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1.
N Z Med J ; 137(1593): 56-67, 2024 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-38603787

RESUMO

AIMS: Emergency departments (EDs) around the world are increasingly overcrowded, which is associated with significant patient harm. Alcohol use is a known contributor to ED overcrowding. This study aimed to assess trends in the characteristics of alcohol-related ED presentations over time. METHODS: A cross-sectional observational study of Christchurch ED attendances during 3-week waves of data collection in November-December 2013, 2017 and 2022 was conducted. Potential participants were those patients attending the Christchurch Hospital ED who had ingested alcohol in the 4 hours prior to arrival, and/or the presentation was thought to be related to alcohol. Those who consented to take part were interviewed to examine amount and source of alcohol. RESULTS: There has been a change in the age profile towards a greater proportion of older patients attending the ED with alcohol-related issues. In 2022, a greater proportion of alcohol was purchased from on-licence venues compared to previous years, although off-licence alcohol purchase and consumption in private locations remained the most common. CONCLUSION: Alcohol use and harm places a significant, yet preventable, burden on EDs and the wider healthcare system. Implementation of evidence-based alcohol policies is urgently needed to reduce the impact of alcohol in the ED and improve the health of communities.


Assuntos
Consumo de Bebidas Alcoólicas , Transtornos Relacionados ao Uso de Álcool , Humanos , Estudos Transversais , Nova Zelândia , Consumo de Bebidas Alcoólicas/epidemiologia , Serviço Hospitalar de Emergência , Transtornos Relacionados ao Uso de Álcool/epidemiologia
3.
SSM Popul Health ; 25: 101622, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38380053

RESUMO

Background: Mental disorders and perceived discrimination share common risk factors. The association between having a mental disorder and experiencing discrimination is well-known, but the extent to which familial factors, such as genetic and shared environmental factors, might confound this association, including sex differences in familial confounding, remains unexplored. Aims: We investigated potential unmeasured familial confounding in the association between mental disorders and perceived discrimination using a matched twin study design. Method: We examined data from 2044 same-sex twin pairs (n = 4088) aged 16-25 years from the German population-based study 'TwinLife'. We applied random-effects logistic regression to within-individual and within-and-between pair models of the association between mental disorder and perceived discrimination, and used likelihood ratio tests (LRTs) to compare these models. Multivariable models were adjusted for body mass index, educational attainment, and life satisfaction. Results: There were 322 (8.1%) participants with a diagnosed mental disorder, and 15% (n = 604) of the cohort reported having experienced discrimination in the previous 12 months. Mental disorder and discrimination were associated in the adjusted within-individual model (adjusted odds ratio = 2.19, 95% confidence interval: 1.42-3.39, P<0.001). However, the within-and-between pair model showed that this association was explained by the within-pair mean (aOR = 4.24, 95% CI: 2.17-8.29, P<0.001) and not the within-pair difference (aOR = 1.26, 95% CI: 0.70-2.28, P = 0.4) of mental disorder. Therefore, this association was mostly explained by familial confounding, which is also supported by the LRTs for the unadjusted and adjusted models (P<0.001 and P = 0.03, respectively). This familial confounding was more prominent for males than females. Conclusions: Our findings show that the association between mental disorder and discrimination is at least partially explained by unmeasured familial factors. Designing family-based healthcare models and incorporating family members in interventions targeted at ameliorating mental ill-health and experiences of discrimination among adolescents may improve efficacy.

5.
Australas Psychiatry ; 31(6): 846-849, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37606036

RESUMO

OBJECTIVE: To describe the perspectives of those with lived experience of stimulant use disorder on methamphetamine-related violence in psychiatric inpatient settings. METHOD: Eight adult psychiatric inpatients with stimulant use disorder were recruited. Semi-structured interviews were recorded, transcribed and analysed using thematic analysis. RESULTS: Participants reported that traumatic experiences predisposed those using methamphetamine to violent behaviour. Participants were fearful of psychiatric hospitalisation because of loss of autonomy and stigma. Methamphetamine use was associated with mercurial intense emotions. Participants believed these factors led to violence during psychiatric admissions. CONCLUSIONS: People with stimulant use disorder have a sophisticated understanding of the complex causal pathways from methamphetamine use to violent behaviour. Their lived experience can make an important contribution to service development.


Assuntos
Pacientes Internados , Metanfetamina , Adulto , Humanos , Pacientes Internados/psicologia , Violência , Pesquisa Qualitativa , Agressão , Metanfetamina/efeitos adversos
6.
Entropy (Basel) ; 25(4)2023 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-37190449

RESUMO

We propose definitions of fairness in machine learning and artificial intelligence systems that are informed by the framework of intersectionality, a critical lens from the legal, social science, and humanities literature which analyzes how interlocking systems of power and oppression affect individuals along overlapping dimensions including gender, race, sexual orientation, class, and disability. We show that our criteria behave sensibly for any subset of the set of protected attributes, and we prove economic, privacy, and generalization guarantees. Our theoretical results show that our criteria meaningfully operationalize AI fairness in terms of real-world harms, making the measurements interpretable in a manner analogous to differential privacy. We provide a simple learning algorithm using deterministic gradient methods, which respects our intersectional fairness criteria. The measurement of fairness becomes statistically challenging in the minibatch setting due to data sparsity, which increases rapidly in the number of protected attributes and in the values per protected attribute. To address this, we further develop a practical learning algorithm using stochastic gradient methods which incorporates stochastic estimation of the intersectional fairness criteria on minibatches to scale up to big data. Case studies on census data, the COMPAS criminal recidivism dataset, the HHP hospitalization data, and a loan application dataset from HMDA demonstrate the utility of our methods.

8.
Addict Behav ; 144: 107714, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37060881

RESUMO

BACKGROUND: Identifying predictors of methamphetamine use can inform population prevention strategies. METHODS: Participants (n = 1265) born in Christchurch, New Zealand were followed from birth to age 40. Methamphetamine outcomes (any use since the last interview, and regular use, defined as any period of at least weekly use) were ascertained by self-report at six interviews from age 18 to 40. Predictors with plausible associations with methamphetamine use were extracted from the study database. These were grouped into early predictors (age 0-16), comprising childhood, familial and individual characteristics; and later time-dynamic correlates of methamphetamine use in adulthood (ages 16-40). Generalised estimating equation models were fitted to identify predictors of methamphetamine use outcomes. RESULTS: In adjusted models, paternal overprotectiveness and childhood anxious / withdrawn behavior were associated with any use of methamphetamine, but not regular use. Conversely, childhood conduct problems and parental illicit drug were associated with regular use but not any use. Male sex, high novelty seeking and deviant peer affiliations were associated with both any use and regular use in adjusted models. The strongest correlates of methamphetamine use in adulthood were unemployment, life stress and other substance use disorders (cannabis, nicotine, and alcohol). CONCLUSION: Markers of externalizing problems in childhood and adolescence (conduct problems, high novelty seeking, parental illicit substance use, and deviant peer affiliations) are the strongest predictors of regular methamphetamine use in adulthood.


Assuntos
Metanfetamina , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Humanos , Masculino , Adulto , Adulto Jovem , Recém-Nascido , Lactente , Pré-Escolar , Criança , Estudos Longitudinais , Coorte de Nascimento , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
9.
Bipolar Disord ; 25(4): 263-277, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36949602

RESUMO

BACKGROUND: Cognitive impairment is a core feature of mood disorders and has been identified as an important treatment target. A better understanding of the factors contributing to cognitive impairment in mood disorders would be beneficial in developing interventions to address cognitive impairment. One key factor is childhood trauma. The aim of this review was to systematically synthesise and review research examining associations between reported childhood trauma and cognitive functioning in mood disorders. METHODS: Studies in adult samples examining the relationship between objective cognitive function and reported childhood trauma in major depressive disorder and/or bipolar disorder (in-episode or euthymia) were identified. Searches were conducted on PubMed, Embase and PsycINFO until January 2022. A narrative review technique was used due to the heterogeneity of group comparisons, cognitive tests and data analysis across studies. RESULTS: Seventeen studies met the criteria for inclusion (mood disorders N = 1723, healthy controls N = 797). Evidence for childhood trauma being related to poorer cognitive functioning was consistent across global cognitive functioning and executive function domains for euthymic patients and psychomotor speed for in-episode patients. There was mixed evidence for verbal learning and memory and executive function for in-episode patients. Identification of patterns within other domains was difficult due to limited number of studies. CONCLUSION: Findings from this review suggest childhood trauma is associated with poorer cognitive functioning in people with mood disorders. Targeted interventions to improve cognition may be warranted for this group.


Assuntos
Experiências Adversas da Infância , Transtorno Bipolar , Transtornos Cognitivos , Transtorno Depressivo Maior , Adulto , Humanos , Transtornos do Humor/complicações , Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Transtorno Depressivo Maior/complicações , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Cognição , Transtorno Ciclotímico , Testes Neuropsicológicos
10.
Psychol Med ; 53(3): 987-994, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-34134802

RESUMO

BACKGROUND: This study examined the association between methamphetamine use and psychotic symptoms in a New Zealand general population birth cohort (n = 1265 at birth). METHODS: At age 18, 21, 25, 30, and 35, participants reported on their methamphetamine use and psychotic symptoms in the period since the previous interview. Generalized estimating equations modelled the association between methamphetamine use and psychotic symptoms (percentage reporting any symptom, and number of symptoms per participant). Confounding factors included childhood individual characteristics, family socioeconomic circumstances and family functioning. Long term effects of methamphetamine use on psychotic symptoms were assessed by comparing the incidence of psychotic symptoms at age 30-35 for those with and without a history of methamphetamine use prior to age 30. RESULTS: After adjusting for confounding factors and time-varying covariate factors including concurrent cannabis use, methamphetamine use was associated with a modest increase in psychosis risk over five waves of data (adjusted odds ratio (OR) 1.33, 95% confidence interval (CI) 1.03-1.72 for the percentage measure; and IRR 1.24, 95% CI 1.02-1.50 for the symptom count measure). The increased risk of psychotic symptoms was concentrated among participants who had used at least weekly at any point (adjusted OR 2.85, 95% CI 1.21-6.69). Use of methamphetamine less than weekly was not associated with increased psychosis risk. We found no evidence for a persistent vulnerability to psychosis in the absence of continuing methamphetamine use. CONCLUSION: Methamphetamine use is associated with increased risk of psychotic symptoms in the general population. Increased risk is chiefly confined to people who ever used regularly (at least weekly), and recently.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas , Metanfetamina , Psicoses Induzidas por Substâncias , Transtornos Psicóticos , Recém-Nascido , Humanos , Criança , Adulto , Metanfetamina/efeitos adversos , Psicoses Induzidas por Substâncias/epidemiologia , Psicoses Induzidas por Substâncias/etiologia , Coorte de Nascimento , Nova Zelândia/epidemiologia , Fatores de Risco , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Transtornos Relacionados ao Uso de Anfetaminas/complicações , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/complicações , Estudos Longitudinais
12.
Psychiatry ; 85(4): 373-386, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35286251

RESUMO

OBJECTIVE: Firesetting in children is thought to be an indicator of severe conduct problems in young people. However, no research has examined whether childhood firesetting is also associated with increased risk of externalizing and suicidal behaviors in adulthood. METHOD: Data were obtained from a longitudinal study (n = 1265). Childhood firesetting/conduct problems (7-10 years) were derived from an assessment of antisocial behavior. Externalizing/suicidal behavior was derived from the Composite International Diagnostic Interview and the Self-Report Delinquency Inventory. Generalized estimating equation (GEE) models estimated associations between childhood firesetting and adult substance use disorders, criminal offending, and suicidal ideation, adjusting for childhood conduct problems and other confounding factors. Associations between childhood and adult firesetting (age 18-40 years) were examined using cross-tabulation (χ2). RESULTS: Five percent of children reported firesetting (7-10 years). Childhood firesetting appeared to increase the risk of adult firesetting; however, in most cases adult firesetting was not associated with childhood firesetting (χ2 (1) = 4.15, p = .0417). Childhood firesetting was a risk marker for adult externalizing/suicidal behavior; however, the effect was relatively weak (IRR = 1.51; 95% CI: 1.11-2.05). Children with conduct problems who also engaged in firesetting were found to be at substantially higher risk of later externalizing/suicidal behavior (IRR = 2.84; 95% CI: 1.24-6.49). CONCLUSION: This study found that childhood firesetting is a risk marker for adult externalizing/suicidal behavior, not an independent risk factor. It may be more useful for clinicians to focus on child conduct problems generally, rather than focussing on firesetting behavior.


Assuntos
Piromania , Ideação Suicida , Criança , Adulto , Humanos , Adolescente , Adulto Jovem , Estudos Longitudinais , Estudos de Coortes , Coorte de Nascimento , Piromania/epidemiologia
13.
BMJ Open ; 12(1): e057029, 2022 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-35074824

RESUMO

INTRODUCTION: Amphetamine type stimulant (ATS) use and self-harm are both major public health concerns globally. Use of ATS is associated with a range of health and social problems, and has been increasing internationally in the last decade. Self-harm and ATS use share a number of underlying risk factors and occur at elevated rates in marginalised groups with high rates of exposure to trauma. The relationship between self-harm and ATS use is likely complex, and the causal pathway may run in either direction. A comprehensive review, synthesis and analysis of the evidence are warranted to investigate this relationship and inform policy and practice. METHODS AND ANALYSIS: We will search the Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Scopus databases for relevant observational studies published in peer-reviewed journals. The initial search was conducted on 5 February 2021, with a final search expected on 1 February 2022. All studies will be independently screened by two reviewers, first on title and abstract, and then on full-text to determine inclusion in the review. We place no restriction on the population that studies investigate, our exposure of interest is both prescription and illicit ATS use, comparators will be those not currently using ATS, and our primary outcome of interest is the prevalence of self-harm. Data will be extracted using a predesigned template, and pooled prevalence and pooled measures of effect for the association between ATS use and self-harm. If sufficient data are available, we will perform multiple meta-analyses to produce pooled measures of effect for each measure of ATS exposure, as well as different population sub-groups. The Methodological Standard for Epidemiological Research scale will be used to assess study quality, and Egger's test and I2 values will be used to assess publication bias and heterogeneity, respectively. ETHICS AND DISSEMINATION: No ethical approval is required for this review. We will only synthesise information from published studies that were conducted with ethical approval, so no individual participant data will be used. We will disseminate our findings via publication in a peer-reviewed journal, national and international conference presentations, and presentations to stakeholders in the community. TRIAL REGISTRATION NUMBER: This study has been registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42021226562).


Assuntos
Estimulantes do Sistema Nervoso Central , Comportamento Autodestrutivo , Anfetaminas , Humanos , Estudos Observacionais como Assunto , Viés de Publicação , Projetos de Pesquisa , Comportamento Autodestrutivo/epidemiologia , Revisões Sistemáticas como Assunto
14.
Int J Law Psychiatry ; 80: 101762, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34861488

RESUMO

INTRODUCTION: In 1992, New Zealand's mental health legislation created the distinct concept of a 'restricted patient' - effectively creating a pathway into forensic patient status, but via the civil committal process, without the patient passing through the criminal justice system en route. This regime was aimed at civilly committed patients who present "special difficulties" because of the danger they pose to others. It remains in force but has attracted little scrutiny. OBJECTIVE: This paper traverses the background to restricted patient status, and the legal regime, before describing and analysing, in anonymous form, the circumstances of all those declared to be restricted patients, and their outcomes, since the regime began. It then considers the continuing appropriateness of this legal regime in light of contemporary human rights principles. METHODS: We reviewed the records of every person placed under restricted patient status since the legislation came into force over a nearly 30-year-period. RESULTS: New Zealand's restricted patient status is rarely used. Only eight people have been subject to such orders (seven male, median age 45 years at the making of the order). All had a history of violent offending and had previously been forensic patients. None re-offended after becoming a restricted patient, but they spent longer as compulsory inpatients than patients unfit to stand trial or not guilty by reason of insanity. There is no evidence they were uniquely dangerous. The legal criteria, namely, that the person presented with "special difficulties", are unclear and have been interpreted differently by the judiciary. They have sometimes included the risk of inadequate care being provided by mental health services. CONCLUSION: Given the rarity with which restricted patient status has been used in New Zealand, the subsequent evolution and development of forensic services providing alternative pathways through care, and its problematic human rights aspects, we would not recommend equivalent restricted patient provisions to other countries. We suggest this hybrid form of civil/forensic compulsory mental health treatment is a form of arbitrary detention and incompatible with human rights norms. It should be omitted from New Zealand's next Mental Health Act.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Psiquiatria Legal , Humanos , Defesa por Insanidade , Masculino , Transtornos Mentais/terapia , Saúde Mental , Pessoa de Meia-Idade , Nova Zelândia
15.
Curr Opin Psychiatry ; 35(1): 45-52, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34855696

RESUMO

PURPOSE OF REVIEW: This review examines the prevalence of personality disorder in those with mental state disorder. Some challenges disentangling these psychopathologies are delineated and advances in understanding broadly are reviewed. RECENT FINDINGS: Recent taxonomic changes to a dimensionally based classification system in the ICD-11 and DSM of mental disorders-V's alternative model of personality disorder include requiring cut offs to examine clinical outcomes akin to those in hypertension. These new criteria affect personality disorder prevalence where it is comorbid with mental state disorder, although more robust the dimensional approach complicates understanding both theoretically and practically. Such issues include: deciding the cut off for 'pathology', understanding if psychopathology is related to mental state disorder, personality disorder or both, and consideration of the clinical value of comorbidity. SUMMARY: There is overlap between personality pathology and all types of mental state disorder. However, the shift to a dimensional framework of personality pathology means new methods to define and measure this comorbidity are needed. Dimensional conceptualisation of personality pathology challenges the underlying ontology of comorbidity in this area.


Assuntos
Transtornos Mentais , Transtornos da Personalidade , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Classificação Internacional de Doenças , Transtornos Mentais/epidemiologia , Transtornos da Personalidade/epidemiologia , Prevalência
16.
Alcohol Alcohol ; 57(1): 16-25, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33480397

RESUMO

AIMS: To demonstrate a novel method for presenting and exploring data in systematic reviews of the alcohol literature. METHODS: Harvest plots are a graphical method for displaying data on the overall pattern of evidence from a systematic review. They can display the direction of effects and risk of bias within studies for multiple outcomes in a single graphical chart. Using data from our previous meta-analysis on the association between personality disorder and alcohol treatment outcome, we extended the application of harvest plots by developing an interactive online harvest plot application. RESULTS: Studies included in the review were heterogeneous in design. There were many different primary outcomes, and similar outcomes were often defined differently across studies. The interactive harvest plot allows readers to explore trends in the data across multiple outcomes, including the impact of within-study bias and year of publication. In contrast, meta-analysis on the same data was hampered by a lack of consistency in the way outcomes were measured, and incomplete reporting of effect sizes and their variance. This meant many studies included in the systematic review could not be meta-analysed. CONCLUSIONS: Interactive harvest plots are a novel graphical method to present data from systematic reviews. They can supplement or even replace meta-analysis when the studies included in a systematic review use heterogeneous designs and measures, as is often the case in the alcohol literature.


Assuntos
Serviços de Saúde , Projetos de Pesquisa , Humanos , Revisões Sistemáticas como Assunto , Resultado do Tratamento
17.
Health Justice ; 9(1): 27, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34652519

RESUMO

BACKGROUND: With over 11 million people incarcerated globally, prevention and control of COVID-19 in custodial settings is a critical component of the public health response. Given the risk of rapid transmission in these settings, it is important to know what guidance existed for responding to COVID-19 in the early stages of the pandemic. We sought to identify, collate, and summarise guidance for the prevention and control of COVID-19 in custodial settings in the first six months of 2020. We conducted a systematic search of peer-reviewed and grey literature, and manually searched relevant websites to identify publications up to 30 June 2020 outlining recommendations to prevent and/or control COVID-19 in custodial settings. We inductively developed a coding framework and assessed recommendations using conventional content analysis. RESULTS: We identified 201 eligible publications containing 374 unique recommendations across 19 domains including: preparedness; physical environments; case identification, screening, and management; communication; external access and visitation; psychological and emotional support; recreation, legal, and health service adaptation; decarceration; release and community reintegration; workforce logistics; surveillance and information sharing; independent monitoring; compensatory measures; lifting control measures; evaluation; and key populations/settings. We identified few conflicting recommendations. CONCLUSIONS: The breadth of recommendations identified in this review reflects the complexity of COVID-19 response in custodial settings. Despite the availability of comprehensive guidance early in the pandemic, important gaps remain in the implementation of recommended prevention and control measures globally, and in the availability of evidence assessing their effectiveness on reducing COVID-19 disease, impact on people in custody and staff, and implementation.

19.
J Psychiatr Ment Health Nurs ; 28(5): 924-939, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33837640

RESUMO

WHAT IS KNOWN ON THE SUBJECT?: Aggression and violence are persistent problems in psychiatric inpatient units. Violence preventive factors have been identified from both staff's and patients' perspectives. Violent and aggressive inpatient incidents have not been adequately explained in research and reviews to date. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This review is novel in that it provides a comparison of patients' and staff's perspectives and identified that these differ and were influenced by factors attributable to the inpatient culture. The one contributory factor both agreed upon was the role of staff's interpersonal skills in either exacerbating or de-escalating aggression and violence. The inpatient culture was found to engender differing perceptions of most contributory factors to violence and aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While staff's interpersonal skills were identified as a primary influence on whether their interaction with patients contributed to aggression and violence, this was shaped by the inpatient environment's culture. Patient-centred interactional skills need to focus on the patients' needs for respect and active participation rather than engendering feelings of disrespect or coercion. Patient-centred communication skills that demonstrate an understanding of the patient's experience in the inpatient environment need to be core skills for mental health nurses. ABSTRACT: Introduction High rates of aggression and violence are a persistent problem in inpatient mental health environments. A comparison of staff's and patients' perceptions of the causes may provide novel insights. Aim This review aimed to compare patients' and staff's perspectives on the causes of aggression and violence in inpatient environments. Method An integrative review of the literature was conducted with a search of Ovid (Medline, Embase, PsycINFO) databases and manual searching. Results Thirty articles met criteria for inclusion. Interactions prior to aggressive or violent incidents were characterized by patients as disrespectful and coercive, and by staff as indicative of the patient's mental state or personality. Both groups identified the importance of patient-centred communication skills. Discussion The review identified that patients and staff have differing perspectives on the causes of violence and aggression. There was an interactional dynamic between staff and patients that was shaped by the culture of the inpatient setting. Implications for Practice Understanding how the inpatient culture plays a role in shaping a dynamic between patients and staff and developing communication skills that acknowledge this may help reduce violence and aggression in inpatient settings.


Assuntos
Agressão , Enfermagem Psiquiátrica , Coerção , Humanos , Pacientes Internados , Violência
20.
J Adolesc Health ; 69(2): 329-334, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33610403

RESUMO

PURPOSE: Parenting is a modifiable factor affecting the development of alcohol use disorder (AUD); however, the persistence of this effect into adulthood remains poorly understood. This study aimed to explore the longitudinal relationship between positive parenting and AUD in adulthood. METHODS: Data were gathered from the Christchurch Health and Development Study (CHDS), a birth cohort of 1,265 children born in Christchurch (New Zealand) in mid-1977. Positive parenting was quantified to age 16, and included the extent to which cohort members self-reported: high scores on measures of maternal and paternal care; low scores on a measure of maternal and paternal overprotection; high scores on a measure of parental attachment; low scores on a measure of parental intimate partner violence; and occasional or no use of physical punishment. Outcome measures were AUD incidence and symptoms at ages 15-35, with potential confounding factors and time-dynamic covariates included. RESULTS: There was a significant association between positive parenting and AUD outcomes, with higher levels of positive parenting associated with a lower incidence of AUD and AUD symptoms. Controlling for confounding factors reduced the association between positive parenting and AUD outcomes, but they remained statistically significant. Adjustment for mental health, life stress, and employment reduced the magnitude of the association between positive parenting and alcohol outcomes to statistical nonsignificance. CONCLUSIONS: Parenting factors in childhood and adolescence are linked to AUD outcomes in adulthood, as well as mental health, substance use, and life stress. Investment in positive parenting in adolescence may reduce AUD and associated harms in adulthood.


Assuntos
Alcoolismo , Poder Familiar , Adolescente , Adulto , Alcoolismo/epidemiologia , Criança , Estudos de Coortes , Humanos , Masculino , Nova Zelândia/epidemiologia , Pais , Fatores de Risco , Adulto Jovem
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