[Relations between anxious, depressive and borderline symptomatology and frequency of cannabis use and dependence]. / Relations entre les symptomatologies anxieuse, dépressive et limite et la consommation et la dépendance au cannabis chez l'adolescent et le jeune adulte.

The aims of this paper is to study the relations between anxious, depressive and borderline symptomatology and cannabis use and dependence in adolescents and young adults. A convenient sample of 212 subjects composed of high-school and college students from Toulouse, France (85 boys, 127 girls; mean age=18.3 1.8 Years) completed questionnaires assessing the patterns of cannabis use, age of first use, the symptoms of dependence using a questionnaire derived from the Mini International Neuropsychiatric Interview, and the anxious, depressive and borderline symptomatology using the STAI-YA (State-Trait Anxiety Inventory; Spielberger et al., 1970), the CES-D (Center for Epidemiological Studies-Depression scale; Radloff, 1977) and the BPI (Borderline Personality Inventory; Leichsenring, 1999), respectively; 54% of subjects reported having used cannabis once during the last 6 Months (45.3% of girls and 66.6% of boys, p=0.002). Frequency of use was higher in boys: eg, 61% of boys used cannabis at least almost daily versus 31% of girls (p<0.00001). Age of first use was lower in boys than in girls (14.6 2.6 versus 15.7 2.3, t=- 2.46, p=0.02). Length of use was higher in boys than in girls (3.9 2.2 versus 3 1.6, t=2.2, p=0.03). Among users, near of 64% of boys and 36% of girls met the criteria for cannabis dependence (p=0.003). BPI, CES-D and STAI-YA scores were compared between non-users and users and between non-dependent and dependent users: the only significant differences were that BPI scores were higher in users versus non-users and in dependent users versus non-dependent users; CES-D and STAI-YA scores did not distinguished users from non-users and dependent users from non-dependent users. BPI and CES-D scores were correlated with the length of cannabis use (Pearson r=0.19 and r=0.19, respectively, p<0.05). In a multiple regression analysis predicting the frequency of cannabis use, we entered age, sex, CES-D, STAI-YA and BPI scores. This model accounted for 23% of the variance of the frequency of use (F5,206=14.4, p<0.0001). Sex, age, and BPI scores were significant predictors (b=- 0.31, t=- 5.03, p<0.0001; b=0.29, t=4.87, p<0.0001, b=0.27, t=3.80, p<0.0001, respectively). CES-D scores were a nearly significant predictor (b=- 0.17, t=- 1.96, p=0.051). STAI-YA scores were not a significant predictor (b=0.11, t=1.29, p=0.20). In a multiple regression analysis predicting the dependence scores, we entered age, sex, frequency of use, CES-D, STAI-YA and BPI scores. This model accounted for 41% of the variance of the dependence score (F6,107=12.6, p=0.005). Frequency of use and BPI scores were significant predictors (b=0.51, t=6.12, p<0.0001; b=0.26, t=2.86, p=0.005, respectively). Age, sex, CES-D and STAI-YA scores were not significant predictors (b=- 1.04, t=- 1.32, p=0.19; b=0.008, t=0.09, p=0.92; b=0.16, t=1.53, p=0.12; b=- 0.14, t=- 1.46, p=0.15, respectively). The frequency of use and dependence observed in this study confirm the results obtained in epidemiological studies of use and dependence in France. The high frequency of daily or almost daily users suggests that a high proportion of subjects were "high" while completing the questionnaires. This is a confounding variable now inevitable in epidemiological studies of cannabis use given the high proportion of daily users. The consequence may be that responses to mood questionnaire express both the acute effect of cannabis consumption and the chronic effect that might be different: the acute euphoriant effect of cannabis may mask a chronic depressive symptomatology induced by chronic cannabis consumption. The antidepressant and anti-anxiety acute effect of cannabis may explain that CES-D and STAI-YA scores did not distinguished users from non-users and dependent users from non-dependent users. The correlation between length of use and CES-D scores may reveal the depressant chronic effect of long-term use. The correlation between length of use and BPI scores suggest that long-term cannabis use induces an increase in borderline symptomatology. Results of the regression analyses suggest that the borderline symptomatology is highly linked to frequency of use and cannabis dependence. This may be due to the increase in borderline symptomatology induced by both acute and chronic effects of cannabis. The relation between cannabis use and dependence on one hand and anxious and depressive symptomatology on the other hand may have been obscured by the acute mood effect of cannabis consumption. Borderline symptomatology appeared to be highly linked to cannabis use and dependence in adolescents and young adults. Borderline personality disorder in adolescents is not the only risk factor for cannabis use and dependence in adolescents: borderline symptomatology even at a subclinical level seems to be a higher risk factor than anxious or depressive symptomatology. The frequency of daily or almost daily users may be a confounding variable for the study of relations between anxiety and depressive disorders in adolescents and young adults.

[Personality disorders in a nonclinical sample of adolescents]. / Troubles de la personnalité dans un échantillon non clinique d'adolescents.

OBJECTIVE: To examine the comorbidity of borderline personality disorder and other personality disorders in a nonclinical sample of high-school students. METHOD: 311 high-school students who completed the French version of the CES-D (Center for Epidemiological Studies-Depression Scale), were asked to participate to interviews evaluating personality functioning: 60 subjects (19%) accepted to participate in the study. The mean CES-D score of these 60 subjects (16 boys, 44 girls, mean age=17.7 1.7) was significantly higher than the mean score of the whole sample (23.9 10.4 versus 16.7 9.8). Thus the interviewed sample was not representative of the population of high-school students. Subjects were assessed using the major depressive episode module of the MINI (Mini International Neuropsychiatric Interview) and the SIDP IV (Structured Interview for DSM IV Personality). Inter-rater reliability was determined by comparing the independent ratings of interviewers and an experienced clinician on a random sample of 20 interviews. For DSM IV borderline personality disorder diagnosis, the Cohen's kappa coefficient was 0.85. For personality disorder criteria, kappa ranged from 0.6 to 1.0 (average kappa=0.79). RESULTS: Sixteen of these subjects (26,7%, 4 males, 12 females) received a diagnosis of borderline personality disorder according to DSM IV criteria. The mean CES-D score of borderline subjects (30.6 10.2) was significantly higher than the mean score of nonborderline subjects (21.6 10.5). Of the 16 borderline subjects, 11 (75%) received a diagnosis of major depressive disorder versus 14 (31%) of the non borderline subjects. None of the other personality disorders approached the frequency of borderline personality disorder. The next most frequent diagnoses were depressive and dependent personality disorders which occurred in respectively in 16.6% and 10% of the 60 subjects. All the personality-disorders occurred at higher rates in the group with borderline personality disorder with the exception of obsessive-compulsive personality disorder which was diagnosed only in nonborderline subjects. Of the 16 borderline subjects, 11 (68.7%) met the criteria for another personality disorder which were depressive personality disorder (N=5), paranoid personality disorder (N=4), dependent personality disorder (N=3), antisocial personality disorder (N=2), histrionic personality disorder (N=2), avoidant personality disorder (N=2), negativistic personality disorder (N=2), schizotypal personality disorder (N=1), narcissistic personality disorder (N=1), self-defeating personality disorder (N=1). The optional diagnoses (self-defeating, depressive and negati-vistic personality disorders) accounted for 8 of 23 (34.7%) cases of personality disorders diagnosed among borderline subjects. Among these 11 adolescents, 5 received 2 diagnoses of personality disorders (borderline and paranoid personality disorders, N=1; borderline and dependent personality disorders, N=1; borderline and depressive personality disorders, N=3), 3 received 3 diagnoses (borderline, antisocial and histrionic personality disorders, N=1; borderline, avoidant and negativistic personality disorders, N=1; borderline, depressive and negativistic personality disorders, N=1), 3 received 5 diagnoses (borderline, paranoid, histrionic, narcissistic and dependent personality disorders, N=1; borderline, paranoid, dependent, avoidant and depressive personality disorders, N=1; borderline, paranoid, schizotypal, antisocial and self-defeating personality disorders, N=1). Among the 44 adolescents (12 boys, 32 girls) without borderline personality disorder, 10 (22.7%) (3 boys, 7 girls) met the criteria for another personality disorder which were depressive personality disorder (N=5) or cluster C disorders -obsessive-compulsive personality disorder (N=4), dependent personality disorder (N=2), avoidant personality disorder (N=1) - with the exception of one diagnosis of histrionic personality disorder. Two subjects received 2 diagnoses (obsessive-compulsive and depressive personality disorder). The internal consistency of personality disorders criteria was assessed with Cronbach's alpha coefficient. Borderline personality disorder criteria had high internal consistency (0.82). The factor structure of borderline personality disorder criteria was studied with an exploratory factorial analysis which extracted three factors. The eigenvalues were 3.70, 1.06, and 1.01. Confirmatory factorial analyses were conducted. The correlated two-factor model and the three-factor model fit the data well but the correlation between factors was, however, judged too high, ranging from 0.70 to 0.78. The one-factor model proved to have a good fit (Goodness of Fit Index=0.89, Comparative Fit Index=0.90, Root Mean Square Residual=0.07). As a previous study showed the frequency of two schizotypal personality disorder criteria (odd beliefs/magical thinking experiences and unusual perceptual experiences), an exploratory factorial analysis was performed on the combined set of criteria of borderline and schizotypal personality disorders. It yielded 2 factors: the first factor consisted of all the borderline personality disorder criteria, odd beliefs/magical thinking, and unusual perceptual experiences and could be called the borderline factor; the second factor consisted of the paranoid and the social avoidance criteria and could be called the interpersonal hypersensitivity factor. A confirmatory factor analysis showed that this two-factor model provided a good fit to the data (GFI=0.82, CFI=0,91, RMSR=0.10). The correlation between factors was weak (0.25). These results suggest that odd beliefs/magical thinking and unusual perceptual experiences are a component of borderline symptomatology in adolescents. DISCUSSION: The high frequency of major depressive disorder and personality disorders in the interviewed sample may be due to the possibility that adolescents with psychological problems have used the interview as a way to obtain attention and support from a psychologist. The interviewed sample, which was characterized by a high intensity of depressive symptomatology and by a high frequency of borderline personality disorder, could thus be seen as intermediate between a clinical and a community sample. Our results may be more generalizable to an outpatients population of adolescents. This study found conflicting results about the construct validity of borderline personality disorder in adolescent. The high internal consistency and the one-factor structure of the borderline personality disorder criteria argue for their validity in adolescents. However, the high rates of comorbidity of borderline personality disorder with depression and other personality disorders, extended to clusters A, B and C and to optional diagnoses, suggest the lack of construct validity of either borderline personality or cluster B disorders in adolescents. CONCLUSION: Borderline symptomatology in adolescents appears more in adequacy with a dimensional model than with a typological classification. More studies are needed to assess and improve the construct validity of borderline personality disorder in adolescents.

[Study of the CES-D on a sample of 1,953 adolescent students]. / Etude de la CES-D dans un échantillon de 1 953 adolescents scolarisés.

OBJECTIVE: To evaluate the psychometric characteristics of the CES-D (Center for Epidemiological Studies - Depression Scale) in adolescents and to estimate the prevalence of major depression in French high-school students. METHOD: A random sample of 2 583 high-school students from the departments of Haute-Garonne and Pyrénées-Orientales, France, were asked to complete the CES-D. Of these subjects, 1 953 (75.6%) (966 boys and 987 girls, mean age=17 1.4) completed satisfactorily the questionnaire. A sub-sample of 60 adolescents volunteered for an interview and were assessed using the major depressive episode module of the MINI (Mini International Neuropsychiatric Interview). RESULTS: The internal consistency of the CES-D was satisfactory (Cronbach alpha=0.85). A principal component analysis produced consistent sub-scales. The factor structure was similar to that observed in previous studies in adults. Four factors were extracted which accounted for 49.6% of the variance: a depressive cognition factor (items 1, 9, 10, 15, 19); a positive affect factor (items 4, 8, 12, 16); a factor reflecting slowing of thought and reduction of energy (items 5, 7, 20); and a depressive affect factor (items 2, 3, 6, 11, 14, 17, 18). Among the 1 953 subjects, the mean score for girls was significantly higher than for boys (18,8 10,2 versus 14,4 7,7). Of the 60 subjects who were assessed with the MINI, 28 received the diagnosis of major depressive episode. The mean scores of depressed girls and boys in this sub-sample (respectively 35.5 8.7 and 27.7 9.6) were significantly higher than the mean scores of girls and boys for the total sample. According to the results, the best cut-off score was a score of 24 or higher, providing a sensibility of 0.74 and a specificity of 0.73. According to this cut-off score, 9.9% of boys and 24.2% of girls had a probable major depressive episode. DISCUSSION: This study showed a high level of depressive symptoms and a high frequency of probable depression in French adolescents. Two findings suggest the reliability of these results: first, the male-female ratio, close to 1:2 for probable depression, is in keeping with current epidemiological data; second, the high internal consistency and the factor structure are indicators of the reliability of CES-D in adolescents. Our study found a higher cut-off score than the previous French study of the CES-D in adolescents by Bailly et al. This discrepancy may be due to our small interview sample. However, the cut-off of 24, identified with our study, provided frequency rates more in agreement with epidemiological data than the cut-off of 21 proposed by Bailly et al. Mean CES-D scores of boys and girls in our study were respectively significantly higher than those obtained in boys (n=439, 12.4 7.5) and girls (n=305, 16.6 9.7) by Bailly et al. eleven years before. Given the similarities of mean age and representativeness of samples in both studies, this discrepancy may be due to an increase in depressive symptoms in French adolescents which may be linked to the parallel increase in substance use and particularly in cannabis use. CONCLUSION: The high internal consistency and the factor structure of the CES-D suggest its reliability in adolescents. This study found a high frequency of probable major depression in French high-school students.