title: Pattern and risk of developing alcohol use disorders, illegal substance use and psychiatric disorders after early onset of alcohol use: Results of the Thai National Mental Health Survey 2013.
abstract: Although underage drinking is a global concern, little is known about the relationship between age at first drink and development of various psychiatric comorbidities.
  
  
  
  A secondary data analysis was done among 2928 lifetime drinkers from the Thai National Mental Health Survey 2013. Age at first drink, and onset of related psychiatric outcomes were inquired. Survival analysis using Cox regression was performed to estimate the risk over time for psychiatric problems across age ranges at first drink.
  
  
  
  Two-thirds of male and one-third of female drinkers were considered underage at drinking onset. Substance use and abuse developed earlier (<5 years) than alcohol use disorders (AUDs) and other outcomes (mostly >10 years). Those who started drinking before age 15 years were more likely to develop use of cannabis (HR=4.75; 95% CI 2.73, 8.24), club drugs (HR=2.88; 95% CI 1.46, 5.71) and inhalants (HR=6.46; 95% CI% 1.64, 25.37), compared to those who were 20 years or older at drinking onset. Using age as an alternative time-scale, those aged <15years at drinking onset were significantly more likely to experience AUDs, psychotic symptoms, intermittent explosive disorder and panic disorder. However, the early onset drinkers were less likely to develop depression compared to those who started at age 20 years and over.
  
  
  
  Premature alcohol consumption tends to be a gateway to various serious consequences. Efforts of such drinking age policy and interventions are needed to address vulnerable young populations.
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanich Road, Hat Yai, Songkhla 90110, Thailand; Songkhla Rajanagarindra Psychiatric Hospital, 472 Saiburi Road, Mueang Songkhla, Songkhla 90000, Thailand. Electronic address: atanaree@gmail.com.
authors.forename: Athip
authors.initials: A
authors.lastname: Tanaree
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanich Road, Hat Yai, Songkhla 90110, Thailand.
authors.forename: Sawitri
authors.initials: S
authors.lastname: Assanangkornchai
authors.affiliation: Mental Health Service Administration, Department of Mental Health, 88/20 Moo 4, Soi 4, Muang, Nonthaburi 11000, Thailand.
authors.forename: Phunnapa
authors.initials: P
authors.lastname: Kittirattanapaiboon
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology*; D019973:Alcohol-Related Disorders / Q000453:epidemiology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000453:epidemiology*; D015995:Prevalence; D011619:Psychotropic Drugs; D012306:Risk; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: Illegal substance use; Psychiatric comorbidity; Underage alcohol use