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


CONCLUSIONS
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.
Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America.|Department of Hygiene, School of Medicine, Wakayama Medical University, Wakayama City, Japan.
Kouichi
K
Yoshimasu
Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America.
William J
WJ
Barbaresi
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America.
Robert C
RC
Colligan
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America.
Robert G
RG
Voigt
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America.
Amy L
AL
Weaver
Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America.
Slavica K
SK
Katusic
D000293:Adolescent; D001007:Anxiety / Q000150:complications; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications*; D002648:Child; D015331:Cohort Studies; D019955:Conduct Disorder / Q000150:complications*; D003863:Depression / Q000150:complications*; D003866:Depressive Disorder / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D019966:Substance-Related Disorders / Q000209:etiology*