Search

Objective: The purpose of this study was to investigate the prevalence and correlates of depression among adolescents being treated for chemical dependence. Method: Using the National Institute of Mental Health Diagnostic Interview Schedule, the authors interviewed 223 adolescents, aged 15-19 years, who were in residential treatment for alcohol or drug dependence diagnosed according to DSM-III-R criteria. Data on sociodemographic characteristics, school and social performance, past history, family composition, familial alcohol and drug abuse, and previous victimization of the subjects were also gathered. Results: Fifty-four (24.7%) of the subjects met the DSM-III-R criteria for depression. Very few of the traditional correlates of depression discriminated depressed from nondepressed subjects, suggesting that the presence of chemical dependence overrides other predictors of depression. Only female gender, paternal psychopathology, and victimization (physical abuse, sexual abuse) emerged as important variables associated with depression. However, subjects whose onset of depression preceded their chemical dependence had different characteristics from those whose depression began after their chemical dependence. Conclusions: The prevalence of depressive illness in these chemically dependent adolescents was approximately three times that reported for nonreferred groups of similar age. This high rate of depression reflects the contributions of two distinct groups - those with primary depression and those with depression subsequent to chemical dependence - whose characteristics differed, suggesting the possibility of two pathologic processes, similar in manifestation but with different associated features and possibly with distinct etiologies. Confirmation of these findings in further research could indicate that the two forms of depression may require different treatment approaches.

The suicide rate among adolescents aged 15 to 19 rose from 5.2 to 9.0 per 100,000 between 1970 and 1984. Based on these statistics, experts believe there is an urgent need to identify high-risk adolescents. Two known risk factors for adolescent suicide are substance abuse and major depression. Suicidal ideation (thoughts) has been established as a risk factor for adults but its role in adolescents is not known. The way these three risk factors interact has not been investigated. Difficulties in separating these predictors result from the frequent coexistence of major depression and substance abuse and the tendency for research subjects to have several different disorders. A group of 424 college students participated in a study where the vast majority were 18 or 19 years old and white. Results showed that substance abuse and major depression were independent and interacting risk factors for suicidal thoughts and attempts at suicide. Risk was especially high for men who abused alcohol or drugs. A suicide attempt was more likely if a person expressed a long-term desire to be dead than if the individual had a thought of suicide. In conclusion, older teenagers who have suicidal ideation with major depression and/or substance abuse should receive intensive treatment as they are at significant risk for suicide.

• An investigation of the prenatal, delivery, and neonatal experience of 145 autistic children matched with 330 unaffected siblings revealed that among the propositi there was a preponderance of first-born children. Obstetrical records, which had been made prior to the diagnosis of autism, indicated that autistic children were more likely than their siblings to have experienced at least one untoward event during their mothers' gestations and deliveries. Similarly, the autistic children had an increased risk of neonatal complications. Despite the significant excess of total reproductive complications in the autistic series, there was no single event or a combination of biologically related complications that could reasonably account for any large number of cases of autism. While it is possible that autism may be the product of several diverse deleterious events experienced in utero, during delivery, or in the early neonatal period, our finding could be a chance occurrence or could signal the presence of an unknown factor responsible both for autism and for a variety of reproductive complications.(Am J Dis Child 134:860-864, 1980)