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Preventing Co-Occurring Disorders: Prospects and Opportunities. J. David Hawkins Ph.D. Social Development Research Group University of Washington.

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Preventing co occurring disorders prospects and opportunities

Preventing Co-Occurring Disorders: Prospects and Opportunities

J. David Hawkins Ph.D.

Social Development Research Group

University of Washington

Data are from the Seattle Social Development Project supported by grants from the National Institute on Drug Abuse and the National Institute of Mental Health.


Prevention of co-occurring disorders requires identification of malleable risk and protective factors that predict comorbidity.


The research base for prevention of co occurring conditions
The Research Base for Prevention of Co-Occurring Conditions identification of malleable risk and protective factors that predict comorbidity.

Longitudinal studies have identified risk and protective factors that predict substance abuse, depression, violence and other problem behaviors.


Predicting adolescent problems

Risk Factors identification of malleable risk and protective factors that predict comorbidity.

Substance Abuse

Delinquency

Teen Pregnancy

School Drop-Out

Violence

Depression & Anxiety

Community

Availability of Drugs

Availability of Firearms

Community Laws and Norms Favorable Toward Drug Use, Firearms, and Crime

Media Portrayals of Violence

Transitions and Mobility

Low Neighborhood Attachment and Community Disorganization

Extreme Economic Deprivation

Predicting Adolescent Problems

Used by permission of Channing Bete Company


Risk Factors identification of malleable risk and protective factors that predict comorbidity.

Substance Abuse

Delinquency

Teen Pregnancy

School Drop-Out

Violence

Depression & Anxiety

Family

Family History of the Problem Behavior

Family Management Problems

Family Conflict

Favorable Parental Attitudes and Involvement in the Problem Behavior

Predicting Adolescent Problems

Used by permission of Channing Bete Company


Predicting adolescent problems1

Risk Factors identification of malleable risk and protective factors that predict comorbidity.

Substance Abuse

Delinquency

Teen Pregnancy

School Drop-Out

Violence

Depression & Anxiety

School

Academic Failure Beginning in Late Elementary School

Lack of Commitment to School

Predicting Adolescent Problems

Used by permission of Channing Bete Company


Risk Factors identification of malleable risk and protective factors that predict comorbidity.

Substance Abuse

Delinquency

Teen Pregnancy

School Drop-Out

Violence

Depression & Anxiety

Individual/Peer

Early and Persistent Antisocial Behavior

Rebelliousness

Friends Who Engage in the Problem Behavior

Favorable Attitudes Toward the Problem Behavior

Early Initiation of the Problem Behavior

Constitutional Factors

Predicting Adolescent Problems

Used by permission of Channing Bete Company


Protective and promotive factors
Protective and Promotive Factors identification of malleable risk and protective factors that predict comorbidity.

Individual Characteristics

  • High Intelligence

  • Resilient Temperament

  • Competencies and Skills

    In family, school, peer group and neighborhood:

  • Prosocial Opportunities

  • Reinforcement for Prosocial Involvement

  • Bonding

  • Healthy Beliefs and Clear Standards


Question
Question identification of malleable risk and protective factors that predict comorbidity.

Can predictors of comorbid alcohol use disorders and major depression in early adulthood be identified in early adolescence?


Seattle social development project
Seattle Social Development Project identification of malleable risk and protective factors that predict comorbidity.

  • A theory-driven longitudinal study of the etiology of prosocial and antisocial behaviors.

  • An intervention study nested in the longitudinal study.

  • Initiated in 1981 in 8 Seattle elementary schools.

  • Expanded in 1985, to include 18 Seattle elementary schools that over-represented students from high crime neighborhoods.

  • 808 (77%) of the 5th grade students in these schools and their parents consented to participate in the longitudinal study; they constitute the study sample.


Study characteristics
Study Characteristics identification of malleable risk and protective factors that predict comorbidity.

Demographics

  • 51% Male

  • 46% Caucasian, 26% African American, 21% Asian-American

  • 52% from low income families (free-lunch eligible)

  • 40% from single-parent families

    Comparison Group Design

  • Full treatment (grades 1-6) = 149

  • Late treatment (grades 5-6) = 243

  • Control = 206

  • Parent training only = 208


Ssdp panel retention

Middle identification of malleable risk and protective factors that predict comorbidity.

High

Elementary

Adult

SSDP Panel Retention

MEANAGE 10 11 12 13 14 15 16 (17) 18 21 24 27

N 808 703 558 654 778 783 770 -- 757 766 752 747

% 87% 69% 81% 96% 97% 95% -- 94% 95% 93% 93%

Interview completion rates for the sample have remained above 93% since 1989, when subjects were 14 years old.


Prevalences in the seattle social development project at age 21
Prevalences in the Seattle Social Development Project at Age 21

Alcohol Use Disorders Only 19.1% (n=144)

More common among men (26.9%) than women (11.2%)

Major Depression Only 11.9% (n=90)

More common among women (15.7%) than men (8.2%)

Comorbid AUD and MDD 7.8% (n=59)



Questions
Questions 21

  • What SDM factors at age 14 predict either alcohol use disorders alone or depression alone at age 21?

  • What SDM factors at age 14 predict comorbid alcohol use disorders and depression at age 21?


Multinomial logistic regression analyses
Multinomial Logistic Regression Analyses 21

Three Odds Ratios:

1) Alcohol use disorder only versus neither

2) Depression only versus neither

3) Comorbid disorders versus neither

Separate regression equations for each predictor at age 14

Controlling for gender, alcohol problems, and anxious/depressive symptoms at age 13.


Summary
Summary 21

  • Predictors of comorbid alcohol use disorders and major depressive disorder are identifiable by age 14.

  • Comorbid alcohol use disorders and major depression are predicted by more factors than either disorder alone.


Predicting violence and depression at age 21
Predicting Violence and Depression at Age 21 21

Childhood conduct problems at age 10 are malleable risk factors for both violence and depression at age 21.


Adjusted Odds Ratios (95% Confidence Interval) for 21Conduct Problems Predicting Age 21 Outcomes(Controlling for Gender, Ethnicity, and Low Income Status)

N = 765. **p < .01; ***p < .001.

Adapted from Mason et al. (2004), Seattle Social Development Project data.


Summary1
Summary 21

We have substantial knowledge of malleable predictors of comorbid alcohol disorders, depressive disorders and violence.


Questions1
Questions 21

  • Can addressing these predictors prevent these diverse problems?

  • Can addressing these predictors prevent comorbid disorders in early adulthood?


Seattle social development project intervention targeted risk factors
Seattle Social Development Project Intervention 21Targeted Risk Factors

  • School Domain

    • Low commitment to school

    • Academic failure

  • Family Domain

    • Poor family management

    • Family conflict

  • Individual Domain

    • Early antisocial behavior

    • Favorable attitudes to problem behavior

    • Friends who engage in problem behavior

    • Early initiation of problem behavior



Intervention goals
Intervention Goals 21

  • Promote bonding to school and family by:

    • Enhancing opportunities for involvement in school and family

    • Enhancing rewards for involvement in school and family

    • Strengthening children’s social competencies


Ssdp intervention
SSDP Intervention 21

  • Teachers: 5 days of training annually, grades 1 to 6, in proactive classroom management, interactive teaching and cooperative learning.

  • Children: training in grades 1 and 6 on interpersonal problem-solving and refusal skills.

  • Parents: offered voluntary training (43%) in grades 1 to 6 on child behavior management skills, academic support skills and skills to reduce risks for drug use.


Significant effects of SSDP intervention on childhood predictors have been found:

  • Age 7: Less aggressiveness, antisocial behavior & self-destructiveness.

  • Age 10: Better family management & bonding; better school bonding.

  • Age 12: better social skills; more classroom participation; better school bonding, grades & achievement test scores.


Seattle social development project results at age 18
Seattle Social Development Project predictors have been found:Results at Age 18

Scale score


Seattle social development project results by age 18
Seattle Social Development Project predictors have been found:Results by Age 18

*p< .05


Seattle social development project results at age 18 heavy alcohol use
Seattle Social Development Project predictors have been found:Results at Age 18Heavy Alcohol Use

*p< .05


Seattle social development project effects by age 21
Seattle Social Development Project predictors have been found:Effects by Age 21

*p< .05


Seattle social development project effects at age 21
Seattle Social Development Project predictors have been found:Effects at Age 21

*p< .05


Seattle Social Development Project predictors have been found:Effects at Age 21

Prevalence

*

+

**

+p<.10; *p<.05; **p<.01

compared with controls.


Summary2
Summary predictors have been found:

Universal intervention with an urban multiethnic population during elementary grades targeted at shared predictors significantly reduced comorbid alcohol use disorders and major depressive disorder 9 years after intervention ended.


Conclusion
Conclusion predictors have been found:

Prevention of co-occurring disorders is possible by addressing shared malleable predictors of these disorders during childhood.


Implications for access and utilization
Implications for Access and Utilization predictors have been found:

  • Schools are key delivery sites for universal and selective preventive interventions focused on shared risk and protective factors for comorbid disorders.


Involving schools as prevention partners
Involving Schools as Prevention Partners predictors have been found:

  • Shared predictors of academic, behavior, and mental health outcomes must be recognized.

  • The potential to achieve better academic outcomes by addressing these shared predictors must be understood by school personnel.


Access and utilization
Access and Utilization predictors have been found:

Primary care providers should screen for shared malleable predictors of comorbid disorders, like childhood conduct problems, to guide referrals for selective preventive interventions.


Access and utilization1
Access and Utilization predictors have been found:

Systems for community wide assessment, planning and action to address predictors of comorbid disorders in youth populations are needed.


Preventing co occurring disorders prospects and opportunities1

Preventing Co-Occurring Disorders: predictors have been found:Prospects and Opportunities

J. David Hawkins Ph.D.

Social Development Research Group

School of Social Work

University of Washington

www.sdrg.org

[email protected]


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