PREDICTORS OF COMORBID ALCOHOL AND SUBSTANCE-ABUSE IN DEPRESSED ADOLESCENTS

Objective: To identify clinical profiles discriminating depressed adol escents on the basis of comorbid alcohol/substance use disorders and t o determine whether or not profiles with high predictive power are gen der-specific. Method: One hundred three adolescent inpatients with maj or depression (65 girls, 38 boys) participated in a comprehensive diag nostic evaluation. Independent assessments of depression, suicidality, and psychosocial adjustment were conducted using well-validated instr uments. Results: Gender-specific clinical profiles were identified tha t predicted alcohol/substance abuse in depressed adolescents with high levels of sensitivity (90%). The significant discriminant function fo r depressed girls included the following predictors: longer depressive episodes, more conduct problems and psychosocial impairment, and more active involvement in relationships with boys. The significant discri minant function for depressed boys included conduct disorder, older ag e, and schoolwork problems. These profiles correctly identified most d epressed adolescents with comorbid alcohol/substance abuse. Conclusion s: Given that alcohol abuse and depression are associated with highly impaired social functioning and increased risk of self-harm, sensitivi ty in case identification is critical. Clinicians should conduct compr ehensive assessments of alcohol/substance abuse in depressed adolescen ts with the identified clinical profiles.