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Longitudinal associations between childhood and adulthood externalizing and internalizing psychopathology and adolescent substance use

  • J. Miettunen (a1) (a2), G. K. Murray (a3) (a4), P. B. Jones (a3), P. Mäki (a1) (a2), H. Ebeling (a5), A. Taanila (a6) (a7), M. Joukamaa (a8) (a9), J. Savolainen (a10), S. Törmänen (a1), M.-R. Järvelin (a6) (a7) (a11) (a12) (a13), J. Veijola (a1) (a2) and I. Moilanen (a5)...

Emotional and behavioral problems are commonly associated with substance use in adolescence but it is unclear whether substance use precedes or follows mental health problems. The aim was to investigate longitudinal associations between externalizing and internalizing psychopathology and substance use in a prospective population study design.


The sample was the Northern Finland Birth Cohort 1986 Study (NFBC 1986; n = 6349; 3103 males). Externalizing and internalizing mental health problems were assessed at age 8 years (Rutter scales), substance use and externalizing and internalizing problems [Youth Self-Report (YSR)] at age 15–16 years, and hospital diagnoses for internalizing disorders (age 25) and criminal offences (age 20) from nationwide registers in adulthood.


Externalizing problems at age 8 were associated with later substance use. After adjustment for sociodemographic factors, parental alcohol use and psychiatric disorders, and earlier externalizing and internalizing problems, substance use predicted criminality, especially among males, with the highest odds ratio (OR) for cannabis use [adjusted OR 6.2, 95% confidence interval (CI) 3.1–12.7]. Early internalizing problems were not a risk for later substance use. Female adolescent cannabis (OR 3.2, 95% CI 1.4–7.3) and alcohol (OR 2.1, 95% CI 1.1–4.2) use predicted internalizing disorders in adulthood.


Externalizing problems precede adolescent substance use in both genders, whereas, among boys, substance use also precedes criminal offences. Internalizing problems may follow substance use in females. These associations were robust even when taking into account previous mental health problems.

Corresponding author
* Address for correspondence: Adjunct Professor J. Miettunen, Department of Psychiatry, PO Box 5000, 90014 University of Oulu, Finland. (Email:
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AchenbachTM (1991). Manual for the ASEBA School-Age Forms and Profiles. University of Vermont, Research Center for Children, Youth and Families: Burlington, VT.
AchenbachTM, RescorlaLA (2001). Manual for the ASEBA School-Age Forms and Profiles. University of Vermont, Research Center for Children, Youth and Families: Burlington, VT.
BovassoGB (2001). Cannabis abuse as a risk factor for depressive symptoms. American Journal of Psychiatry 158, 20332037.
BrookDW, BrookJS, ZhangC, CohenP, WhitemanM (2002). Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders. Archives of General Psychiatry 59, 10391044.
ChinetL, PlancherelB, BologniniM, BernardM, LagetJ, DanieleG, HalfonO (2006). Substance use and depression. Comparative course in adolescents. European Child and Adolescent Psychiatry 15, 149155.
ColderCR, ScalcoM, TruccoEM, ReadJP, LenguaLJ, WieczorekWF, HawkLWJ (2013). Prospective associations of internalizing and externalizing problems and their co-occurrence with early adolescent substance use. Journal of Abnormal Child Psychology 41, 667677.
CostelloEJ, ErkanliA, FedermanE, AngoldA (1999). Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex. Journal of Clinical Child Psychology 28, 298311.
DegenhardtL, HallW, LynskeyM (2001). Alcohol, cannabis and tobacco use among Australians: a comparison of their associations with other drug use and use disorders, affective and anxiety disorders, and psychosis. Addiction 96, 16031614.
ElanderJ, RutterM (1996). Use and development of the Rutter Parents' and Teachers' Scales. International Journal of Methods in Psychiatric Research 6, 6378.
FergussonDM, BodenJM, HorwoodLJ (2011). Structural models of the comorbidity of internalizing disorders and substance use disorders in a longitudinal birth cohort. Social Psychiatry and Psychiatric Epidemiology 46, 933942.
GrieslerPC, HuMC, SchaffranC, KandelDB (2008). Comorbidity of psychiatric disorders and nicotine dependence among adolescents: findings from a prospective, longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry 47, 13401350.
Griffith-LenderingMF, HuijbregtsSC, MooijaartA, VolleberghWA, SwaabH (2011). Cannabis use and development of externalizing and internalizing behaviour problems in early adolescence: a TRAILS study. Drug and Alcohol Dependence 116, 1117.
GudjonssonGH, SigurdssonJF, SigfusdottirID, YoungS (2012). A national epidemiological study of offending and its relationship with ADHD symptoms and associated risk factors. Journal of Attention Disorders. Published online: 20 04 2012 . doi:10.1177/1087054712437584.
HaukoosJS, NewgardCD (2007). Advanced statistics: missing data in clinical research – Part 1: An introduction and conceptual framework. Academic Emergency Medicine 14, 662668.
HayatbakhshMR, McGeeTR, BorW, NajmanJM, JamrozikK, MamunAA (2008). Child and adolescent externalizing behavior and cannabis use disorders in early adulthood: an Australian prospective birth cohort study. Addictive Behaviors 33, 422438.
HelsteläL, SouranderA (2001). Self-reported competence and emotional and behavioral problems in a sample of Finnish adolescents. Nordic Journal of Psychiatry 55, 381385.
HodginsS, LarmP, Molero-SamulesonY, TengströmA, LarssonA (2009). Multiple adverse outcomes over 30 years following adolescent substance misuse treatment. Acta Psychiatrica Scandinavica 119, 484493.
HovensJG, GiltayEJ, WiersmaJE, SpinhovenP, PenninxBW, ZitmanFG (2012). Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Acta Psychiatrica Scandinavica 126, 198207.
KeränenH, MalinenP, AulaskariO (2001). The Effect of Consolidations of Municipalities in 2001 to Rural Area Classification [in Finnish]. University of Oulu, Research and Development Centre of Kajaani and Finnish Regional Research FAR Memorandum 13.2.2001.
KingSM, IaconoWG, McGueM (2004). Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Addiction 99, 15481559.
KorhonenT, van LeeuwenAP, ReijneveldSA, OrmelJ, VerhulstFC, HuizinkAC (2010). Externalizing behavior problems and cigarette smoking as predictors of cannabis use: the TRAILS Study. Journal of the American Academy of Child and Adolescent Psychiatry 49, 6169.
KresanovK, TuominenJ, PihaJ, AlmqvistF (1998). Validity of child psychiatric screening methods. European Child and Adolescent Psychiatry 7, 8595.
MaggsJL, PatrickME, FeinsteinL (2008). Childhood and adolescent predictors of alcohol use and problems in adolescence and adulthood in the National Child Development Study. Addiction 103 (Suppl. 1), 722.
MarmorsteinNR, IaconoWG (2011). Explaining associations between cannabis use disorders in adolescence and later major depression: a test of the psychosocial failure model. Addictive Behaviors 36, 773776.
MiettunenJ, TörmänenS, MurrayGK, JonesPB, MäkiP, EbelingH, MoilanenI, TaanilaA, HeinimaaM, JoukamaaM, VeijolaJ (2008). Association of cannabis use with prodromal symptoms of psychosis in adolescence. British Journal of Psychiatry 192, 470471.
MonshouwerK, van DorsselaerS, VerdurmenJ, BogtTT, de GraafR, VolleberghW (2006). Cannabis use and mental health in secondary school children. Findings from a Dutch survey. British Journal of Psychiatry 188, 148153.
MooreTH, ZammitS, Lingford-HughesA, BarnesTR, JonesPB, BurkeM, LewisG (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet 370, 319328.
NiemeläS, SouranderA, ElonheimoH, PoikolainenK, WuP, HeleniusH, PihaJ, KumpulainenK, MoilanenI, TamminenT, AlmqvistF (2008). What predicts illicit drug use versus police-registered drug offending? Findings from the Finnish ‘From a Boy to a Man’ birth cohort study. Social Psychiatry and Psychiatric Epidemiology 43, 697704.
PattonGC, CoffeyC, CarlinJB, DegenhardtL, LynskeyM, HallW (2002). Cannabis use and mental health in young people: cohort study. British Medical Journal 325, 11951198.
ReefJ, DiamantopoulouS, van MeursI, VerhulstFC, van der EndeJ (2012). Developmental trajectories of child to adolescent externalizing behavior and adult DSM-IV disorder: results of a 24-year longitudinal study. Social Psychiatry and Psychiatric Epidemiology 46, 12331241.
RutterM (1967). A children's behaviour questionnaire for completion by teachers: preliminary findings. Journal of Child Psychology and Psychiatry 8, 111.
SchiffmanRF (2004). Drug and substance use in adolescents. MCN. The American Journal of Maternal Child Nursing 29, 2127.
StoltzS, van LondenM, DekovicM, de CastroBO, PrinzieP, LochmanJE (2012). Effectiveness of an individual school-based intervention for children with aggressive behaviour: a randomized controlled trial. Behavioural and Cognitive Psychotherapy. Published online: 12 07 2012 . doi:10.1017/S1352465812000525.
ThorntonLK, BakerAL, JohnsonMP, LewinTJ (2012). Attitudes and perceptions towards substances among people with mental disorders: a systematic review. Acta Psychiatrica Scandinavica 126, 87105.
WittchenHU, FröhlichC, BehrendtS, GüntherA, RehmJ, ZimmermannP, LiebR, PerkoniggA (2007). Cannabis use and cannabis use disorders and their relationship to mental disorders: a 10-year prospective-longitudinal community study in adolescents. Drug and Alcohol Dependence 88 (Suppl. 1), S60S70.
YoungS, WellsJ, GudjonssonGH (2011). Predictors of offending among prisoners: the role of attention-deficit hyperactivity disorder and substance use. Journal of Psychopharmacology 25, 15241532.
Zahn-WaxlerC, ShirtcliffEA, MarceauK (2008). Disorders of childhood and adolescence: gender and psychopathology. Annual Review of Clinical Psychology 4, 275303.
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Psychological Medicine
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