Mediating and Moderating Role of Depression, Conduct Disorder or Attention-Deficit/Hyperactivity Disorder in Developing Adolescent Substance Use Disorders: A Population-Based Study

PLoS One. 2016 Jun 13;11(6):e0157488. doi: 10.1371/journal.pone.0157488. eCollection 2016.

Abstract

Objective: To evaluate the mediating/moderating effects of common internalizing /externalizing disorders on the association between ADHD and adolescent substance use disorders (SUD) in a population-based birth cohort.

Methods: Among 5718 children in the birth cohort, 343 ADHD incident cases and 712 matched controls were identified. Psychiatric diagnoses prior to age 19 were classified into DSM-IV categories. The association between ADHD and SUD was summarized (hazard ratios (HR), 95% CI). The effect of depression, CD/ODD, anxiety was evaluated separately.

Results: Assessment of the joint effects of ADHD and each psychiatric disorder did not support a moderating effect of these disorders on SUD on additive scale. However, the association between ADHD and SUD was partially explained by a mediating role of these psychiatric disorders.

Conclusion: For clinicians our results emphasize that depression (or CD/ODD) confers greater risk for SUD than ADHD alone. Early detection/treatment of SUD among adolescents with depression (or CD/ODD) is crucial regardless of ADHD.

MeSH terms

  • Adolescent
  • Anxiety / complications
  • Attention Deficit Disorder with Hyperactivity / complications*
  • Child
  • Cohort Studies
  • Conduct Disorder / complications*
  • Depression / complications*
  • Depressive Disorder / complications*
  • Female
  • Humans
  • Male
  • Proportional Hazards Models
  • Substance-Related Disorders / etiology*