Depressive symptoms, negative urgency and substance use initiation in adolescents
Introduction
Adolescent substance use remains remarkably prevalent in the general population (Substance Abuse and Mental Health Services Administration and Quality, 2013). Alcohol and drug use in adolescence greatly increases risk of substance use disorders in adulthood (Englund et al., 2008, Grant and Dawson, 1997, Lynskey et al., 2003) as well as poorer educational outcomes, lower income, greater welfare dependence and unemployment and lower relationship and life satisfaction (Fergusson and Boden, 2008). Thus, efforts toward understanding of processes associated with initiation of adolescent substance use may help inform substance use prevention efforts and ultimately reduce the public health burden of substance use disorders.
In adolescent samples there is evidence that higher level of depressive symptoms associate with an increase in smoking uptake and progression (Audrain-McGovern et al., 2011, Audrain-McGovern et al., 2012) and increased risk for early life initiation of alcohol or illicit drug use (Tang and Orwin, 2009). However, the mechanisms that account for the covariation between depressive symptoms and substance use initiation are unclear. Identifying whether depressive symptoms associate with initiation of use of specific substances and elucidating factors that link depressive symptoms and teen substance use initiation could shed light on the development of prevention interventions that target these mediational processes and ultimately perhaps buffer substance use risk channeled by depressive symptoms.
Dispositions towards mood-based rash action (i.e., trait urgency) may be an underlying mechanism linking depressive symptoms and substance use initiation. Urgency is a personality construct that reflects the tendency to act rashly without considering consequences specifically during emotional states and can be separated into rash actions during extreme positive states (i.e., positive urgency) and rash actions during periods of extreme negative emotion (i.e., negative urgency; Cyders and Smith, 2008). Empirical evidence shows that urgency is psychometrically and conceptually distinct from other impulsive traits such as the tendency to seek out novel and thrilling experiences (i.e., sensation seeking) and the tendency to act without thinking and inability to remain focused on a task (i.e., deficits in conscientiousness; Cyders and Smith, 2008, Smith et al., 2007).
In considering mechanisms accounting for depression-substance use relations, negative urgency may be particularly relevant trait within the overarching cluster of impulsivity-relevant constructs because of its link to both affect and rash actions. We purport that depressive symptoms may generate an accumulation of affective disturbance that may ultimately cloud one's judgment and engender greater opportunities for rash actions in negative affect states (i.e., negative urgency). Specifically, depressive symptoms such as agitation/restlessness, crying, and other negative states as well as difficulty concentrating may interfere with one's ability to inhibit methodical decision-making. One such expression of rash action may be the decision to overlook the long-term negative consequences of substance use and experiment with substances. Indeed, negative urgency has been shown to associate with amount of use of alcohol, cigarettes, and illicit drugs (i.e., marijuana, cocaine, LSD, heroin, ecstasy, other illegal drugs, and misuse of prescription drugs; Kaiser et al., 2012, Settles et al., 2012). Furthermore, negative urgency associates with depression in adolescence and children (d’Acremont and Van der Linden, 2007, Marmorstein, 2013) and one study showed negative urgency partially mediated relations between depression and problematic drinking in college students (Gonzalez et al., 2011). Yet, a sizable proportion of substance users initiate in adolescence prior to entering young adulthood (Substance Abuse and Mental Health Services Administration and Quality, 2013). Furthermore, age of initiation may also be an important factor with studies suggesting that earlier onset of use of a substance results in poorer alcohol (Hingson and Zha, 2009, Kang et al., 2014) and marijuana (Ellickson et al., 2004) related outcomes. Thus, understanding processes surrounding initiation is important and current research on risk factors related to substance use in young adulthood may inadequately capture these processes.
This cross-sectional study is the first to our knowledge that investigates negative urgency as a mediator of associations between depressive symptoms and onset of use of various substances in early adolescence (mean age 14.5). We hypothesized that depressive symptoms would be associated with increased likelihood of substance initiation, and that this relation would be accounted for (i.e., statistically mediated by) negative urgency. As secondary outcomes we examined, among the subsample of substance initiators, retrospective reports of age of use onset as well as use frequency within past 30 days. Here, we hypothesized that higher depressive symptoms, higher negative urgency, and their mediational relations would associate with earlier age of onset and greater use frequency. Given the prior scant literature on this topic, we did not propose hypotheses regarding which particular substances might be associated by the aforementioned mediational relationships. Nonetheless, assessment of a variety of different substances, which often has not been addressed in prior work in this area, allows us to make wider spanning generalizations to drug use etiology and prevention programs targeting multiple substances.
Section snippets
Participants
The current report is a secondary analysis of 9th grade participants enrolled in one of two public high schools in the Los Angeles metropolitan area participating in a study on the relation between personality, psychopathology, health behavior, and substance use. All students were eligible to participate with the exception of those in either special education or English as a second language programs. A total of 807 students were eligible. Of the 689 (85%) who provided assent, 585 (82%) provided
Preliminary analyses
The adolescent sample [mean age = 14.5 (SD = 0.54)] was 51.3% female, largely Hispanic/Latino (48.3%) and white (24.1%), with some representation from those reporting being American Indian/Alaska Native (.9%), Asian (6.0%), Black/African American (1.9%), Native Hawaiian/Pacific Islander (2.2%), or some Other ethnic or multi-racial category (16.6%). The highest parental education was as follows: 8th or less (4.4%), Some high school (6.3%), High school graduate (17.2%), Some college (22.9%), College
Discussion
This study found that depressive symptom level associated with the lifetime use of cigarettes, other forms of tobacco products, marijuana, alcohol, inhalants, prescription painkillers, and any substance in an adolescent sample. This is consistent with previous research showing depressive symptoms associate with lifetime cigarette use (Audrain-McGovern et al., 2011, Audrain-McGovern et al., 2012), earlier onset of use of alcohol (Cerda et al., 2013), and literature showing associations between
Role of funding source
This research was supported by funds from Tobacco-Related Disease Research Program of the University of California, Grant Number 22FT-0062 and by NIDA grants R01-DA033296 and R21-DA034768. Funding sources had no further role in study design, in the collection, analysis and interpretation of data, in writing the report or in the decision to submit for publication.
Contributors
Authors Leventhal and Sussman designed the study and wrote the protocol. Authors Pang, Farrahi, and Glazier managed literature searches and summaries of previous work. Pang undertook the statistical analysis and wrote the first draft of the manuscript. All authors contributed to and approved the final manuscript.
Conflict of interest
No conflict declared.
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2020, Drug and Alcohol DependenceCitation Excerpt :However, the number of participants from each U.S. state positively correlated with the state population data (r = .79, r > .001), which suggests that the current sample was fairly representative of actual state populations. Lastly, other forms of illicit substance use and alcohol use were not assessed in the present study, which have also been shown to relate to greater DD (Amlung et al., 2017), NU (Pang et al., 2014), and coping motives (Cooper et al., 1995). However, the fact that the present study did control for tobacco cigarette use, which is likely the substance with the strongest relationship with DD (Amlung et al., 2017), provides additional evidence supporting a direct relationship between DD and cannabis use.