Illicit Substance Use Among Child Welfare Involved Adolescents: A Consequence of Depression and a Risk Factor for Sexual Risk Behavior

Background and Purpose: Adolescents who have suffered maltreatment are at elevated risk for a number of negative behavioral health outcomes (Bensley, Ven Eenwyk, & Simmons, 2000). Studies show that young adults with a history of child maltreatment are more likely to become depressed than their non-maltreated counterparts (Fergusson, Horwood, & Lynskey, 1996). Childhood maltreatment also has been established as a predictor of sexual risk behaviors and substance use and abuse (Parillo, Freeman, Collier, Young, 2001). This data is especially troubling given the negative health outcomes that can result from both drug abuse and sexual risk taking, such as STI/HIV infection. Prevention efforts for this population require a better understanding of the scope, unique risk factors, and protective factors for negative behavioral health outcomes among child welfare involved youth. The present study sought to examine the longitudinal relationship between early adolescent depression, and future substance use and sexual risk behavior among adolescents engaged by the child welfare system.

Methods: Data come from Waves 1 and 4 of the National Survey of Child and Adolescent Well-Being (NSCAW), a national probability study of children and adolescents undergoing investigation for abuse or neglect. The sample for this analysis was restricted to 953 youth who were 11 years or older at baseline data collection. Baseline depression was assessed using the Children's Depression Inventory. Wave 4 substance use was assessed by reports of illicit substance use (inhalants, hard drugs, and use of prescription medication for non-medical purposes) and social substance use (marijuana and alcohol) in the past 30 days. Wave 4 sexual risk was assessed via reports of condom use. Covariates of interest included gender, ethnicity, and age. The main effects and moderation models between baseline depression and subsequent substance use and sexual risk behavior were examined using multivariate logistic regression.

Results: Hispanic ethnicity (OR=7.17, p<0.001), baseline depression (OR=1.04, p<0.01), and 30 day illicit drug (OR=1.26, p<0.001) use were significantly related to sexual risk behavior. 30 day social substance use was not related to sexual risk behavior. When controlling for covariates, 30 day use of illicit substances moderated the relationship between early adolescent depression and future sexual risk taking behavior (OR = 0.85 ; p< 0.001) such that individuals who were more depressed at baseline and who used illicit drugs within the last 30 days were less likely to use condoms. Conversely, individuals with higher levels of depression at baseline who had not engaged in illicit substance use in the last 30 days were more likely to use protection during sexual activity.

Implications: Results indicate that elevated levels of depression during early adolescence are related to subsequent use of illicit substances as children age thorough adolescence. Additionally, the combination of having a history of depression when coupled with illicit substance use places adolescents at increased risk for unsafe sexual behavior, and the negative health outcomes that accompany such behavior. Interventions for child welfare engaged youth should focus on the early detection and treatment of depression as well as the prevention of substance use and abuse.