School-based extracurricular activity involvement and high school dropout among at-risk students: Consistency matters.

Encouraging involvement in school-based extracurricular activities (ECA) may be important for preventing high school dropout. However, the potential of these activities remains underexploited, perhaps because studies linking ECA involvement and dropout are rare and based on decades-old data. Previous studies also ignore key parameters of student involvement. The present study expands and updates this limited literature by using recent data from a high-risk Canadian sample (N = 545) and by considering a range of involvement parameters. Results showed that consistent involvement in the past year was associated with lower odds of dropout (OR = 0.32; 95% CI = 0.17-0.61). However, adolescents who interrupted their involvement during this period (e.g., because of cancelations or exclusions) were as much at risk of dropout as those who were not involved at all. Findings notably imply that excluding students from ECA (e.g., because of No Pass/No Play policies) may heighten their dropout risk.

The Potential Influence of Group Membership on Outcomes in Indicated Cognitive-Behavioral Adolescent Depression Prevention.

BACKGROUND: Adolescent depression prevention programs are typically delivered in groups in which adolescents share a common setting and interventionist, but the influence of the group is usually ignored or statistically controlled. We tested whether the primary outcomes of reductions in depressive symptoms and future onset of major depressive disorder (MDD) varied as a function of group membership. METHODS: Data were available from two randomized trials in which 220 adolescents received the Blues Program indicated prevention intervention in 36 separate groups; participants were assessed at baseline, post intervention, and at 6-, 12-, and 24-month follow-ups. RESULTS: Ten percent of participants had developed MDD 2 years post intervention. Group-level effects for MDD onset over follow-up were nonsignificant (accounted for <1% of variance; ICC = 0.004, ns). Group-level effects for depressive symptom change across the follow-up period were also nonsignificant (ICC = 0.001, ns) but group effects accounted for 16% of depressive symptom change immediately post intervention (ICC = 0.159, p < 0.05). Group-level clustering of posttest depressive symptoms was not associated with size of group or gender composition. CONCLUSIONS: Membership in specific adolescent cognitive-behavioral depression prevention groups may have an impact in terms of immediate symptom reduction but does not appear to have significant prevention effects in terms of long-term symptom change or MDD onset.

Codifying explicit and tacit practitioner knowledge in community social pediatrics organizations: Evaluation of the first step of a knowledge transfer strategy.

In this article, we the present the evaluation of the first phase of a KT initiative, the codification of the tacit and explicit knowledge of community social pediatrics (CSP) practitioners. As increasing numbers of professionals began working in the CSP field, it became necessary to capture the know-how to make it better understood. This first phase of the initiative took advantage of one of the KM stages, the codifying process that is absent from KT models. The evaluation aim to answer the question: "What is the CSPs practitioners level of familiarity with the codification document, as well as their perceptions of its utility and its contribution to the understanding of the CSP model". The results, show that most respondents had consulted the codification document and were able to describe in detail parts of it. The results also show that they considered it to be a useful and necessary tool to guide practices and helpful in understanding the model. The results of this evaluation is paving the way for the next steps of the KT initiative.

Consistent participation in organized physical activity predicts emotional adjustment in children.

BACKGROUND: The objectives of this study were to derive trajectories of childhood participation in organized physical activity (PA) and to examine how these trajectories are associated with pre-existing and subsequent emotional adjustment. METHODS: Trajectories of mother-reported participation in organized PA were derived from age 6 to 10 for 1492 children from the Québec Longitudinal Study of Child Development birth cohort. Parents and teachers reported on internalizing behavior (emotional distress, anxiety, shyness, social withdrawal) at ages 4 and 12, respectively. RESULTS: Longitudinal latent class analysis identified two typical trajectories of participation in organized PA. The Consistent Participation trajectory (61%) included children with elevated probability of participation at all ages. The Low-Inconsistent Participation trajectory (39%) included children who did not participate or participated only once or twice, generally in late childhood. Pre-existing internalizing behavior at age 4 did not predict trajectory membership. However, children in the Low-Inconsistent Participation trajectory showed higher subsequent emotional distress (B = 0.87, 95% confidence interval [CI] = 0.46-1.28), anxiety (B = 0.61, 95% CI = 0.18-1.04), shyness (B = 0.92, 95% CI = 0.39-1.44), and social withdrawal (B = 0.86, 95% CI = 0.37-1.34) at age 12 than those in the Consistent Participation trajectory. CONCLUSIONS: Our findings suggest that early and sustained involvement in organized PA is beneficial for children's emotional development.

Feasibility and preliminary effectiveness of a drum circle activity to improve affect in patients, families and staff of a pediatric hospital.

Background: Children, families and staff in pediatric hospitals often experience elevated psychological distress. Art-based initiatives, such as group drumming, have been proposed as strategies to support well-being in this context. Methods: This study evaluated the feasibility and potential benefits of a drum circle activity designed to improve the affective experience of patients, families and staff in a large pediatric hospital. A total of 48 patients, 16 employees and 15 visitors completed questionnaires before and after up to 12 joint drum circle sessions. A total of 12 respondents took part in semi-structured interviews. Results: Quantitative analyses showed significant pre-post-session increases in positive affect (beta = .48; p < .001) and decreases in negative affect (beta = -.29; p < .001). Qualitative results corroborated these findings, in addition to suggesting the safety of the activity as well as other potential benefits. Conclusions: This preliminary study supports the usefulness of group drumming to enhance the well-being of pediatric hospital patients, families and staff.

Prospective associations between participation in leisure-time physical activity at age 6 and academic performance at age 12.

For many children, leisure time represents a privileged moment to engage in physical activity. This study aims to examine prospective associations between kindergarten participation in leisure-time physical activity and academic performance by the end of sixth grade. Gender-specific associations are also explored. Participants are from the Quebec Longitudinal Study of Child Development, a 1997-1998 birth cohort from the province of Quebec, Canada (n = 2837). When children were age 6 (2004), mothers reported on their child's participation in three types of leisure-time physical activity (sports, other structured physical activities, and unstructured physical activities). At age 12 (2010), children's academic indicators were reported by teachers and by children themselves. Academic outcomes were then linearly regressed on leisure-time physical activity participation, while controlling for individual and family confounders. Unstructured physical activities were the most popular among both girls and boys. Sports were the second most popular activity among boys, whereas other structured physical activities were the second most popular among girls. Higher overall participation in leisure-time physical activity at age 6 was associated with better teacher-reported grades in language and math (ß = 0.075 and ß = 0.102, respectively) and self-reported grades in language (ß = 0.103), as well as with higher classroom engagement (ß = 0.077,) at age 12. Regression coefficients are standardized. All the associations were significant (p ≤ .05). Promoting leisure-time physical activity may be an effective way to encourage children to be active and to help them improve their academic performance, both leading to long-term wider benefits.

Witnessing violence in early secondary school predicts subsequent student impairment.

BACKGROUND: Past research suggests that adolescents who witness violence are at risk of adjustment problems. However, few studies have implemented a longitudinal design and have accounted for direct experiences of victimisation and other major confounders. This prospective study examines the relationship between witnessing school violence and subsequent impairment and whether such associations depend on the kind of violence witnessed. METHODS: 3936 adolescents from Quebec (Canada) were followed from ages 12 through 15 years. Linear regression tested associations between witnessing school violence at age 13 and subsequent antisocial behaviour (drug use, delinquency), emotional distress (social anxiety, depressive symptoms) and academic adjustment (school achievement, engagement) at age 15. We compared the relative contribution of differing forms of witnessing school violence versus being victimised directly. RESULTS: General school violence predicted later impairment. The adjusted associations between indirectly experiencing violence as a bystander and subsequent impairment were comparable to those of direct victimisation. Witnessing covert and major violence was associated with drug use and delinquency. Witnessing minor violence was associated with increases in drug use, social anxiety, depressive symptoms and decreases in school engagement. CONCLUSIONS: Almost all students witnessed school violence, which predicted impairment. Witnessing violence was associated with risk of subsequent adjustment problems 2 years later. Directly experienced victimisation showed a comparable magnitude of risk. This suggests that when it comes to symptoms of conduct disorder, witnessing violence might have the same impact as experiencing it directly. Witnessing earlier covert and major violence predicted social impairment whereas minor violence predicted psychological and academic impairment.

Prospective associations between sport participation and psychological adjustment in adolescents.

BACKGROUND: Engaging in sport has been suggested to be mitigate against psychological distress. Using a prospective-longitudinal design, we examine whether sport participation is associated with reduced psychological difficulties in adolescents and whether associations differ by sport and personal characteristics. METHODS: 17 550 adolescents from grade 7 to 10 (mean age=14.4 years old) self-reported on sport participation, depressive symptoms, social anxiety symptoms and loneliness in Spring 2007 and 1 year later. Analyses tested the association between sport participation and subsequent psychological difficulties using linear regression, while adjusting for pre-existing psychological and sociodemographic characteristics. Analyses also verified whether associations differed by sport frequency (weekly/more than weekly) and type (team/individual) using Wald tests of parameter constraints, as well as sex, age and pre-existing psychological difficulties using interaction terms. RESULTS: After adjusting for potential confounders, sport participation predicted lower social anxiety symptoms (beta=-0.02 (-0.04, -0.01)) and loneliness (beta=-0.04 (-0.05, -0.02)), but not depressive symptoms. Moderation analyses showed that sport participation predicted greater reductions in depressive symptoms, social anxiety symptoms and loneliness in adolescents with higher baseline scores on each outcome. Associations did not differ by sport frequency and type, sex and age. Post hoc analyses revealed bidirectional associations between sport participation and social anxiety symptoms and loneliness. CONCLUSIONS: Sport participation predicts small reductions in adolescent psychological distress. Reductions seem most important in youth experiencing greater pre-existing psychological difficulty. Our findings suggest that sport participation represents a protective factor that supports psychological resilience in at-risk youth.

Major depression prevention effects for a cognitive-behavioral adolescent indicated prevention group intervention across four trials.

Major depressive disorder (MDD) in young people is a leading cause of disability but most depressed youth are not treated, emphasizing the need for effective prevention. Our goal is to synthesize MDD onset prevention effects for the Blues Program, a brief cognitive-behavioral (CB) indicated prevention group, by merging data from four trials (three of which included CB bibliotherapy) and conducting an individual patient data (IPD) meta-analysis. Data were available from 766 high school/college students (M age = 16.4, SD = 2.3; 60% female, 64% White). CB group resulted in significantly lower MDD incidence rates relative to brochure control that persisted to 6-month follow-up; CB group also was associated with a lower 2-year MDD incidence rate relative to bibliotherapy but heterogeneity across trials was detected. Contrasts between bibliotherapy and brochure control were nonsignificant. For significant contrasts, the number needed to treat (NNT) by CB group to prevent one MDD onset relative to brochure or bibliotherapy ranged from 10 to 21. A brief CB group depression prevention intervention for at-risk adolescent is achieving meaningful effects compared to both active and minimal controls but outcomes need to be improved, perhaps by better screening or augmentations to produce more persistent intervention effects.

Depressive and anxious symptoms and the risk of secondary school non-completion.

BackgroundEvidence regarding the association between adolescent internalising symptoms and school non-completion has been limited and inconclusive.AimsTo examine whether depressive and anxious symptoms at secondary school entry predict school non-completion beyond confounders and whether associations differ by baseline academic functioning.MethodWe used logistic regression to examine associations between depressive and anxious symptoms in grade 7 (age 12-14) and school non-completion (age 18-20) in 4962 adolescents.ResultsDepressive symptoms did not predict school non-completion after adjustment, but moderation analyses revealed an association in students with elevated academic functioning. A curvilinear association was found for anxiety: both low and high anxious symptoms predicted school non-completion, although only low anxiety remained predictive after adjustment.ConclusionsAssociations between internalising symptoms and school non-completion are modest. Common school-based interventions targeting internalising symptoms are unlikely to have a major impact on school non-completion, but may prevent non-completion in selected students.

The structure of psychopathology in adolescence and its common personality and cognitive correlates.

The traditional view that mental disorders are distinct, categorical disorders has been challenged by evidence that disorders are highly comorbid and exist on a continuum (e.g., Caspi et al., 2014; Tackett et al., 2013). The first objective of this study was to use structural equation modeling to model the structure of psychopathology in an adolescent community-based sample (N = 2,144) including conduct disorder, attention-deficit/hyperactivity disorder (ADHD), oppositional-defiant disorder (ODD), obsessive-compulsive disorder, eating disorders, substance use, anxiety, depression, phobias, and other emotional symptoms, assessed at 16 years. The second objective was to identify common personality and cognitive correlates of psychopathology, assessed at 14 years. Results showed that psychopathology at 16 years fit 2 bifactor models equally well: (a) a bifactor model, reflecting a general psychopathology factor, as well as specific externalizing (representing mainly substance misuse and low ADHD) and internalizing factors; and (b) a bifactor model with a general psychopathology factor and 3 specific externalizing (representing mainly ADHD and ODD), substance use and internalizing factors. The general psychopathology factor was related to high disinhibition/impulsivity, low agreeableness, high neuroticism and hopelessness, high delay-discounting, poor response inhibition and low performance IQ. Substance use was specifically related to high novelty-seeking, sensation-seeking, extraversion, high verbal IQ, and risk-taking. Internalizing psychopathology was specifically related to high neuroticism, hopelessness and anxiety-sensitivity, low novelty-seeking and extraversion, and an attentional bias toward negatively valenced verbal stimuli. Findings reveal several nonspecific or transdiagnostic personality and cognitive factors that may be targeted in new interventions to potentially prevent the development of multiple psychopathologies. (PsycINFO Database Record

GROUP-BASED SYMPTOM TRAJECTORIES IN INDICATED PREVENTION OF ADOLESCENT DEPRESSION.

BACKGROUND: Adolescent depression prevention research has focused on mean intervention outcomes, but has not considered heterogeneity in symptom course. Here, we empirically identify subgroups with distinct trajectories of depressive symptom change among adolescents enrolled in two indicated depression prevention trials and examine how cognitive-behavioral (CB) interventions and baseline predictors relate to trajectory membership. METHODS: Six hundred thirty-one participants were assigned to one of three conditions: CB group intervention, CB bibliotherapy, and brochure control. We used group-based trajectory modeling to identify trajectories of depressive symptoms from pretest to 2-year follow-up. We examined associations between class membership and conditions using chi-square tests and baseline predictors using multinomial regressions. RESULTS: We identified four trajectories in the full sample. Qualitatively similar trajectories were found in each condition separately. Two trajectories of positive symptom course (low-declining, high-declining) had declining symptoms and were distinguished by baseline symptom severity. Two trajectories of negative course (high-persistent, resurging), respectively, showed no decline in symptoms or decline followed by symptom reappearance. Participants in the brochure control condition were significantly more likely to populate the high-persistent trajectory relative to either CB condition and were significantly less likely to populate the low-declining trajectory relative to CB group. Several baseline factors predicted trajectory classes, but gender was the most informative prognostic factor, with males having increased odds of membership in a high-persistent trajectory relative to other trajectories. CONCLUSIONS: Findings suggest that CB preventive interventions do not alter the nature of trajectories, but reduce the risk that adolescents follow a trajectory of chronically elevated symptoms.

Adolescent Trajectories of Depressive Symptoms: Codevelopment of Behavioral and Academic Problems.

PURPOSE: Increasing evidence suggests the existence of heterogeneity in the development of depressive symptoms during adolescence, but little remains known regarding the implications of this heterogeneity for the development of commonly co-occurring problems. In this study, we derived trajectories of depressive symptoms in adolescents and examined the codevelopment of multiple behavioral and academic problems in these trajectories. METHODS: Participants were 6,910 students from secondary schools primarily located in disadvantaged areas of Quebec (Canada) who were assessed annually from the age 12 to 16 years. Trajectories were identified using growth mixture modeling. The course of behavioral (delinquency, substance use) and academic adjustment (school liking, academic achievement) in trajectories was examined by deriving latent growth curves for each covariate conditional on trajectory membership. RESULTS: We identified five trajectories of stable-low (68.1%), increasing (12.1%), decreasing (8.7%), transient (8.7%), and stable-high (2.4%) depressive symptoms. Examination of conditional latent growth curves revealed that the course of behavioral and academic problems closely mirrored the course of depressive symptoms in each trajectory. CONCLUSIONS: This pattern of results suggests that the course of depressive symptoms and other adjustment problems over time is likely to involve an important contribution of shared underlying developmental process(es).

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.

Latent classes of substance use in adolescent cannabis users: predictors and subsequent substance-related harm.

Cannabis use is highly prevalent in late adolescence, but not all users experience significant negative consequences. Little information is available to identify the substance use patterns and risk factors of users who are at greater risk of experiencing negative consequences. In this prospective study, we aimed to empirically identify latent classes of substance use in adolescent cannabis users and to examine how these classes relate to antecedent psychosocial predictors and subsequent substance-related outcomes. The sample was recruited from 68 high schools in Quebec and consisted of 1618 participants who reported using cannabis in grade 10. We used latent class analysis to empirically identify classes of users based on the age of onset, frequency, and typical quantity of cannabis and other substance use, as well as substance mixing behaviors. We then compared classes in terms of (a) sociodemographic and psychosocial predictors in grades 7-8 and (b) substance-related consequences in grade 11. Four distinct classes were identified: Late-Light Users (28%); Late-Heavy + Polydrug Users (14%); Early-Moderate Users (33%); Early-Heavy + Polydrug Users (26%). Late-Light Users reported the lowest levels of substance use, while Early-Heavy + Polydrug Users reported the highest levels. Intermediate levels of substance use were found in the other two classes. Sex, age, delinquency, peer delinquency, school bonding, parental monitoring, and parental conflict all helped to differentiate classes. Class membership predicted substance-related harm, with greater consequences in early- and late-onset heavy using classes. In light of results, in addition to age and sex, screening and intervention for risky cannabis use among adolescents should focus on school bonding in order to target the most risky late-onset adolescents and on peer delinquency in order to target the most risky early-onset ones.

Moderators of two indicated cognitive-behavioral depression prevention approaches for adolescents in a school-based effectiveness trial.

OBJECTIVE: Our aim was to identify moderators of the effects of a cognitive behavioral group-based prevention program (CB group) and CB bibliotherapy, relative to an educational brochure control condition and to one another, in a school-based effectiveness randomized controlled prevention trial. METHOD: 378 adolescents (M age = 15.5, 68% female) with elevated depressive symptoms were randomized in one of three conditions and were assessed at pretest, posttest, and 6-month follow-up. We tested the moderating effect of three individual (baseline depressive symptoms, negative attributional style, substance use), three environmental (negative life events, parental support, peer support), and two sociodemographic (sex, age) characteristics. RESULTS: Baseline depressive symptoms interacted with condition and time. Decomposition indicated that elevated baseline depressive symptoms amplified the effect of CB bibliotherapy at posttest (but not 6-month follow-up) relative to the control condition, but did not modify the effect of CB group relative to the control condition or relative to bibliotherapy. Specifically, CB bibliotherapy resulted in lower posttest depressive symptoms than the control condition in individuals with elevated, but not average or low baseline symptoms. We found no interaction effect for other putative moderators. CONCLUSIONS: Our findings suggest that bibliotherapy is effective only in participants who have elevated depressive symptoms at baseline. The fact that no study variable moderated the effects of CB group, which had a significant main effect in reducing depressive symptoms relative to the control condition, suggests that this indicated prevention intervention is effective for a wide range of adolescents.

Adolescent illicit drug use and subsequent academic and psychosocial adjustment: an examination of socially-mediated pathways.

BACKGROUND: Questions remain regarding the consequences of illicit drug use on adolescent adjustment and the nature of mechanisms that may explain these consequences. In this study, we examined whether early-onset illicit drug use predicts subsequent academic and psychosocial adjustment and whether associations are socially-mediated by decreased school engagement and increased peer deviancy. METHOD: 4885 adolescents were followed throughout secondary school. We used regressions to determine whether illicit drug use in grade 7 predicted academic achievement, school dropout, depressive symptoms, and conduct problems in grades 10-11, adjusting for potential confounders. We used path analysis to test whether significant associations were mediated by school engagement and peer deviancy in grade 8. RESULTS: Illicit drug use predicted conduct problems and school dropout, but not academic achievement and depressive symptoms. The association between illicit drug use and conduct problems was fully mediated by increased peer deviancy. The association between illicit drug use and school dropout was partially mediated by increased peer deviancy, but remained mostly direct. No indirect association via decreased school engagement was found. Examination of reverse pathways revealed that conduct problems and academic achievement in grade 7 predicted drug use in grades 10-11. These associations were mediated by peer deviancy and school engagement (conduct problems only). CONCLUSION: Adolescent illicit drug use influences the risk of school dropout and conduct problems in part by contributing to deviant peer affiliation. Reciprocal social mediation characterizes the association between drug use and conduct problems. A reverse mechanism best explains the association with academic achievement.

Indicated cognitive behavioral group depression prevention compared to bibliotherapy and brochure control: acute effects of an effectiveness trial with adolescents.

OBJECTIVE: We tested whether a brief cognitive behavioral (CB) group and bibliotherapy prevention reduce major depressive disorder (MDD) onset, depressive symptoms, and secondary outcomes relative to brochure controls in adolescents with self-reported depressive symptoms when school personnel recruit participants and deliver the intervention. METHOD: Three hundred seventy-eight adolescents (M age = 15.5 years, SD = 1.2; 68% female, 72% White) with elevated self-assessed depressive symptoms were randomized to a 6-session CB group, minimal contact CB bibliotherapy, or educational brochure control. Participants were assessed at pretest, posttest, and 6-month follow-up. RESULTS: CB group participants showed a significantly lower risk for major depressive disorder onset (0.8%), compared to both CB bibliotherapy (6.3%) and brochure control (6.5%; hazard ratio = 8.1 and 8.3, respectively). Planned contrasts indicated that CB group resulted in lower depressive symptom severity than brochure control at posttest (p = .03, d = 0.29) but not 6-month follow-up; differences between CB group and bibliotherapy were nonsignificant at posttest and 6-month follow-up. Condition effects were nonsignificant for social adjustment and substance use. CONCLUSIONS: The finding that a brief CB group intervention delivered by real-world providers significantly reduced MDD onset relative to both brochure control and bibliotherapy is very encouraging, although effects on continuous outcome measures were small or nonsignificant and approximately half the magnitude of those found in efficacy research, potentially because the present sample reported lower initial depression.

Comorbidity between major depression and alcohol use disorder from adolescence to adulthood.

BACKGROUND: Limited information exists regarding the long-term development of comorbidity between Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD; abuse/dependence). Using a representative prospective study, we examine multiple aspects pertaining to MDD+AUD comorbidity, with a focus on the relation between disorders across periods (adolescence, early adulthood, adulthood) and cumulative impairments by age 30. METHOD: 816 participants were diagnostically interviewed at ages 16, 17, 24, and 30. RESULTS: Rates of comorbid MDD+AUD were low in adolescence (2%), but increased in early adulthood (11%) and adulthood (7%). Rates of cumulative comorbidity were elevated (21%). Most individuals with a history of MDD or AUD had the other disorder, except for women with MDD. Prospectively, adolescent AUD predicted early adult MDD, while early adult MDD predicted adult AUD. Compared to pure disorders, MDD+AUD was associated with higher risk of alcohol dependence, suicide attempt, lower global functioning, and life dissatisfaction. CONCLUSIONS: Lifetime rates of comorbid MDD+AUD were considerably higher than in cross-sectional studies. Comorbidity was partly explained by bidirectional and developmentally-specific associations and predicted selected rather than generalized impairments. Clinically, our findings emphasize the need to always carefully assess comorbidity in patients with MDD or AUD, taking into account concurrency and developmental timing.