Review
Childhood Psychiatric Disorders as Risk Factor for Subsequent Substance Abuse: A Meta-Analysis

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Objective

To assess the prospective risk of developing substance-related disorders after childhood mental health disorders (i.e., attention-deficit/hyperactivity disorder [ADHD], oppositional defiant disorder [ODD] or conduct disorder [CD], anxiety disorder, and depression) using meta-analysis.

Method

PubMed, Embase, and PsycInfo were searched for relevant longitudinal studies that described childhood (<18 years old) ADHD, ODD or CD, anxiety, or depression in relation to later alcohol-, nicotine-, or drug-related disorders or substance use disorders (SUDs) published in peer-reviewed journals in the English language from 1986 to May 2016. Two researchers conducted all review stages. Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed.

Results

Thirty-seven studies including more than 762,187 participants were identified for quantitative analyses. These studies included 22,029 participants with ADHD, 434 participants with ODD or CD, 1,433 participants with anxiety disorder, and 2,451 participants with depression. Ninety-seven effects sizes were extracted for analyses. Meta-analysis showed a significantly increased risk for addiction in ADHD (n = 23, odds ratio [OR] 2.27, 95% CI 1.98–3.67; OR alcohol 2.15, 95% CI 1.56–2.97; OR drugs 1.52, 95% CI 1.52–5.27; OR nicotine 2.52, 95% CI 2.01–3.15; OR SUDs 2.61, 95% CI 1.77–3.84), ODD or CD (n = 8, OR 3.18, 95% CI 1.97–5.80; OR alcohol 1.73, 95% CI 1.51–2.00; OR drugs 4.24, 95% CI 1.3.21.5.59; OR nicotine 4.22, 95% CI 3.21–5.55; OR SUDs 4.86, 95% CI 3.09–7.56), and depression (n = 13, OR 2.03, 95% CI 1.47–2.81; OR alcohol 1.10, 95% CI 1.02–1.19; OR nicotine 2.56, 95% CI 1.89–3.48; OR SUDs 2.20, 95% CI 1.41–3.43), but not for anxiety disorders (n = 15, OR 1.34, 95% CI 0.90–1.55, not significant).

Conclusion

Childhood ADHD, ODD, CD, and depression increase the risk of developing substance-related disorders. Anxiety disorders do not seem to increase the risk for future substance-related disorders, although the findings are highly heterogeneous. These findings emphasize the need for early detection and intervention to prevent debilitating substance-related disorders in later life.

Section snippets

Study Selection

Authors A.G. and T.J. (postdoctoral researchers) performed the selection of studies. The complete search query is available in the supplement (available online). Studies published in peer-reviewed journals in the English language (i.e., no other languages were included because no members of the review team were fluent in languages other than English) from 1986 (i.e., the DSM-III-R) through May 20, 2016 were included. The inclusion of studies was based on study type, population, and outcome.

Studies Included in Meta-Analysis

A total of 8,750 studies were identified (Figure 1), of which 6,439 remained after removal of duplicates. Titles of all studies were screened for eligibility, leaving 296 studies that were screened for eligibility using abstracts and full texts. Thirty-seven studies including 762,187 participants were identified for quantitative analyses; for a summary, see Table 18, 9, 10, 14, 15, 19, 20, 21, 22, 23, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50

Discussion

We aimed to clarify prospective outcomes concerning substance-related disorders for childhood ADHD, ODD or CD, anxiety disorder, or depression. Thirty-seven studies including more than 762,187 participants were identified for meta-analysis. Substance-related disorders result in high personal, societal, and economic costs,1 and prevention should be a top priority. We found that individuals with childhood externalizing disorders (ADHD and ODD or CD) were at increased risk of later

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    Disclosure: Drs. Groenman, Janssen, and Oosterlaan report no biomedical financial interests or potential conflicts of interest.

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