Transcript Document

Differences in Mental Health by Age at Entry to Substance Abuse Treatment
during Pregnancy
Victoria H. Coleman-Cowger, Ph.D. & Michael L. Dennis, Ph.D.
Chestnut Health Systems, Normal, IL
Pregnant adolescents entering
substance abuse treatment
programs differ from their adult
counterparts in that they more often
report weekly marijuana use and a
higher number of externalizing
behaviors--particularly conduct
disorder symptoms.
Introduction
 Approximately 750,000 adolescent girls
become pregnant each year (The Alan
Guttmacher Institute, 2006). Though the
adolescent pregnancy rate had been
declining since 1990, it rose 3.4% from
2005-2006 and an additional 1% from
2006-2007 (National Center for Health
Statistics, 2009).
 The increasing rate of adolescent
pregnancy over the past 2 years is a
concern given that babies born to
adolescent mothers are at elevated risk
of poor birth outcomes, including higher
rates of low birthweight, preterm birth,
and death in infancy (National Center for
Health Statistics, 2009).
 Research has demonstrated that the
odds of psychiatric morbidity are greater
among younger women (Vesga-Lopez et
al., 2008) and that mental distress can
have a negative impact on pregnancy
(Orr et al., 2007). It is hypothesized that
pregnant adolescents may be
experiencing greater mental distress
than pregnant adults, given their higher
rates of substance use during pregnancy
(SAMHSA, 2008).
Method
Analysis
 Data analyzed in this study are from
118 individual substance abuse
treatment facilities located across the
United States.
 The Global Appraisal of Individual
Needs (GAIN; Dennis et al., 2003)
was administered at intake by trained
and certified GAIN administrators
during a one-on-one interview.
 The GAIN is a comprehensive
biopsychosocial assessment tool. It is
a progressive and integrated series of
measures designed to support a
number of treatment practices.
 Staff-administered in about 6090 minutes.
 Yields DSM/ICD diagnostic
impressions and ASAM/other
treatment planning information.
 Strong history of psychometric
integrity.
 The dataset was limited to cases for
which pregnancy status was
available. Information from 4,050
females (ages 12-53) was used for
the analyses. Of these, 331 (8.2%)
reported having been pregnant in the
past year.
 Characteristics of the entire sample
are outlined below.
 The type of distress is particularly
relevant, as Bardone et al. (1996) found
that conduct disorder at age 15
exclusively predicts antisocial personality
disorder, substance dependence, illegal
behavior, dependence on multiple
welfare sources, and physical partner
violence at age 21.
Race
 The purpose of this study is to examine
Global Appraisal of Individual Needs
(GAIN; Dennis et al., 2003) data to
determine differences in the nature of
comorbid mental distress by age.
White
Adolescents
Adults
(ages 12-17)
(ages 18-53)
(n=3704)
(n=346)
48.3%
Mixed
18.5%
12.1%
Hispanic
20.9%
26.0%
9.4%
8.7%
Native American
1.1%
0.9%
Other
0.8%
0.3%
1.0%
1.2%
Victimized in past year
39.6%
34.4%
Current criminal justice system involvement
61.5%
65.0%
Weekly any drug use
50.4%
46.6%
Weekly tobacco use*
54.3%
63.5%
Weekly marijuana use*
34.9%
24.9%
Weekly alcohol use
14.2%
17.4%
Weekly cocaine use*
3.8%
7.5%
Any past year substance dependence
50.8%
54.8%
Any past year substance abuse
27.0%
23.7%
Any co-occurring mental health disorder*
76.1%
67.3%
*Significant difference at p < 0.001
 Data analysis was conducted utilizing
SPSS version 17.0.
15.62
16.00
 Differences in intake characteristics
and other categorical variables were
examined by chi-square analysis.
Univariate analysis of variance was
used to analyze continuous variables
by age group.
Conclusions
Figure 1. Mental Health Scale Scores: Pregnant Adolescents/Adults
15.18
13.20
14.00
12.00
Adolescents (n=286)
10.00
Score
 Significance was achieved at p<0.05.
Adults (n=45)
8.71
8.00
6.00
4.45
4.96
4.51
3.82 3.84
4.42
4.29
4.00
Scale Descriptions
2.49
1.15
2.00
0.81 0.56
0.84
Analysis of data by
age group revealed
significant difference in
type of mental distress
reported in the past
year. Adolescents who
were pregnant in the
past year were
significantly more likely
than their adult
counterparts to report
externalizing
problems.
0.00
 Internal Mental Distress Scale (IMDS) –
count of symptoms including somatic,
depression, anxiety, traumatic stress,
and suicide/homicide in the past year.
(Low 0-8; Mod 9-23; High 24-43)
 Behavior Complexity Scale (BCS) –
count of external behavioral problems in
the past year. (0-5; 6-18; 19-23)
 Depressive Symptom Scale (DSS9) –
count of past year DSM-IV symptoms of
depression. (0-1; 2-5; 6-9)
 Homicidal/Suicidal Thought Scale
(HSTS) – count of endorsed items
related to killing/hurting someone else,
thoughts of, plans for action towards, or
attempted suicide in the past year.
(0; 1-3; 4-5)
IMDS
DSS9
HSTS
AFSS
TSS
BCS*
ADHDS*
CDS*
Scale
Figure 2. Percentage of Adolescents/Adults with High scale scores
Pregnant Adol. (n=328)
Pregnant Adults (n=58)
Never pregnant Adol. (n=3702)
Never pregnant Adults (n=346)
CDS*
ADHDS
BCS
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
 The trend of
reporting more
externalizing problems
in the adolescent
group was also true in
the never-pregnant
sample, though the
pregnant adolescents
were significantly more
likely than all other
groups to report
symptoms of conduct
disorder.
60.0%
Table 1. Demographics of pregnant sample
 Anxiety/Fear Symptom Scale (AFSS) –
count of past year DSM-IV symptoms of
anxiety disorders. (0-1; 2-6; 7-12)
Adolescents
Adults
(ages 13-17)
(ages 18-42)
(n=286)
(n=45)
White
42.3%
40.0%
Race
50.9%
African-American
Asian
Results
% with high level of problem
Abstract
 Traumatic Stress Scale (TSS) – count of
past yr. symptoms or memories related
to past trauma, current trauma, or other
disorders of extreme stress.
(0; 1-4; 5-13)
Mixed
22.0%
11.1%
Hispanic
21.3%
35.6%
African-American
12.2%
8.9%
Native American
0.7%
2.2%
Asian
0.7%
Other
0.3%
2.2%
Victimized in past year
47.7%
44.4%
 ADHD Scale (ADHDS) – count of DSMIV symptoms associated with attention
deficit and hyperactivity disorder.
(0-5; 6-11; 12-18)
Current criminal justice system involvement
71.0%
64.4%
Weekly any drug use
54.4%
43.2%
Weekly tobacco use
60.6%
68.9%
Weekly marijuana use*
38.5%
20.0%
Weekly alcohol use
14.0%
11.4%
Weekly cocaine use
4.9%
8.9%
 Conduct Disorder Scale (CDS) – count
of past year DSM-IV symptoms of
conduct disorder. (0-2; 3-7; 8-15)
Any past year substance dependence
59.9%
64.4%
Any past year substance abuse
21.6%
22.2%
Any co-occurring mental health disorder
79.0%
71.1%
*Significant difference at p < 0.05
0.0%
Pregnant adults and
adolescents reported
similar demographic
characteristics. The
singular difference
noted (from variables
examined) was that
significantly more
pregnant adolescents
reported weekly
marijuana use than
pregnant adults.
 Comprehensive psychological
assessment and targeted
interventions for younger pregnant
girls are warranted, particularly in the
area of externalizing behaviors. This
population has shown a specific need
for interventions focused on conduct
disorder symptoms and marijuana
use during pregnancy.
References
Bardone, A.M., Moffitt, T., Caspi, A., & Dickson,
N. (1996). Adult mental health and social
outcomes of adolescent girls with depression
and conduct disorder. Development and
Psychopathology, 8, 811-829.
Dennis, M.L., Titus, J.C., White, M., Unsicker,
J., & Hodgkins, D., Webber. R. (2003).
Global Appraisal of Individual Needs:
Trainer’s Training Manual and Resources.
Bloomington, IL: Chestnut Health Systems.
Hamilton BE, Martin JA, Ventura SJ. Births:
Preliminary data for 2007. National vital
statistics reports, Web release; vol 57 no 12.
Hyattsville, MD: National Center for Health
Statistics. Released March 18, 2009.
Martin JA, Hamilton BE, Sutton PD, Ventura SJ,
et al. Births: Final data for 2006. National vital
statistics reports; vol 57 no 7. Hyattsville, MD:
National Center for Health Statistics. 2009.
Substance Abuse and Mental Health Services
Administration, Office of Applied Studies.
(December 4, 2008). The NSDUH Report:
Trends in Substance Use, Dependence or
Abuse, and Treatment among Adolescents:
2002 to 2007. Rockville, MD.
Vesga-Lopez, O., Blanco, C., Keyes, K., et al.
(2008). Psychiatric disorders in pregnant and
postpartum women in the United States. Arch
Gen Psychiatry, 65, 805-815.
Acknowledgments
Analysis of the GAIN data reported in this
presentation was supported by Substance Abuse
and Mental Health Services Administration's
(SAMHSA's) Center for Substance Abuse
Treatment (CSAT) under Contracts 207-98-7047,
277-00-6500, 270-03-00006, and 270-200700004C using data provided by grantees. The
opinions expressed here belong to the author and
are not official positions of the government. For
more information, please contact Victoria H.
Coleman-Cowger, Ph.D. * Chestnut Health
Systems * 448 Wylie Drive * Normal, IL 61761 *
309-451-7797 * E-mail: [email protected].
The first author would like to acknowledge receipt
of a 2009 NIDA Travel Award for this presentation
at APA.