The Relationship Between Mental Health & Substance Abuse Among Adolescents

The Relationship Between Mental Health and Substance Abuse Among Adolescents

4.6 Conclusions

The inclusion of the YSR items on the 1994, 1995, and 1996 NHSDA presented the opportunity to examine the relationship between specific measures of psychological functioning and substance use in a large national probability sample of adolescents aged 12 to 17. Among the eight syndromes measured by the YSR, the three subscales that best predicted substance use were Delinquent Behavior, Social Problems, and Attention Problems. Other identified emotional risk factors for substance use were dependent on age, gender, or substance use indicator. The findings suggest a complex pattern of psychosocial influences on substance use. Those adolescents who were more likely to use substances reported delinquent behaviors, such as stealing, using obscene language, cutting classes or skipping school, hanging around with others who get into trouble, and running away from home. Among reported subjective experiences, an item from the Attention Problems scale, "feeling confused or in afog," was highly predictive of substance use. In contrast, specific items from the Social Problems scale were less likely to be reported by adolescents who use substances. These items generally concerned peer and parental relations: specifically, adolescents who use substances are less likely than their peers who report no substance use to acknowledge getting teased, preferring younger friends, acting too young, or overdependence on adults.

The results suggest that some psychological symptoms are highly associated with substance use among adolescents; however this study was not designed to investigate the association between substance use and specific psychiatric diagnoses. DSM-IV diagnoses (APA, 1994) are not available for these adolescents. Further research is necessary to determine the complex relation of emotional risk factors for substance use among specific subgroups of adolescents.Longitudinal research is necessary to investigate the developmental relationship between emotional and behavioral problems and adolescent substance use.

Table 4.1 Means and Standard Errors for the YSR Syndromes by Age Group and Gender, NHSDA National Sample and Achenbach (1991) Nonclinical Sample


		Males				Females
		NHSDA			Achenbach	NHSDA			Achenbach
		12-13	14-15	16-17	Achenbach	12-13	14-15	16-17	Achenbach
	n	2,275	2,375	2,126	536	2,237	2,277	2,277	518
Withdrawn	Mean	2.31	2.40	2.64	3.4	2.91	3.14	3.23	4.0
Withdrawn	S.E	0.06	0.06	0.05	0.1	0.06	0.07	0.07	0.1
Somatic Complaints	Mean	2.48	2.20	2.04	2.2	3.19	3.58	3.61	3.0
Somatic Complaints	S.E.	0.08	0.07	0.07	0.1	0.08	0.09	0.08	0.1
Anxious/Depressed	Mean	3.68	3.68	4.00	5.2	5.11	6.04	6.05	6.5
Anxious/Depressed	S.E.	0.11	0.10	0.12	0.2	0.13	0.14	0.15	0.2
Social Problems	Mean	2.67	2.38	2.25	2.7	2.66	2.43	2.18	2.7
Social Problems	S.E	0.06	0.06	0.05	0.1	0.06	0.06	0.05	0.1
Thought Problems	Mean	2.52	2.63	2.67	2.3	2.91	3.16	3.13	2.5
Thought Problems	S.E	0.06	0.06	0.06	0.1	0.07	0.07	0.07	0.1
Attention Problems	Mean	3.88	3.99	3.96	4.7	3.99	4.42	4.29	4.7
Attention Problems	S.E	0.08	0.08	0.08	0.1	0.08	0.09	0.09	0.1
Delinquent Problems	Mean	2.66	3.27	3.39	3.1	2.44	3.23	3.20	2.5
Delinquent Problems	S.E	0.07	0.06	0.07	0.1	0.07	0.07	0.08	0.1
Aggressive Problems	Mean	7.35	7.81	7.65	8.4	7.67	8.48	8.30	8.1
Aggressive Problems	S.E.	0.14	0.13	0.15	0.2	0.15	0.14	0.15	0.2

Note: The eight syndrome scales of the YSR are formed from scores on the individual items. The syndrome measures are obtained by summing the individual items for each scale.

*The item indicating alcohol and drug abuse was removed from the Delinquent Behavior scale for all analysis in this chapter.

Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-1996


Table 4.2 Interitem Consistency Coefficients (Alpha) for YSR Syndromes by Gender
	Males		Females
Scales (Items)	NHSD A	Achenbac h	NHS DA	Achenbach
Withdrawn (7)	.62	.59	.64	.59
Somatic Complaints (9)	.78	.77	.80	.80
Anxiety/Depression (16)	.82	.86	.86	.90
Social Problems (8)	.53	.68	.57	.68
Thought Problems (7)	.65	.69	.70	.71
Attention Problems (9)	.70	.75	.75	.78
Delinquent Behavior (11)	.70	.76	.74	.76
Aggressive Behavior (19)	.84	.86	.84	.86
Note: Alphas for the Achenbach sample were obtained from Achenbach (1991). Alpha is a measure (from 0 to 1) of the degree to which the items form a reliable theoretical construct. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-6


Table 4.3 Correlations Among the YSR Scales for the Entire NHSDA Sample
	Somatic Complaints	Anxious/ Depressed	Social Problems	Thought Problems	Attention Problems	Delinquent Behavior	Aggressive Behavior
Withdrawn	.50	.70	.57	.53	.51	.42	.46
Somatic Complaints		.60	.40	.50	.50	.41	.48
Anxious/ Depressed			.54	.60	.64	.47	.59
Social Problems				.47	.61	.36	.48
Thought Problems					.62	.49	.61
Attention Problems						.53	.66
Delinquent Behavior							.65
Aggressive Behavior
Note:The correlation coefficients indicate the degree of relationship among the different syndrome scales in the YSR. A higher value indicates a higher degree of relationship between scales. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-6


Table 4.4 Correlations Among the YSR Scales for 12- to 13-Year-Old Males (Upper Diagonal) and Females (Lower Diagonal)
	Withdrawn	Somatic Complaints	Anxious/ Depressed	Social Problems	Thought Problems	Attention Problems	Delinquent Behavior	Aggressive Behavior
Withdrawn		.44	.70	.62	.56	.51	.47	.52
Somatic Complaints	.53		.57	.44	.45	.48	.41	.46
Anxious/ Depressed	.70	.59		.63	.61	.64	.53	.65
Social Problems	.61	.43	.58		.52	.66	.42	.55
Thought Problems	.54	.54	.61	.50		.63	.45	.62
Attention Problems	.55	.53	.68	.64	.64		.51	.69
Delinquent Behavior	.47	.50	.53	.41	.51	.55		.66
Aggressive Behavior	.49	.51	.63	.53	.64	.67	.66
Note: Entries are Pearson Product Moment Correlations. The correlation coefficients indicate the degree of relationship among the different YSR syndrome scales for 12- to 13-year-old males and females. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-6


Table 4.5 Correlations Among the YSR Scales for 14- to 15-Year-Old Males (Upper Diagonal) and Females (Lower Diagonal)
	Withdrawn	Somatic Complaints	Anxious/ Depressed	Social Problems	Thought Problems	Attention Problems	Delinquent Behavior	Aggressive Behavior
Withdrawn		.50	.67	.59	.51	.49	.39	.42
Somatic Complaints	.52		.58	.43	.51	.51	.38	.47
Anxious/ Depressed	.70	.63		.56	.58	.63	.45	.56
Social Problems	.58	.40	.55		.47	.60	.35	.48
Thought Problems	.52	.54	.63	.46		.60	.47	.58
Attention Problems	.52	.53	.68	.60	.63		.53	.66
Delinquent Behavior	.42	.49	.50	.35	.56	.53		.65
Aggressive Behavior	.44	.54	.59	.47	.61	.66	.66
Note: Entries are Pearson Product Moment Correlations. The correlation coefficients indicate the degree of relationship among the different YSR syndrome scales for 14- to 15-year-old males and females. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-6


Table 4.6 Correlations among the YSR Scales for 16- to 17-Year-Old Males (Upper Diagonal) and Females (Lower Diagonal)
	Withdrawn	Somatic Complaints	Anxious/ Depressed	Social Problems	Thought Problems	Attention Problems	Delinquent Behavior	Aggressive Behavior
Withdrawn		.45	.68	.57	.50	.49	.41	.41
Somatic Complaints	.49		.53	.36	.45	.44	.37	.41
Anxious/ Depressed	.69	.59		.54	.55	.61	.46	.54
Social Problems	.54	.38	.51		.45	.59	.38	.44
Thought Problems	.51	.47	.58	.46		.61	.49	.58
Attention Problems	.50	.51	.65	.58	.61		.53	.64
Delinquent Behavior	.43	.42	.47	.36	.48	.55		.62
Aggressive Behavior	.42	.49	.58	.46	.58	.62	.66
Note: Entries are Pearson Product Moment Correlations. The correlation coefficients indicate the degree of relationship among the different YSR syndrome scales for 16- to 17-year-old males and females. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-6


Table 4.7 Mean and Median Correlations Among the Syndrome Scales by Age and Gender
	Male		Female
Age Group	Mean	Median	Mean	Median
12-13	.55	.54	.56	.54
14-15	.52	.51	.55	.54
16-17	.50	.50	.52	.51
Note: The table summarizes the overall degree of relationship among the eight different YSR syndrome scales by presenting mean and median correlations for each age and gender group. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-6

Table 4.8 start here


Table 4.8 Results for Logistic Regression of YSR Scales on Any Past Month Cigarette Smoking, Overall and by Age Group and Gender
		All	Males			Females
	age	12-17	12-13	14-15	16-17	12-13	14-15	16-17
	n	13,567	2,275	2,375	2,126	2,237	2,277	2,277
Intercept	Coef. S.E.	-2.40 0.06	-3.16 0.19	-2.25 0.15	-1.67 0.13	-3.59 0.23	-2.73 0.17	-1.96 0.15
Withdrawn	Coef. S.E.	-0.08 0.02	-0.09 0.07	-0.13 0.05	-0.10 0.04	-0.04 0.06	-0.07 0.04	-0.15 0.04
Somatic Complaints	Coef. S.E.	-0.00 0.01	-0.06 0.04	0.08 0.03	-0.01 0.03	0.01 0.04	-0.03 0.03	0.03 0.02
Anxious/ Depressed	Coef. S.E.	0.02 0.01	-0.06 0.04	-0.01 0.03	0.02 0.02	0.01 0.03	0.01 0.02	0.04 0.02
Social Problems	Coef. S.E.	-0.14 0.02	-0.19 0.07	-0.01 0.05	-0.04 0.04	-0.18 0.07	-0.13 0.05	-0.12 0.05
Thought Problems	Coef. S.E.	-0.03 0.02	0.07 0.05	-0.07 0.04	-0.09 0.04	-0.07 0.06	0.01 0.05	-0.03 0.04
Attention Problems	Coef. S.E.	0.08 0.01	0.12 0.04	0.03 0.04	0.07 0.03	0.10 0.06	0.12 0.04	0.08 0.03
Delinquent Behavior	Coef. S.E.	0.31 0.01	0.28 0.04	0.28 0.03	0.27 0.03	0.40 0.05	0.31 0.03	0.32 0.03
Aggressive Behavior	Coef. S.E.	0.01 0.01	0.04 0.03	0.00 0.02	0.02 0.02	0.03 0.03	0.02 0.02	-0.01 0.02
Note: Logistic regression analysis was used to determine whether scores from the YSR Scales are predictive of past month cigarette smoking. The analyses were conducted for the entire sample and then separately for each of the six different age and gender groups: 12-13, 14-15, and 16- to 17-year-old males and 12-13, 14-15, and 16- to 17-year-old females. Each of these seven models included the eight YSR Scales as continuous independent variables. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-6


Table 4.9 Results for Logistic Regression of YSR Scales on Any Past Month Alcohol Use, Overall and by Age Group and Gender
		All	Males			Females
	age	12-17	12-13	14-15	16-17	12-13	14-15	16-17
	n	13,567	2,275	2,375	2,126	2,237	2,277	2,277
Intercept	Coef. S.E.	-2.13 0.06	-3.19 0.19	-2.22 0.13	-1.14 0.11	-3.79 0.26	-2.40 0.13	-1.60 0.13
Withdrawn	Coef. S.E.	-0.03 0.02	-0.06 0.09	0.02 0.04	-0.15 0.04	0.12 0.08	-0.02 0.04	-0.11 0.04
Somatic Complaints	Coef. S.E.	0.02 0.01	0.02 0.04	0.03 0.03	0.01 0.03	-0.01 0.05	0.06 0.03	0.06 0.02
Anxious/ Depressed	Coef. S.E.	0.00 0.01	-0.07 0.05	-0.07 0.03	0.05 0.03	-0.04 0.05	0.01 0.02	0.00 0.02
Social Problems	Coef. S.E.	-0.18 0.02	-0.21 0.08	-0.17 0.04	-0.07 0.04	-0.26 0.07	-0.12 0.04	-0.10 0.05
Thought Problems	Coef. S.E.	-0.03 0.02	0.05 0.05	-0.00 0.04	-0.16 0.04	0.02 0.08	-0.02 0.04	0.01 0.04
Attention Problems	Coef. S.E.	0.05 0.02	0.04 0.05	0.06 0.03	0.02 0.03	0.04 0.06	0.03 0.03	0.05 0.03
Delinquent Behavior	Coef. S.E.	0.29 0.01	0.33 0.06	0.27 0.03	0.29 0.03	0.37 0.05	0.27 0.03	0.23 0.03
Aggressive Behavior	Coef. S.E.	0.01 0.01	0.02 0.03	0.01 0.02	0.03 0.02	0.02 0.03	0.02 0.02	0.01 0.02
Note: Logistic regression analysis was used to determine whether scores from the YSR Scales are predictive of past month alcohol use. The analyses were conducted for the entire sample and then separately for each of the six different age and gender groups: 12-13, 14-15, and 16- to17-year-old males and 12-13, 14-15, and 16- to17-year-old females. Each of these seven models included the eight YSR Scales as continuous independent variables. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-6


Table 4.10 Results for Logistic Regression of YSR Scales on Any Past Month Marijuana Use for the Entire Sample and by Age Group and Gender
		All	Males			Females
	age	12-17	12-13	14-15	16-17	12-13	14-15	16-17
	n	13,567	2,275	2,375	2,126	2,237	2,277	2,277
Intercept	Coef. S.E.	-3.60 0.09	-4.67 0.31	-3.88 0.22	-2.56 0.18	-6.37 0.41	-4.12 0.29	-3.24 0.17
Withdrawn	Coef. S.E.	-0.01 0.02	-0.21 0.14	-0.02 0.06	-0.01 0.05	-0.14 0.16	-0.07 0.05	0.01 0.06
Somatic Complaints	Coef. S.E.	-0.02 0.02	-0.02 0.08	-0.03 0.04	0.04 0.04	-0.12 0.07	0.01 0.06	-0.03 0.03
Anxious/ Depressed	Coef. S.E.	-0.00 0.02	-0.03 0.07	-0.04 0.04	-0.00 0.03	0.15 0.08	0.01 0.03	-0.04 0.02
Social Problems	Coef. S.E.	-0.21 0.03	-0.20 0.15	-0.21 0.06	-0.15 0.05	-0.51 0.16	-0.17 0.07	-0.09 0.06
Thought Problems	Coef. S.E.	-0.03 0.03	0.07 0.08	-0.06 0.06	-0.06 0.05	-0.08 0.13	-0.03 0.07	0.00 0.05
Attention Problems	Coef. S.E.	0.08 0.02	0.07 0.08	0.16 0.05	0.04 0.04	0.02 0.16	0.03 0.05	0.08 0.05
Delinquent Behavior	Coef. S.E.	0.37 0.02	0.49 0.09	0.39 0.04	0.32 0.04	0.51 0.08	0.37 0.05	0.31 0.04
Aggressive Behavior	Coef. S.E.	-0.01 0.01	-0.05 0.06	-0.03 0.02	-0.02 0.02	0.10 0.07	0.04 0.04	0.00 0.02
Note: Logistic regression analysis was used to determine whether scores from the YSR Scales are predictive of past month marijuana use. The analyses were conducted for the entire sample and then separately for each of the six different age and gender groups: 12-13, 14-15, and 16-to 17-year-old males and 12-13, 14-15, and 16- to 17-year-old females. Each of these seven models included the eight YSR Scales as continuous independent variables. Source: Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse, 1994-6


Table 4.11 Results for Logistic Regression of YSR Scales on Alcohol Dependency Indicator, for the Entire Sample and by Age Group and Gender
		All	Males			Females
	age	12-17	12-13	14-15	16-17	12-13	14-15	16-17
	n	13,567	2,275	2,375	2,126	2,237	2,277	2,277
Intercept	Coef. S.E.	-4.41 0.11	-6.20 0.41	-4.69 0.33	-3.60 0.22	-6.60 0.43	-4.71 0.26	-3.85 0.24
Withdrawn	Coef. S.E.	-0.06 0.03	-0.25 0.21	-0.06 0.09	-0.08 0.07	-0.04 0.12	-0.00 0.06	-0.14 0.07
Somatic Complaints	Coef. S.E.	0.05 0.02	0.10 0.10	-0.04 0.06	0.04 0.04	0.11 0.08	-0.02 0.05	0.11 0.03
Anxious/ Depressed	Coef. S.E.	0.02 0.02