Common Cause Versus Dynamic Mutualism: An Empirical Comparison of Two Theories of Psychopathology in Two Large Longitudinal Cohorts.

Mental disorders are among the leading causes of global disease burden. To respond effectively, a strong understanding of the structure of psychopathology is critical. We empirically compared two competing frameworks, dynamic-mutualism theory and common-cause theory, that vie to explain the development of psychopathology. We formalized these theories in statistical models and applied them to explain change in the general factor of psychopathology (p factor) from early to late adolescence (N = 1,482) and major depression in middle adulthood and old age (N = 6,443). Change in the p factor was better explained by mutualism according to model-fit indices. However, a core prediction of mutualism was not supported (i.e., predominantly positive causal interactions among distinct domains). The evidence for change in depression was more ambiguous. Our results support a multicausal approach to understanding psychopathology and showcase the value of translating theories into testable statistical models for understanding developmental processes in clinical sciences.

Beyond the Situation: Hanging Out with Peers now is Associated with Short-Term Mindsets Later.

It is well-established that unstructured unsupervised socializing with peers (UUS) motivates deviance while in that specific context. In this article, we extend this situational view by arguing that repeated UUS may also gradually shape adolescents' norms and decision making beyond the situation. Specifically, we argue that UUS promotes short-term mindsets, i.e., an increased focus on present rewards at the expense of considering future consequences. We test this hypothesis with fixed-effects models, using longitudinal data from a representative sample of 1,675 adolescents from Zurich, Switzerland. Consistent with our preregistered predictions, more frequent UUS is associated with increased short-term mindsets. Thus, our finding suggests that the effects of UUS on later deviance might be driven by becoming more present-oriented. This link offers new insights into the developmental pathways toward adolescent delinquency and offers a potential target for intervention. Supplementary Information: The online version contains supplementary material available at 10.1007/s40865-024-00249-2.

Short-term mindsets show co-development with adolescent delinquency, but not with adolescent cannabis use.

Guided by General Theory of Crime and Psychosocial Maturity Hypothesis, we investigated co-development between short-term mindsets (impulsivity and future orientation) and risk behaviors (cannabis use and delinquency). Parallel process latent growth modeling on three-wave data from ethnically diverse Swiss adolescents (N = 1365; Mage 13.67 years, 48.6% female), showed baseline-level associations between short-term mindsets and risk behaviors, and between the two risk behaviors. Additionally, correlated change (co-development) existed between short-term mindsets-particularly impulsivity-and delinquency, but not between short-term mindsets and cannabis use. These results support the above-mentioned theories and emphasize the importance of investigating the correlates of change in delinquency and cannabis use separately, as divergent findings might emerge. These divergent findings could partially stem from Switzerland's liberal views on cannabis use.

Higher paracetamol levels are associated with elevated glucocorticoid concentrations in hair: findings from a large cohort of young adults.

Paracetamol is one of the most commonly used over-the-counter medications. Experimental studies suggest a possible stress-suppressing effect of paracetamol in humans facing experimental stress-inducing paradigms. However, no study has investigated whether paracetamol and steroid hormones covary over longer time frames and under real-life conditions. This study addresses this gap by investigating associations between steroid hormones (cortisol, cortisone, and testosterone) and paracetamol concentrations measured in human hair, indexing a timeframe of approximately three months. The data came from a large community sample of young adults (N = 1002). Hair data were assayed using liquid chromatography-tandem mass spectrometry. Multiple regression models tested associations between paracetamol and  steroid hormones, while adjusting for a wide range of potential confounders, such as sex, stressful live events, psychoactive substance use, hair colour, and body mass index. Almost one in four young adults from the community had detectable paracetamol in their hair (23%). Higher paracetamol hair concentrations were robustly associated with more cortisol (ß = 0.13, ηp = 0.016, p < 0.001) and cortisone (ß = 0.16, ηp = 0.025, p < 0.001) in hair. Paracetamol and testosterone hair concentrations were not associated. Paracetamol use intensity positively correlated with corticosteroid functioning across several months. However, a potential corticosteroid-inducing effect of chronic paracetamol use has yet to be tested in future experimental designs.

Assessing the Effect of First-time Police Contact on Internalizing Problems Among Youth in Zurich, Switzerland: A Quasi-experimental Analysis.

Growing evidence suggests that experiences with police are associated with a range of negative mental health problems among youth. This study examined the impact of negative police contact on changes in adolescent internalizing problems, measured by anxiety and depression. Six waves of data from a longitudinal study in Zurich, Switzerland were used in order to assess the direct relations between first reported police contact in the years prior to the survey moment and internalizing problems at the time of the survey and follow-up waves. The sample consists of a cohort of youth (max n = 1353, 49.4% females) spanning ages 11 to 24 (mean age and SD at each wave = 11.32 (0.37), 13.67 (0.36), 15.44 (0.36), 17.45 (0.37), 20.58 (0.38), 24.46 (0.38)). Specifically, difference-in-differences techniques for multiple time periods were employed to assess the average treatment effects for the treated population (first contact with police) compared to those who were never treated (never had contact). Across all models, police contact did not lead to an increase in internalizing problems. These results diverge from previous studies mostly conducted in the United States, and possible explanations including differences in historical contexts of policing, juvenile justice, health care, and dosage of intrusive contacts are discussed.

Daily life affective dynamics as transdiagnostic predictors of mental health symptoms: An ecological momentary assessment study.

BACKGROUND: Affective dynamics have been identified as a correlate of a broad span of mental health issues, making them key candidate transdiagnostic factors. However, there remains a lack of knowledge about which aspects of affective dynamics - especially as they manifest in the course of daily life - relate to a general risk for mental health issues versus specific symptoms. METHODS: We leverage an ecological momentary assessment (EMA) study design with four measures per day over a two-week period to explore how negative affect levels, inertia, lability, and reactivity to provocation and stress in the course of daily life relate to mental health symptoms in young adults (n = 256) in the domains of anxiety, depression, psychosis-like symptoms, behaviour problems, suicidality, and substance use. RESULTS: Dynamic structural equation modelling (DSEM) suggested that negative affect levels in daily life were associated with depression, anxiety, indirect and proactive aggression, psychosis, anxiety, and self-injury; negative affective lability was associated with depression, physical aggression, reactive aggression, suicidal ideation, and ADHD symptoms; negative affective inertia was associated with depression, anxiety, physical aggression, and cannabis use; and emotional reactivity to provocation was related to physical aggression. LIMITATIONS: The cross-sectional design, the limited span of mental health issues included, and the convenience nature and small size of the sample are limitations. CONCLUSIONS: Findings suggest that a subset of mental health symptoms have shared negative affective dynamics patterns. Longitudinal research is needed to rigorously examine the directionality of the effects underlying the association between affective dynamics and mental health issues.

Longitudinal Associations Between Adolescent Dating Violence Victimization and Adverse Outcomes: A Systematic Review.

Evidence on the outcomes of adolescent dating violence (ADV) victimization mainly derives from cross-sectional studies, which have limitations in suggesting causal relationships. Furthermore, the complexity of factors and overlapping dimensions in dating violence research, such as the forms of violence experienced, may have contributed to the variability of findings across the literature. To address these gaps and provide a more comprehensive understanding of the impact of ADV, this study reviews findings from prospective cohort studies, with a focus on the type of violence experienced and the gender of the victim. A systematic search was conducted in nine electronic databases and additional relevant journals. Prospective longitudinal studies were included if dating violence victimization occurred during adolescence and chronologically preceded the outcomes. A quality assessment was conducted using the Mixed Methods Appraisal Tool. A narrative approach was used to synthesize findings. After screening 1,838 records, 14 publications met the selection criteria and were included in this review. Our findings suggest that experiencing ADV is longitudinally associated with many adverse outcomes, including higher internalizing symptoms and externalizing behaviors, poorer well-being, increased substance use, and increased revictimization. However, the associations are not consistently reported across studies when considering the type of ADV experienced and the gender of the victim. This review highlights the limited number of longitudinal studies examining the outcomes of ADV victimization, the unbalanced approach in investigating different forms of violence, and the lack of diverse samples examining this subject. Implications for research, policy, and practice are outlined.

The Role of Maternal Depression Symptoms and Maternal Attachment in Predicting Exclusive Breastfeeding: A Multisite Prospective Study.

Background: Previous research shows that 61% of children younger than 6 months in low- and middle-income countries (LMICs) are not exclusively breastfed. Although data on the role of pre- and postnatal depression on breastfeeding exclusivity is mixed, fetomaternal attachment might foster breastfeeding exclusivity. Thus, we tested the potential mediating role of fetomaternal attachment and postnatal depression in the relationship between maternal prenatal depression and exclusive breastfeeding. Materials and Methods: Data were collected as part of a prospective, cross-cultural project, Evidence for Better Lives Study, which enrolled 1208 expectant mothers, in their third trimester of pregnancy across eight sites, from LMICs. Of the whole sample, 1185 women (mean age = 28.32, standard deviation [SD] = 5.77) completed Computer-Aided Personal Interviews on prenatal depressive symptoms, fetomaternal attachment, and socioeconomic status. A total of 1054 women provided follow-up data at 3-6 months after birth, about postnatal depressive symptoms, exclusive breastfeeding, and infant health indicators. Path analysis was used to assess parallel mediation. Results: In the whole sample, the effect of prenatal depression on breastfeeding exclusivity was completely mediated by postnatal depression, whereas fetomaternal attachment did not mediate the relationship. The full mediation effect was replicated individually in Pakistan and Sri Lanka. Conclusions: The study results indicate that prenatal depression symptoms contributed to the development of depressive symptoms after birth, negatively affecting the probability of exclusive breastfeeding. Future research should explore this in early prevention interventions, increasing the chances of healthy child development in LMICs. Considering the mixed results around the sites, it is important to better understand the relationship between maternal depression, fetomaternal attachment and breastfeeding behavior in each site's socio-cultural context.

Substance use in sexual minority youth: prevalence in an urban cohort.

BACKGROUND: Little comparative data on substance use (SU) between sexual minority youth (SMY) and heterosexual youth (HET) is available. This study compares the prevalence of SU in an urban cohort between SMY and HET and evaluates demographic and psychosocial predictors of SU. METHODS: Data came from a prospective-longitudinal cohort study in an urban setting (N = 1297). SU and psychosocial variables such as internalizing symptoms, self-control, sensation-seeking, bullying-victimization, subjective stress, leisure activities, and peer influences were assessed with self-reports at age 17 and 20. SU was stratified by sex and sexual attraction, and the groups were compared using regression models, with demographic and psychosocial variables included as covariates. RESULTS: SMY- and HET-youth displayed differences in a number of psychosocial variables. Overall, SMY- and HET-youth differed in their 12-months prevalence of SU: At age 17, SMY-females had significantly higher rates of SU than HET-females for cannabis (aOR = 2.14, p = 0.04), ecstasy/MDMA (aOR = 4.29, p = 0.01), and hallucinogens (aOR = 5.59, p = 0.02). At age 20, SMY-females had significantly higher rates of SU than HET-females for tobacco (aOR = 2.06, p = 0.03), cannabis (aOR = 2.24, p = 0.004), ecstasy/MDMA (aOR = 3.93, p < 0.001), stimulants (aOR = 3.45, p = 0.002), and hallucinogens (aOR = 6.65, p < 0.001). SMY-males reported significantly lower rates for tobacco and cannabis than HET-males at age 17. At age 20, they reported significantly higher rates for the use of ecstasy/MDMA (aOR = 2.30, p = 0.04) and hallucinogens (aOR = 2.43, p = 0.03). CONCLUSIONS: Given that psychosocial variables were significant covariates of SMY-status and SU, our results underline the importance of accounting for these when explaining differences in SU between adolescents. While differentiation by sex is established in most studies, such standardized comparisons are lacking with regards to sexual identities. But knowledge about SU of SMY is critical for designing effective interventions. This is especially true for SMY-females: Thus, SU in SMY-females early in life needs to be explored more thoroughly and addressed with adequate prevention measures.

Adverse Childhood Experiences, Intimate Partner Violence, and Mental Well-Being Among Mothers of Toddlers in Tirana, Albania: A Cross-Sectional Mediation Analysis.

This article examines the relationship between maternal exposure to adverse childhood experiences (ACEs), intimate partner violence (IPV), and two aspects of maternal mental well-being-stress and depressive symptoms in the context of Tirana, Albania. Data were obtained from a representative sample of 328 mothers of 2-3-year-old children, who were registered in Tirana's public nurseries. Findings show that maternal ACEs are positively associated with stress levels (ß = .210, z = 4.03, p < .001) and depressive symptoms (ß = .129, z = 2.62, p < .01). In addition, IPV partially mediates the effect of ACEs on maternal stress (ß = .081, z = 3.75, p < .001) and fully mediates the effect of ACEs on depressive symptoms (ß = .054, z = 2.87, p < .01). These results suggest that among mothers of toddlers in Tirana, ACEs influence stress levels both directly and via IPV, while they influence depressive symptoms only via IPV. The findings demonstrate long-term effects of maternal exposure to interpersonal violence on mental well-being.

Associations of psychoactive substances and steroid hormones in hair: Findings relevant to stress research from a large cohort of young adults.

OBJECTIVE: Epidemiological studies increasingly use hair samples to assess people's cumulative exposure to steroid hormones, but how the use of different psychoactive substances may affect steroid hormone levels in hair is, so far, largely unknown. The current study addresses this gap by establishing the substance exposure correlates of cortisol, cortisone, and testosterone in hair, while also accounting for a number of relevant covariates. METHOD: Data came from a large urban community-sample of young adults with a high prevalence of substance use (N = 1002, mean age=20.6 years, 50.2% female), who provided 3 cm of hair samples. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) quantified cortisol, cortisone, and testosterone, as well as delta-9-tetrahydrocannabinol (THC), 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy"), cocaine, several opioids, and their respective metabolites. Multiple linear regression models with covariates were used to predict steroid hormone levels from substance exposure in a four-step approach: In the full sample, low and high substance hair concentrations (median split) were first tested against no use for each substance individually (step 1) and for all substances together (step 2). Then, within the participants with any substance in hair only, the continuous hair concentration of each substance in pg/mg (step 3) and finally of all substances together, were regressed (step 4). RESULTS: Low, high, and continuous levels of THC in hair were robustly associated with higher levels of cortisol (sig. in step 1 low THC: ß = 0.29, p = .021; high THC: ß = 0.42, p = .001; step 2: low THC: ß = 0.27, p = 0.036, and high THC: ß = 0.40, p = .004, and step 4: ß = 0.12, p = .041). Participants with high MDMA levels had higher levels of cortisone without adjusting for other substances (step 1: ß = 0.34, p = .026), but this effect was not significant in the other models. While high THC levels were associated with lower levels of testosterone in step 2 (ß = -0.35, p = .018), MDMA concentration was positively related to testosterone concentration with and without adjusting for other substances (step 3: ß = 0.24, p = .041; step 4: ß = 0.17, 95%, p = .015) in male participants. CONCLUSION: The use of psychoactive substances, especially of cannabis and ecstasy, should be considered in studies investigating steroid hormones in hair.

Predicting Participation Willingness in Ecological Momentary Assessment of General Population Health and Behavior: Machine Learning Study.

BACKGROUND: Ecological momentary assessment (EMA) is widely used in health research to capture individuals' experiences in the flow of daily life. The majority of EMA studies, however, rely on nonprobability sampling approaches, leaving open the possibility of nonrandom participation concerning the individual characteristics of interest in EMA research. Knowledge of the factors that predict participation in EMA research is required to evaluate this possibility and can also inform optimal recruitment strategies. OBJECTIVE: This study aimed to examine the extent to which being willing to participate in EMA research is related to respondent characteristics and to identify the most critical predictors of participation. METHODS: We leveraged the availability of comprehensive data on a general young adult population pool of potential EMA participants and used and compared logistic regression, classification and regression trees, and random forest approaches to evaluate respondents' characteristic predictors of willingness to participate in the Decades-to-Minutes EMA study. RESULTS: In unadjusted logistic regression models, gender, migration background, anxiety, attention deficit hyperactivity disorder symptoms, stress, and prosociality were significant predictors of participation willingness; in logistic regression models, mutually adjusting for all predictors, migration background, tobacco use, and social exclusion were significant predictors. Tree-based approaches also identified migration status, tobacco use, and prosociality as prominent predictors. However, overall, willingness to participate in the Decades-to-Minutes EMA study was only weakly predictable from respondent characteristics. Cross-validation areas under the curve for the best models were only in the range of 0.56 to 0.57. CONCLUSIONS: Results suggest that migration background is the single most promising target for improving EMA participation and sample representativeness; however, more research is needed to improve prediction of participation in EMA studies in health.

The role of student-teacher relationships in the association between negative parenting practices and emotion dynamics - Combining longitudinal and ecological momentary assessment data.

Emotion dysregulation is increasingly implicated as a transdiagnostic risk factor in the etiology of mental health problems. This project aimed to explore the links between emotion regulation, negative parenting and student-teacher relationships using longitudinal and ecologically valid data. A sample of n = 209 young people enrolled in the 'Decades-to-Minutes' (D2M) study, based in Zurich, Switzerland, provided data from the ages of 7-20 via parent- and self-report questionnaires and ecological momentary assessment. Data were analyzed using Dynamic Structural Equation Modeling (DSEM). Worse student-teacher relationships predicted increased negative affectivity and emotional lability. Negative parenting practices predicted emotional lability only via their impact on student-teacher relationships. The findings point to worse student-teacher relationships as risk factors in the socioemotional development of children and young people.

The worst and the best: new insights into risk and resilience in young adults from the COVID-19 pandemic.

Historic declines in young people's mental health began to emerge before the COVID-19 pandemic. In the face of this youth mental health crisis, the pandemic constituted a naturalistic stressor paradigm that came with the potential to uncover new knowledge for the science of risk and resilience. Surprisingly, approximately 19-35% of people reported better well-being in the first few months of the COVID-19 pandemic than before. Therefore, in May and September 2020, we asked N=517 young adults from a cohort study to describe the best and the worst aspects of their pandemic lives (N=1,462 descriptions). Inductive thematic analysis revealed that the best aspects included the deceleration of life and a greater abundance of free time, which was used for hobbies, healthy activities, strengthening relationships, and for personal growth and building resilience skills. Positive aspects also included a reduction in educational pressures and work load and temporary relief from climate change concerns. The worst aspects included disruptions and changes to daily life; social distancing and restrictions of freedoms; negative emotions that arose in the pandemic situation, including uncertainty about the future; and the growing polarization of society. Science that aims to reverse the youth mental health crisis must pay increased attention to sources of young people's distress that are not commonly measured (e.g., their educational, work, and time pressures; their fears and uncertainties about their personal, society's, and the global future), and also to previously untapped sources of well-being - including those that young people identified for themselves while facing the COVID-19 pandemic. Supplementary Information: The online version contains supplementary material available at 10.1007/s42844-023-00096-y.

Respondent characteristics associated with adherence in a general population ecological momentary assessment study.

OBJECTIVES: Ecological momentary assessment (EMA) has seen an explosion in popularity in recent years; however, an improved understanding of how to minimise (selective) non-adherence is needed. METHODS: We examined a range of respondent characteristics predictors of adherence (defined as the number of EMA surveys completed) in the D2M EMA study. Participants were a sample of n = 255 individuals drawn from the longitudinal z-proso cohort who completed up to 4 EMA surveys per day for a period of 2 weeks. RESULTS: In unadjusted analyses, lower moral shame, lower self-control, lower levels of self-injury, and higher levels of aggression, tobacco use, psychopathy, and delinquency were associated with lower adherence. In fully adjusted analyses with predictors selected using lasso, only alcohol use was related to adherence: beer and alcopops to higher adherence and spirits to lower adherence. CONCLUSIONS: These findings provide potential insights into some of the psychological mechanisms that may underlie adherence in EMA. They also point to respondent characteristics for which additional or tailored efforts may be needed to promote adherence.

Trajectories of Screen Time across Adolescence and Their Associations with Adulthood Mental Health and Behavioral Outcomes.

Excessive screen time among adolescents is discussed as a significant public health concern. Identifying adolescent longitudinal patterns of time spent on regularly-used media screens and understanding their young adulthood mental health and behavioral issue correlates may help inform strategies for improving these outcomes. This study aimed to characterize joint developmental patterns of time spent on videogames, surfing/chatting the Internet, and TV/DVDs during adolescence (at ages 11, 13, 15, 17) and their associations with mental health (i.e., depression, anxiety, suicidal ideation, and self-injury) and behavioral issues (i.e., substance use, delinquency, aggression) in early adulthood (at age 20). A parallel-process latent class growth analysis was used to model data from a diverse community-ascertained sample of youth in Zurich, Switzerland (n = 1521; 51.7% males). Results suggested that a five-class model best fitted the data: (1) low-screen use, 37.6%; (2) increasing chatting/surfing, 24.0%; (3) moderate-screen use, 18.6%; (4) early-adolescence screen use, 9.9%; and (5) increasing videogame and chatting/surfing, 9.9%. After adjusting for baseline levels of outcomes (primarily at age 11), the trajectory groups differed in their associations with adulthood outcomes of mental health and behavioral problems, indicating the importance of problematic screen usage patterns in predicting these outcomes. Future research to test the directionality of these associations will be important. These findings suggest which patterns of screen use may be a marker for later mental health and behavioral issues in different domains.

Relationship between polyvictimization and overweight among adolescents from São Paulo city, Brazil.

This study is to identify victimization patterns and analyze the association between the experience of polyvictimization and overweight or obesity among adolescent girls and boys. The sample consisted of 2680 Brazilian ninth-graders enrolled in public and private schools, taken from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Victimization was explored in two ways: (i) as per Finkelhor and (ii) by latent class analysis (LCA). The interest outcomes were overweight and obesity. Multinomial logistic regression models were used to study the relationship between victimization and overweight or obesity, controlling for confounders. LCA grouped boys and girls adolescents into three classes. These classes received the same labels, but the patterns differed between sexes. Class 1 was characterized by fewer types of victimization suffered and lower endorsement values in the analyzed items and was named bullying and indirect victimization (♀: 42.7%, n = 546; ♂: 21.6%, n = 293). Class 2 included more victimization types than Class 1 and less than Class 3. This class was labeled family violence and peer victimization (♀: 29.1%, n = 356; ♂: 47.9%, n = 652). Class 3 was named high polyvictimization (♀: 28.2%, n = 345; ♂: 30.5%, n = 418). According to Finkelhor, polyvictimization was not associated with overweight or obesity in both sexes. Only the class of high polyvictimization was associated with being overweight (ORadj: 1.60, 95%CI: 1.01-2.54) in girls. In this study, polyvictimization was associated with being overweight only among adolescent girls. Longitudinal studies in different contexts and populations are needed to understand this relationship.

Teacher-Student Relationships in Childhood as a Protective Factor against Adolescent Delinquency up to Age 17: A Propensity Score Matching Approach.

In this paper we examined the impact of the quality of teacher-student relationships at age 10 on young people's delinquency at ages 13, 15, and 17 utilizing propensity-score matching. The young people were matched based on 105 characteristics, measured at ages 7 to 10. The sample comprised 1483 (49.4% female) adolescents representing around 80 different countries of origin, residing in Zurich, Switzerland. We found that young people who reported a better relationship with their teacher at age 10, engaged in fewer delinquent acts at ages 13, 15, and 17. These findings suggest that when young people perceive a better relationship with their teachers this serves as a protective factor against their engagement in delinquency up to 7 years later.

Exploring the effect of ADHD traits on the moment-to-moment interplay between provocation and aggression: Evidence from dynamic structural equation modeling.

The relation between attention deficit hyperactivity disorder (ADHD) symptoms and aggression is well documented; however, the processes that account for higher levels of aggression associated with ADHD in the course of daily life are little understood. The current study used ecological momentary assessment to explore how ADHD traits relate to individual differences in perceiving provocation from others and the resultant aggressive behaviors; and the strengths of the links between provocation and aggression in the flow of daily life. A dynamic structural equation model was fit using data from a subpopulation of young adults involved in the longitudinal z-proso study (n = 259, median-age 20). Data on provocation and aggression was collected at four quasi-random time periods per day over a 14-day period. Individuals with higher ADHD trait levels reported higher instances of provocation and aggression, with ADHD traits significantly moderating aggression inertia such that those with higher levels of ADHD traits showed greater persistence of aggressive behavior over time. However, ADHD trait levels did not significantly moderate any of the observed cross-lagged effects. Our findings suggest that individuals with higher levels of ADHD traits are at greater risk of exposure to interpersonal interactions involving interpersonal provocation, show higher levels of aggressive behavior in daily life, and find it more difficult to reduce their aggression once triggered. These findings support the importance of targeting factors such as social skills and emotion regulation that may underpin the increased difficulties in interpersonal interactions often experienced by individuals with high levels of ADHD symptoms.

When Substance Use Is Underreported: Comparing Self-Reports and Hair Toxicology in an Urban Cohort of Young Adults.

OBJECTIVE: Large-scale epidemiological research often uses self-reports to determine the prevalence of illicit substance use. Self-reports may suffer from inaccurate reporting but can be verified with objective measures. This study examined the following: the prevalence of illicit and non-medical substance use with self-reports and hair toxicology, the convergence of self-reported and objectively quantified substance use, and the correlates of under- and overreporting. METHOD: The data came from a large urban cohort study of young adults (n = 1,002, mean age = 20.6 years, 50% female). The participants provided 3 cm of hair (covering the previous 3 months) and reported their illicit and non-medical substance use and their sociodemographic, psychological, and behavioral characteristics. Hair toxicology analyses targeted cannabinoids, ketamine, opiates/opioids, stimulants including 3,4-methylenedioxymethamphetamine, and relevant metabolites. RESULTS: Self-reports underestimated the prevalence of most substances by 30% to 60% compared to hair tests. The average detection ratio (hair test/self-report) was 1.50. Hair tests were typically more sensitive than self-reports. Underreporting was associated with a low level of that substance in hair. Self-reported delinquency and psychopathology were correlated with an increased likelihood of concordant positive self-reports and hair tests compared to underreporting. Overreporting was associated with infrequent self-reported use. CONCLUSION: Our study suggests that self-reports underestimate young adults' exposure to illicit substances and non-medical use of prescription drugs. Consequently, estimates of associations between substance use and risk factors or outcomes are likely biased. Combining self-reports with hair tests may be most beneficial in study samples with occasional substance use. Researchers can use specific factors (eg, detection ratios) to adjust prevalence estimates and correlations based on self-reports.