempters.

Anxiety disorders and risk for alcohol use disorders: the moderating effect of parental support.

BACKGROUND: There have been mixed findings on the temporal relation between anxiety disorders and alcohol use disorders (AUDs), suggesting that the pathway to AUDs may differ among individuals. The aim of the current study was to test whether parental support moderated the association between anxiety disorders and the development of AUDs. We also tested whether our effects differed as a function of age of AUD onset. METHODS: 817 individuals were assessed for lifetime diagnoses of psychopathology during 4-waves between adolescence (mean age=16) and adulthood (mean age=30). RESULTS: Proportional hazards model analyses indicated that baseline anxiety disorders interacted with baseline perceived maternal support to prospectively predict onset of AUDs. At high levels of maternal support, anxiety disorders were associated with a reduced risk for AUD onset (HR=0.74, 95% CI=0.55-1.00). However, this effect was more robust for AUDs that developed prior to age 20. At low levels of maternal support, anxiety disorders were associated with an increased risk for AUD onset (HR=1.65, 95% CI=1.21-2.26). This effect was present for AUDs that developed across adolescence and adulthood. Paternal support was not associated with AUDs and did not interact with anxiety disorders. CONCLUSIONS: Prevention and intervention efforts targeted at maternal support in adolescents with anxiety disorders may be valuable, as this may represent a factor that has a significant impact on the developmental course of AUDs.

Escalation to Major Depressive Disorder among adolescents with subthreshold depressive symptoms: evidence of distinct subgroups at risk.

BACKGROUND: The presence of subthreshold depressive symptoms (SubD) in adolescence is associated with high prospective risk of developing Major Depressive Disorder (MDD). Little is known about variables that predict escalation from SubD to MDD. This study used a longitudinal prospective design in a community sample of adolescents to identify combinations of risk factors that predicted escalation from SubD to MDD. METHODS: Classification tree analysis was used to identify combinations of risk factors that improved the sensitivity and specificity of prediction of MDD onset among 424 adolescents with a lifetime history of SubD. RESULTS: Of the 424, 144 developed MDD during the follow-up period. Evidence for multiple subgroups was found: among adolescents with poor friend support, the highest risk of escalation was among participants with lifetime histories of an anxiety or substance use disorder. Among adolescents with high friend support, those reporting multiple major life events in the past year or with a history of an anxiety disorder were at highest risk of escalation. LIMITATIONS: Study findings may not inform prevention efforts for individuals who first develop SubD during adulthood. This study did not examine the temporal ordering of predictors involved in escalation from SubD to MDD. CONCLUSIONS: Adolescents with a history of SubD were at highest risk of escalation to MDD in the presence of poor friend support and an anxiety or substance use disorder, or in the presence of better friend support, multiple major life events, and an anxiety disorder. Findings may inform case identification approaches for adolescent depression prevention programs.

Anxiety disorders in adolescents and psychosocial outcomes at age 30.

BACKGROUND: Anxiety disorders are associated with adverse psychosocial functioning, and are predictive of a wide range of psychiatric disorders in adulthood. OBJECTIVE: The present study examined the associations between anxiety disorders during childhood and adolescence and psychosocial outcomes at age 30, and sought to address the extent to which psychopathology after age 19 mediated these relations. METHOD: Eight hundred and sixteen participants from a large community sample were interviewed twice during adolescence, at age 24, and at age 30. They completed self-report measures of psychosocial functioning and semi-structured diagnostic interviews during adolescence and young adulthood. RESULTS: Adolescent anxiety predicted poor total adjustment, poor adjustment at work, poor family relationships, problems with the family unit, less life satisfaction, poor coping skills, and more chronic stress. Adolescent anxiety predicted, substance (SUD), alcohol abuse/dependence (AUD), and anxiety in adulthood. No adult psychopathology mediated the relationship between childhood anxiety disorders and psychosocial outcomes at age 30. Adult, SUD, AUD and anxiety mediated the association between adolescent anxiety and most domains of psychosocial functioning at age 30. LIMITATIONS: The participants are ethically and geographically homogenous, and changes in the diagnostic criteria and the interview schedules across the assessment periods. CONCLUSION: Adolescent anxiety, compared to childhood anxiety, is associated with more adverse psychosocial outcomes at age 30. Adolescent anxiety affects negative outcomes at age 30 directly and through adult anxiety, SUD and AUD.

Engagement of pleasant activities in patients with substance use disorders: a correlational study.

BACKGROUND: There is a growing awareness that the treatment of patients with substance use disorders (SUDs) should target increasing patients' involvement in alternative pleasant reinforcers that compete with the reinforcing effects of substance use. The present cross-sectional study sought to identify factors that promote or impede engaging in pleasant activities. METHODS: Patients with SUDs (N = 265) were assessed at treatment entry on sociodemographic characteristics, primary type of substance (ie, alcohol or illicit drugs), addiction severity, craving, personality factors, and psychiatric distress. RESULTS: Regression analyses identified dissimilar predictor sets underlying frequency, enjoyability, and cross-product ratings, highlighting the multifaceted behavioral nature of activity engagement. Personality measures showed the strongest associations with patients' activity engagement, with extraversion as the key predictor. CONCLUSIONS: The present findings emphasize the complexity of patients' involvement in pleasant non-substance-related activities and further investigation is necessary to gain more insight into the underlying mechanisms of activity engagement.

Psychosocial predictors of body mass index at late childhood: a longitudinal investigation.

Little is known about the psychosocial circumstances under which children develop excessive body mass. A community sample was followed up from age 2-10 years to determine which early problems were predictive of increased body mass index. Hypothesized mediators (i.e. eating habits, physical activity, and "screen time") were also examined. After controlling for parental psychopathology, family income, child's gender, and child's body mass index, externalizing behaviors, aggressive behaviors, and anger predicted a relatively high body mass index. Exploratory analyses did not support hypothesized mediators, although low power was an issue.