Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-10-30T13:08:22.582Z Has data issue: false hasContentIssue false

Incipient alcohol use in childhood: Early alcohol sipping and its relations with psychopathology and personality

Published online by Cambridge University Press:  11 June 2020

Ashley L. Watts*
Affiliation:
Department of Psychological Sciences, University of Missouri, Columbia, MI, USA
Phillip K. Wood
Affiliation:
Department of Psychological Sciences, University of Missouri, Columbia, MI, USA
Kristina M. Jackson
Affiliation:
Center for Alcohol and Addiction Studies, Brown University, Providence, USA
Krista M. Lisdahl
Affiliation:
Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
Mary M. Heitzeg
Affiliation:
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
Raul Gonzalez
Affiliation:
Department of Psychology, Florida International University, Miami, FL, USA
Susan F. Tapert
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
Deanna M. Barch
Affiliation:
Departments of Psychological & Brain Sciences, Psychiatry and Radiology, Washington University, St. Louis, MO, USA
Kenneth J. Sher
Affiliation:
Department of Psychological Sciences, University of Missouri, Columbia, MI, USA
*
Author for Correspondence: Ashley L. Watts, Department of Psychological Sciences, 200 S. 7th Street, Columbia, MO 65211, USA. Email: ashleylwatts@gmail.com

Abstract

Prior research has shown that sipping of alcohol begins to emerge during childhood and is potentially etiologically significant for later substance use problems. Using a large, community sample of 9- and 10-year-olds (N = 11,872; 53% female), we examined individual differences in precocious alcohol use in the form of alcohol sipping. We focused explicitly on features that are robust and well-demonstrated correlates of, and antecedents to, alcohol excess and related problems later in the lifespan, including youth- and parent-reported externalizing traits (i.e., impulsivity, behavioral inhibition and activation) and psychopathology. Seventeen percent of the sample reported sipping alcohol outside of a religiously sanctioned activity by age 9 or 10. Several aspects of psychopathology and personality emerged as small but reliable correlates of sipping. Nonreligious sipping was related to youth-reported impulsigenic traits, aspects of behavioral activation, prodromal psychotic-like symptoms, and mood disorder diagnoses, as well as parent-reported externalizing disorder diagnoses. Religious sipping was unexpectedly associated with certain aspects of impulsivity. Together, our findings point to the potential importance of impulsivity and other transdiagnostic indicators of psychopathology (e.g., emotion dysregulation, novelty seeking) in the earliest forms of drinking behavior.

Type
Regular Articles
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms and profiles. Burlington: University of Vermont.Google Scholar
Acheson, A., Richard, D. M., Mathias, C. W., & Dougherty, D. M. (2011). Adults with a family history of alcohol related problems are more impulsive on measures of response initiation and response inhibition. Drug and Alcohol Dependence, 117, 198203. doi:10.1016/j.drugalcdep.2011.02.001CrossRefGoogle ScholarPubMed
Babor, T. F., Hofmann, M., DelBoca, F. K., Hesselbrock, V., Meyer, R. E., Dolinsky, Z. S., & Rounsaville, B. (1992). Types of alcoholics, I: Evidence for an empirically derived typology based on indicators of vulnerability and severity. Archives of General Psychiatry, 49, 599608. doi:10.1001/archpsyc.1992.01820080007002CrossRefGoogle ScholarPubMed
Barch, D. M., Albaugh, M. D., Avenevoli, S., Chang, L., Clark, D. B., Glantz, M. D., … & Alia-Klein, N. (2018). Demographic, physical and mental health assessments in the adolescent brain and cognitive development study: Rationale and description. Developmental Cognitive Neuroscience, 32, 5566.CrossRefGoogle ScholarPubMed
Bjork, J. M., Hommer, D. W., Grant, S. J., & Danube, C. (2004). Impulsivity in abstinent alcohol-dependent patients: relation to control subjects and type 1–/type 2–like traits. Alcohol, 34, 133150. doi:10.1016/j.alcohol.2004.06.012CrossRefGoogle ScholarPubMed
Caspi, A., Roberts, B. W., & Shiner, R. L. (2005). Personality development: Stability and change. Annual Review of Psychology, 56, 453484. doi:10.1146/annurev.psych.55.090902.141913CrossRefGoogle ScholarPubMed
Cloninger, C. R. (1987). Neurogenetic adaptive mechanisms in alcoholism. Science, 236, 410416. doi:10.1126/science.2882604CrossRefGoogle ScholarPubMed
Colder, C. R., Shyhalla, K., & Frndak, S. E. (2018). Early alcohol use with parental permission: Psychosocial characteristics and drinking in late adolescence. Addictive Behaviors, 76, 8287. doi:10.1016/j.addbeh.2017.07.030CrossRefGoogle ScholarPubMed
Cyders, M. A., Smith, G. T., Spillane, N. S., Fischer, S., Annus, A. M., & Peterson, C. (2007). Integration of impulsivity and positive mood to predict risky behavior: development and validation of a measure of positive urgency. Psychological Assessment, 19, 107118. doi:10.1037/1040-3590.19.1.107CrossRefGoogle ScholarPubMed
Dawe, S., Loxton, N. J., Gullo, M. J., Staiger, P. K., Kambouropoulos, N., Perdon, L., & Wood, A. (2007). The role of impulsive personality traits in the initiation, development, and treatment of substance misuse problems. In Translation of addictions science into practice (pp. 321339). San Diego: Elsevier.CrossRefGoogle Scholar
Dawson, D. A. (2000). The link between family history and early onset alcoholism: Earlier initiation of drinking or more rapid development of dependence?. Journal of Studies on Alcohol, 61(5), 637646.CrossRefGoogle ScholarPubMed
DeWit, D. J., Adlaf, E. M., Offord, D. R., & Ogborne, A. C. (2000). Age at first alcohol use: a risk factor for the development of alcohol disorders. American Journal of Psychiatry, 157, 745750. doi:10.1176/appi.ajp.157.5.745CrossRefGoogle ScholarPubMed
Dom, G., Hulstijn, W., & Sabbe, B. G. C. C. (2006). Differences in impulsivity and sensation seeking between early-and late-onset alcoholics. Addictive Behaviors, 31, 298308. doi:10.1016/j.addbeh.2005.05.009CrossRefGoogle ScholarPubMed
Donovan, J. E. (2009). Estimated blood alcohol concentrations for child and adolescent drinking and their implications for screening instruments. Pediatrics, 123, e975e981. doi:10.1542/peds.2008-0027CrossRefGoogle ScholarPubMed
Donovan, J. E., & Molina, B. S. (2008). Children's introduction to alcohol use: sips and tastes. Alcoholism: Clinical and Experimental Research, 32, 108119. doi:10.1111/j.1530-0277.2007.00565.xCrossRefGoogle ScholarPubMed
Donovan, J. E., & Molina, B. S. (2011). Childhood risk factors for early-onset drinking. Journal of Studies on Alcohol and Drugs, 72, 741751. doi:10.15288/jsad.2011.72.741CrossRefGoogle ScholarPubMed
Donovan, J. E., & Molina, B. S. (2014). Antecedent predictors of children's initiation of sipping/tasting alcohol. Alcoholism: Clinical and Experimental Research, 38, 24882495. doi:10.1111/acer.12517CrossRefGoogle ScholarPubMed
Dvorak, R. D., Sargent, E. M., Kilwein, T. M., Stevenson, B. L., Kuvaas, N. J., & Williams, T. J. (2014). Alcohol use and alcohol-related consequences: Associations with emotion regulation difficulties. The American Journal of Drug and Alcohol Abuse, 40, 125–13. doi:10.3109/00952990.2013.877920CrossRefGoogle ScholarPubMed
Ellickson, P. L., Tucker, J. S., & Klein, D. J. (2003). Ten-year prospective study of public health problems associated with early drinking. Pediatrics, 111, 949955. doi:10.1542/peds.111.5.949CrossRefGoogle ScholarPubMed
Ellickson, S. L., Tucker, J. S., Klein, D. J., & McGuigan, K. A. (2001). Prospective risk factors for alcohol misuse in late adolescence. Journal of Studies on Alcohol, 62, 773782. doi:10.15288/jsa.2001.62.773CrossRefGoogle ScholarPubMed
Febrero-Bande, M., & de la Fuente, M. O. (2012). Statistical computing in functional data analysis: The R Package fda.usc. Journal of Statistical Software, 51, 128. doi:10.18637/jss.v051.i04CrossRefGoogle Scholar
Garavan, H., Bartsch, H., Conway, K., Decastro, A., Goldstein, R. Z., Heeringa, S., … Zahs, D. (2018). Recruiting the ABCD sample: design considerations and procedures. Developmental Cognitive Neuroscience, 32, 1622. doi:10.1016/j.dcn.2018.04.004CrossRefGoogle ScholarPubMed
Grant, B. F., Stinson, F. S., & Harford, T. C. (2001). Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: a 12-year follow-up. Journal of Substance Abuse, 13, 493504. doi:10.1016/S0899-3289(01)00096-7CrossRefGoogle ScholarPubMed
Gray, J. A. (1982). The neuropsychology of anxiety. New York: Oxford University Press.Google Scholar
Gunn, R. L., & Smith, G. T. (2010). Risk factors for elementary school drinking: Pubertal status, personality, and alcohol expectancies concurrently predict fifth grade alcohol consumption. Psychology of Addictive Behaviors, 24, 617627. doi:10.1037/a0020334CrossRefGoogle ScholarPubMed
Haeny, A. M., Gueorguieva, R., Morean, M. E., Krishnan-Sarin, S., DeMartini, K. S., Pearlson, G. D., … O'Malley, S. S. (2019). The Association of Impulsivity and Family History of Alcohol Use Disorder on Alcohol Use and Consequences. Alcoholism: Clinical and Experimental Research.Google ScholarPubMed
Harburg, E., Davis, D. R., & Caplan, R. (1982). Parent and offspring alcohol use: Imitative and aversive transmission. Journal of Studies on Alcohol, 43(5), 497516.CrossRefGoogle ScholarPubMed
Hundt, N. E., Kimbrel, N. A., Mitchell, J. T., & Nelson-Gray, R. O. (2008). High BAS, but not low BIS, predicts externalizing symptoms in adults. Personality and Individual Differences, 44, 565575. doi:10.1016/j.paid.2007.09.018CrossRefGoogle Scholar
Hussong, A. M., Jones, D. J., Stein, G. L., Baucom, D. H., & Boeding, S. (2011). An internalizing pathway to alcohol use and disorder. Psychology of Addictive Behaviors, 25, 390404. doi:10.1037/a0024519CrossRefGoogle ScholarPubMed
Jackson, K. M., Barnett, N. P., Colby, S. M., & Rogers, M. L. (2015). The prospective association between sipping alcohol by the sixth grade and later substance use. Journal of Studies on Alcohol and Drugs, 76(2), 212221.CrossRefGoogle ScholarPubMed
Jackson, K. M., Colby, S. M., Barnett, N. P., & Abar, C. C. (2015). Prevalence and correlates of sipping alcohol in a prospective middle school sample. Psychology of Addictive Behaviors, 29, 766778. doi:10.1037/adb0000072CrossRefGoogle Scholar
Jackson, C., Ennett, S. T., Dickinson, D. M., & Bowling, J. M. (2012). Letting children sip: Understanding why parents allow alcohol use by elementary school-aged children. Archives of Pediatrics & Adolescent Medicine, 166, 10531057. doi:10.1001/archpediatrics.2012.1198CrossRefGoogle ScholarPubMed
Jackson, C., Ennett, S. T., Dickinson, D. M., & Bowling, J. M. (2013). Attributes that differentiate children who sip alcohol from abstinent peers. Journal of Youth and Adolescence, 42, 16871695. doi:10.1007/s10964-012-9870-8CrossRefGoogle ScholarPubMed
Jernigan, T. L., & Brown, S. A., & ABCD consortium coordinators. (2018). Introduction. Developmental Cognitive Neuroscience, 32, 13. doi:10.1016/j.dcn.2018.02.002CrossRefGoogle ScholarPubMed
Johnson, S. L., Carver, C. S., & Joormann, J. (2013). Impulsive responses to emotion as a transdiagnostic vulnerability to internalizing and externalizing symptoms. Journal of Affective Disorders, 150(3), 872878.CrossRefGoogle ScholarPubMed
Kapur, S. (2003). Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry, 160, 1323. doi:10.1176/appi.ajp.160.1.13CrossRefGoogle Scholar
Karcher, N. R., Barch, D. M., Avenevoli, S., Savill, M., Huber, R. S., Simon, T. J., … & Loewy, R. L. (2018). Assessment of the Prodromal questionnaire–brief child version for measurement of self-reported psychoticlike experiences in childhood. JAMA Psychiatry, 75(8), 853861.CrossRefGoogle ScholarPubMed
King, K. M., & Chassin, L. (2007). A prospective study of the effects of age of initiation of alcohol and drug use on young adult substance dependence. Journal of Studies on Alcohol and Drugs, 68, 256265. doi:10.15288/jsad.2007.68.256CrossRefGoogle ScholarPubMed
King, S. M., Iacono, W. G., & McGue, M. (2004). Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Addiction, 99, 15481559. doi:10.1111/j.1360-0443.2004.00893.xCrossRefGoogle ScholarPubMed
Kobak, K. A., Kratochvil, C. J., Stanger, C., & Kaufman, J. (2013). Computerized screening of comorbidity in adolescents with substance or psychiatric disorders. Anxiety Disorders and Depression. (La Jolla, CA).Google Scholar
Koning, I. M., Harakeh, Z., Engels, R. C., & Vollebergh, W. A. (2010). A comparison of self-reported alcohol use measures by early adolescents: Questionnaires versus diary. Journal of Substance Use, 15, 166173. doi:10.3109/14659890903013091CrossRefGoogle Scholar
Lenth, R., Singmann, H., Love, J., Buerkner, P., & Herve, M. (2018). Emmeans: Estimated marginal means, aka least-squares means. 2018. R package version 1.4. Retrieved from https://cran.r-project.org/web/packages/emmeans/index.html.Google Scholar
Lisdahl, K. M., Sher, K. J., Conway, K. P., Gonzalez, R., Ewing, S. W. F., Nixon, S. J., … Heitzeg, M. (2018). Adolescent brain cognitive development (ABCD) study: Overview of substance use assessment methods. Developmental Cognitive Neuroscience, 32, 8096. doi:10.1016/j.dcn.2018.02.007CrossRefGoogle ScholarPubMed
Lisdahl, K. M., Tapert, S., Sher, K. J., Gonzalez, R., Nixon, S. J., Ewing, S. W. F., & Conway, K. P., & {ABCD Consortium Investigators} & Heitzeg, M. (in preparation). Substance use patterns in 9–10 year olds: Baseline findings from the Adolescent Brain Cognitive Development (ABCD) Study.Google Scholar
Loewy, R. L., Pearson, R., Vinogradov, S., Bearden, C. E., & Cannon, T. D. (2011). Psychosis risk screening with the Prodromal Questionnaire—brief version (PQ-B). Schizophrenia Research, 129, 4246. doi:10.1016/j.schres.2011.03.029CrossRefGoogle Scholar
Maggs, J. L., Staff, J., Patrick, M. E., & Wray-Lake, L. (2019). Very early drinking: Event history models predicting alcohol use initiation from age 4 to 11 years. Addictive Behaviors, 89, 121127. doi:10.1016/j.addbeh.2018.09.030CrossRefGoogle ScholarPubMed
Martel, M. M., Markon, K., & Smith, G. T. (2017). Research review: Multi-informant integration in child and adolescent psychopathology diagnosis. Journal of Child Psychology and Psychiatry, 58, 116128. doi:10.1111/jcpp.12611CrossRefGoogle ScholarPubMed
Marwaha, S., Broome, M. R., Bebbington, P. E., Kuipers, E., & Freeman, D. (2013). Mood instability and psychosis: Analyses of British national survey data. Schizophrenia Bulletin, 40, 269277. doi:10.1093/schbul/sbt149CrossRefGoogle ScholarPubMed
McGue, M., Iacono, W. G., Legrand, L., Malone, S., & Elkins, I. (2001). The origins of age at first drink: Associations with substance-use disorders, disinhibitory behavior and psychopathology, and P3 amplitude. Alcoholism: Clinical and Experimental Research, 25, 11561165. doi:10.1111/j.1530-0277.2001.tb02330.xCrossRefGoogle ScholarPubMed
Morean, M. E., Corbin, W. R., & Fromme, K. (2012). Age of first use and delay to first intoxication in relation to trajectories of heavy drinking and alcohol-related problems during emerging adulthood. Alcoholism: Clinical and Experimental Research, 36, 19911999. doi:10.1111/j.1530-0277.2012.01812.xCrossRefGoogle ScholarPubMed
Muthén, L. K., & Muthén, B. O. (1998–2017). Mplus user's guide (8th ed.). Los Angeles, CA: Muthén & Muthén.Google Scholar
Pagliaccio, D., Luking, K. R., Anokhin, A. P., Gotlib, I. H., Hayden, E. P., Olino, T. M., … Barch, D. M. (2016). Revising the BIS/BAS Scale to study development: Measurement invariance and normative effects of age and sex from childhood through adulthood. Psychological Assessment, 28, 429442. doi:10.1037/pas0000186CrossRefGoogle ScholarPubMed
R Core Team. (2018). R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. https://www.R-project.org/.Google Scholar
Rice, J. P., Reich, T., Bucholz, K. K., Neuman, R. J., Fishman, R., Rochberg, N., … Begleiter, H. (1995). Comparison of direct interview and family history diagnoses of alcohol dependence. Alcoholism: Clinical and Experimental Research, 19, 10181023. doi:10.1111/j.1530-0277.1995.tb00983.xCrossRefGoogle ScholarPubMed
Rubio, G., Jiménez, M., Rodríguez-Jiménez, R., Martínez, I., Ávila, C., Ferre, F., … Palomo, T. (2008). The role of behavioral impulsivity in the development of alcohol dependence: A 4-year follow-up study. Alcoholism: Clinical and Experimental Research, 32, 16811687. doi:10.1111/j.1530-0277.2008.00746.xCrossRefGoogle ScholarPubMed
Segarra, P., Poy, R., López, R., & Moltó, J. (2014). Characterizing Carver and White's BIS/BAS subscales using the five factor model of personality. Personality and Individual Differences, 61, 1823. doi:10.1016/j.paid.2013.12.027CrossRefGoogle Scholar
Sher, K. J., Grekin, E. R., & Williams, N. A. (2005). The development of alcohol use disorders. Annual Review in Clinical Psychology, 1, 493523. doi:10.1146/annurev.clinpsy.1.102803.144107CrossRefGoogle ScholarPubMed
Sher, K. J., Littlefield, A., & Lee, M. (2018). Personality processes related to the development and resolution of alcohol use disorders. In Fitzgerald, H. E. & Puttler, L. I. (Eds.), Alcohol use disorders: A developmental science approach to etiology (pp. 285304). New York, NY: Oxford University Press.Google Scholar
Sher, K. J., Trull, T. J., Barthoolow, B. D., & Vieth, A. (1999). Personality and alcoholism: Issues, methods, and etiological processes. In Leonard, K. E. & Blane, H. T. (Eds.), Psychological theories of drinking and alcoholism (2nd ed.) (pp. 54105). New York, NY: Guilford Press.Google Scholar
Spear, L. P. (2002). The adolescent brain and the college drinker: Biological basis of propensity to use and misuse alcohol. Journal of Studies on Alcohol (Suppl. 14), 7181.CrossRefGoogle ScholarPubMed
Stautz, K., & Cooper, A. (2013). Impulsivity-related personality traits and adolescent alcohol use: A meta-analytic review. Clinical Psychology Review, 33, 574592. doi:10.1016/j.cpr.2013.03.003CrossRefGoogle ScholarPubMed
Steiger, J. H. (1980). Tests for comparing elements of a correlation matrix. Psychological Bulletin, 87, 245251. doi:10.1037/0033-2909.87.2.245CrossRefGoogle Scholar
Stueve, A., & O'Donnell, L. N. (2005). Early alcohol initiation and subsequent sexual and alcohol risk behaviors among urban youths. American Journal of Public Health, 95, 887893. doi:10.2105/AJPH.2003.026567CrossRefGoogle ScholarPubMed
Tael-Öeren, M., Naughton, F., & Sutton, S. (2019). The relationship between parental attitudes and children's alcohol use: A systematic review and meta-analysis. Addiction, 114, 15271546. doi:10.1111/add.14615CrossRefGoogle ScholarPubMed
Townsend, L., Kobak, K., Kearney, C., Milham, M., Andreotti, C., Escalera, J., … & Rice, D. (2020). Development of three web-based computerized versions of the Kiddie Schedule for Affective Disorders and Schizophrenia child psychiatric diagnostic interview: Preliminary validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 59(2), 309325.CrossRefGoogle ScholarPubMed
Trucco, E. M., Colder, C. R., & Wieczorek, W. F. (2011). Vulnerability to peer influence: A moderated mediation study of early adolescent alcohol use initiation. Addictive Behaviors, 36, 729736. doi:10.1016/j.addbeh.2011.02.008CrossRefGoogle ScholarPubMed
Trull, T. J., & Sher, K. J. (1994). Relationship between the five-factor model of personality and Axis I disorders in a nonclinical sample. Journal of Abnormal Psychology, 103, 350360. doi:10.1037/0021-843X.103.2.350CrossRefGoogle Scholar
Tully, E. C., & Iacono, W. G. (2016). An integrative common liabilities model for the comorbidity of substance use disorders with externalizing and internalizing disorders. In Sher, K. J. (Ed.), The Oxford handbook of substance use and substance use disorders: Volume 2 (pp. 187214). New York: Oxford University Press.Google Scholar
Verdejo-García, A., Lawrence, A. J., & Clark, L. (2008). Impulsivity as a vulnerability marker for substance-use disorders: Review of findings from high-risk research, problem gamblers and genetic association studies. Neuroscience & Biobehavioral Reviews, 32(4), 777810.CrossRefGoogle ScholarPubMed
Warner, L. A., & White, H. R. (2003). Longitudinal effects of age at onset and first drinking situations on problem drinking. Substance Use & Misuse, 38(14), 19832016.CrossRefGoogle ScholarPubMed
Wadolowski, M., Hutchinson, D., Bruno, R., Aiken, A., Clare, P., Slade, T., … Mattick, R. P. (2015). Early adolescent alcohol use: are sipping and drinking distinct? Alcoholism: Clinical and Experimental Research, 39, 18051813. doi:10.1111/acer.12826CrossRefGoogle ScholarPubMed
Watts, A. L., Smith, G. T., Barch, D. M., & Sher, K. J. (2020). Factor structure, measurement and structural invariance, and external validity of an abbreviated youth version of the UPPS-P Impulsive Behavior Scale. Psychological Assessment, 32, 336347.CrossRefGoogle ScholarPubMed
Wood, S. N. & Scheipl, F. (2017). gamm4: Generalized additive mixed models using mgcv and lme4. R package version 0.2. Retrieved from http://cran.r-project.org/package=gamm4.Google Scholar
Young, S. E., Corley, R. P., Stallings, M. C., Rhee, S. H., Crowley, T. J., & Hewitt, J. K. (2002). Substance use, abuse and dependence in adolescence: Prevalence, symptom profiles and correlates. Drug and Alcohol Dependence, 68, 309322.CrossRefGoogle ScholarPubMed
Youngstrom, E. A., Findling, R. L., Danielson, C. K., & Calabrese, J. R. (2001). Discriminative validity of parent report of hypomanic and depressive symptoms on the General Behavior Inventory. Psychological Assessment, 13, 267276. doi:10.1037/1040-3590.13.2.267CrossRefGoogle ScholarPubMed
Youngstrom, E. A., Frazier, T. W., Demeter, C., Calabrese, J. R., & Findling, R. L. (2008). Developing a ten item mania scale from the parent general behavior inventory for children and adolescents. The Journal of Clinical Psychiatry, 69, 831839. doi:10.4088/JCP.v69n0517CrossRefGoogle Scholar
Supplementary material: File

Watts et al. supplementary material

Tables S1-S9

Download Watts et al. supplementary material(File)
File 114.7 KB