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Background. There are inconclusive findings regarding whether danger and loss events differentially predict the onset of anxiety and depression. Method. A community sample of adolescents and young adults (n=2304, age 14–24 years at baseline) was prospectively followed up in up to four assessments over 10 years. Incident anxiety and depressive disorders were assessed at each wave using the DSM-IV/M-CIDI. Life events (including danger, loss and respectively mixed events) were assessed at baseline using the Munich Event List (MEL). Logistic regressions were used to reveal associations between event types at baseline and incident disorders at follow-up. Results. Loss events merely predicted incident ‘pure’ depression [odds ratio (OR) 2.4 per standard deviation, 95% confidence interval (CI) 1.5–3.9, p<0.001] whereas danger events predicted incident ‘pure’ anxiety (OR 2.3, 95% CI 1.1–4.6, p=0.023) and ‘pure’ depression (OR 2.5, 95% CI 1.7–3.5, p<0.001). Mixed events predicted incident ‘pure’ anxiety (OR 2.9, 95% CI 1.5–5.7, p=0.002), ‘pure’ depression (OR 2.4, 95% CI 1.6–3.4, p<0.001) and their co-morbidity (OR 3.6, 95% CI 1.8–7.0, p<0.001). Conclusions. Our results provide further evidence for differential effects of danger, loss and respectively mixed events on incident anxiety, depression and their co-morbidity. Since most loss events referred to death/separation from significant others, particularly interpersonal loss appears to be highly specific in predicting depression.

Background: For optimizing the validity of diagnoses of mental disorders, several sources of information should be used to assess psychopathological symptoms. Among these are relatives of patients with mental illness. The very low number of empirical studies examining the assessment of psychopathology by relatives of adult, nondemented mentally ill patients stands in significant contrast to the clinical importance of this source of information, however. Sampling and Methods: Using the Positive and Negative Syndrome Scale (PANSS), researchers asked 163 relatives of patients with the main clinical ICD-10 diagnosis of schizophrenic, recurrent depressive or bipolar disorders to rate the current symptoms of the patients at the time of outpatient community-oriented treatment. Results: On average, severity of symptoms was rated as absent or minimal, although anxiety, depression and passive/apathetic social as well as emotional withdrawal, motor retardation, poor attention, and disturbance of volition were clearly rated above the PANSS mean total score for all patients. A six-factor structure identified by factor analysis better illustrates the significant differences in the assessments of the three main diagnostic groups than the three established PANSS scales. With the exception of ‘problematic social behavior’, differences among the diagnostic groups appeared in all factors and were particularly pronounced for ‘delusional beliefs’ and ‘motor impairments’. Conclusions: The results of this study showed that the use of standardized instruments such as PANSS for the assessment of psychopathology by relatives is not only practical, but produces adequately reliable results. The use of PANSS for this purpose, however, requires interviewing of relatives by trained experts able to explain technical terms. Because this study did not sufficiently explore the validity of this approach, further research on this specific issue is urgently needed and should, for example, assess the concordance of ratings between professionals and relatives as well as correlation with suitable external criteria. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

We examined parental psychopathology and family environment in subthreshold and DSM-IV threshold conditions of social anxiety disorder (SAD) in a representative cohort sample of 1,395 adolescents. Offspring and parental psychopathology was assessed using the DIAX/ M-CIDI; recalled parental rearing and family functioning via questionnaire. Diagnostic interviews in parents were supplemented by family history reports from offspring. The cumulative lifetime incidence was 23.07% for symptomatic SAD, and 18.38 and 7.41% for subthreshold and threshold SAD, respectively. The specific parent-tooffspring association for SAD occurred for threshold SAD only. For subthreshold and threshold SAD similar associations were found with other parental anxiety disorders, depression and substance use disorders. Parental rearing behaviour, but not family functioning, was associated with offspring threshold SAD, and although less strong and less consistent, also with subthreshold SAD. Results suggest a continued graded relationship between familial risk factors and offspring SAD. Parental psychopathology and negative parental styles may be used defining high-risk groups to assign individuals with already subthreshold conditions of SAD to early intervention programs.

Parental psychopathology and unfavorable family environment are established risk factors for onset of offspring social phobia (SP), but their associations with the further course, e.g., persistence of the disorder, remain understudied. A community cohort of 1395 adolescents and their parents was followed-up over almost 10 years using the DIA-X/M-CIDI. Parental diagnostic interviews were supplemented by family history data. Parental rearing was retrospectively assessed by the Questionnaire of Recalled Parental Rearing Behavior in offspring, and family functioning by the Family Assessment Device in parents. Persistence measures (proportion of years affected since onset) were derived from diagnostic interviews, using age of onset, age of recency, and course information. Lack of emotional warmth and dysfunctional family functioning characteristics were associated with higher SP persistence, particularly in interaction with parental psychopathology. Predictors for SP persistence differ from those predicting SP onset. Unfavorable family environment alone and in interaction with parental disorders predict higher SP persistence.

Le projet de thèse porte sur la consommation de substances psychoactives chez les adolescents et le lien séquentiel entre la consommation de drogues, la performance cognitive, et la santé mentale des jeunes. Les objectifs de la thèse sont : 1) de tester la relation entre la prise de cannabis, ou d’alcool, et la performance cognitive, et d’en observer la séquence, 2) de vérifier si la relation entre la consommation et la performance cognitive permet, en partie, de comprendre l’apparition de symptômes de psychopathologie chez les jeunes, et 3) de définir les pratiques les mieux fondées empiriquement pour prévenir la consommation de substances chez les adolescents. Le premier chapitre de la thèse évalue la relation et la séquence entre les habitudes de consommation d’environ 4000 jeunes de la région métropolitaine de Montréal (Qc, Canada) et la trajectoire de leur développement cognitif sur une période de quatre ans. Dans un deuxième chapitre, la thèse évalue comment la relation entre la consommation et la performance cognitive de ces mêmes jeunes peut expliquer, sur une période de cinq ans, une partie de la relation observée entre la consommation et l’apparition de symptômes de psychopathologie. Dans un dernier chapitre, la thèse fait la revue des données portant sur trois types d’interventions préventives afin d’identifier comment la recherche empirique peut bonifier les efforts de prévention de la toxicomanie chez les adolescents. Les données ont été extraites d’une cohorte d’adolescents issus de la population générale, suivis longitudinalement, dans le cadre de l’étude Co-Venture (n = 3826, âgés de 12 ans à l’admission dans l’étude, suivis annuellement pendant 5 ans). Les résultats ont démontré que, bien que certains facteurs semblent prédisposer un sous-groupe de jeunes à une consommation hâtive ainsi que des difficultés neuropsychologiques, la consommation de drogues, notamment de cannabis, semble liée, de façon à la fois ponctuelle et durable, à un délai du développement cognitif, plus particulièrement des fonctions exécutives. Cette association avec le cannabis semble, en faible partie, jouer un rôle médiateur dans la relation qui unit cette consommation et l’émergence de symptômes de psychopathologie chez les adolescents. Toutefois, des facteurs prédisposants semblent contribuer à l’association entre ces trois variables. Bien que la recherche identifie que plusieurs programmes de prévention peuvent être efficaces, la majorité d’entre eux présentent des effets modestes et ponctuels. Les programmes les plus probants semblent s’inscrire dans le registre des approches de prévention ciblées. Pour bonifier nos méthodes de prévention de la toxicomanie chez les adolescents, nous pourrions tenir compte de certains facteurs prédisposants et les utiliser comme cible d’intervention; par exemple, le fonctionnement cognitif basal pourrait constituer une piste intéressante. De plus, le tempérament ou la personnalité semblent mieux établis pour prévenir la consommation de façon durable et pour aborder les enjeux cognitifs et psychologiques associés à la consommation abusive de substances. Mots-clés : Alcool, cannabis, adolescence, fonctions cognitives, symptômes de psychopathologie, devis longitudinaux, médiation, prévention / This thesis project addresses adolescents’ substance misuse and the sequential link between drug use, cognitive performance, and mental health outcomes in youth. The objectives of this thesis are: 1) to test the relation and sequence between cannabis or alcohol use and cognitive outcomes, 2) to verify if the relation between substance use and cognitive outcomes could help understand, in part, why young substance users report psychopathology symptoms, and 3) to review evidence-based interventions to prevent adolescent substance misuse and to assess what contribution could stem from the collected empirical data. The first chapter of this thesis assesses the relation and sequence between substance use behaviour of nearly 4000 youth from the Montreal metropolitan area (QC, Canada) and their cognitive development over four years. In a second chapter, this thesis analyzes how the association between substance use and cognitive outcomes could partially explain, over five years, the link observed between substance use and the appearance of psychopathology symptoms. In a final chapter, this thesis reviews data surrounding three types of preventative interventions to identify how empirical research could improve addiction prevention strategies. The data was extracted from a group of adolescents issued from the general population followed longitudinally in the scope of the Co-Venture study (n = 3826, from 12 years of age upon admission to the study, followed up annually for a period of five years). The results demonstrated that, although certain factors seem to predispose a sub-group of young people to early consumption and neuropsychological difficulties, drug consumption, especially cannabis consumption, seem to reliably predict a delay in the development of cognitive faculties, particularly the executive functions of the brain. This association with cannabis appears, to a small extent, to partially mediate the link already observed between said consumption and the emergence of psychopathology symptoms in adolescents. Still, predisposing factors seem to contribute to the association between these three variables. Although research would appear to show that several prevention strategies could be effective, most of them present modest and punctual results. The best-substantiated programs appeared to be those that adhered to a targeted prevention approach. To improve our methods of substance use prevention, one could take predisposing factors into account and use them to inform specialized intervention. Baseline cognitive functioning could constitute a particularly promising avenue. All the same, certain predisposing factors such as temperament or personality seem better equipped to prevent early-onset substance misuse and to address the psychological and cognitive issues associated with adolescent substance intake. To improve addiction prevention methods in adolescents, one could factor into account predisposing factors and use them to inform specialized intervention; for example, baseline cognitive functioning could constitute a promising avenue. In addition, temperament or personality traits seem better established to prevent early-onset substance use and to address the psychological and cognitive issues associated with adolescents’ substance misuse. Key words: Alcohol, cannabis, adolescence, cognitive functions, psychopathology symptoms, longitudinal data, mediation, prevention

Les intoxications médicamenteuses volontaires répétées (IMVr) constituent un problème de santé publique croissant, mais sous-évalué et traité comme une conduite suicidaire, alors qu’elles appartiendraient au registre des addictions. Notre travail abonde dans ce sens en montrant que les suicides alcoolisés se font principalement par IMV et correspondent au deliberate self-harm syndrom ; les suicidants récidivants se distinguent par un névrosisme et un attachement anxieux typiques des addictions ; les IMVr même suicidaires témoignent d’une relation addictive aux médicaments ; le facteur le plus prédictif d’IMV serait de l’avoir envisagée. Conceptualisé de façon translationnelle et argumenté par une approche pharmacologique, nous proposons un modèle dimensionnel des conduites suicidaires, intégré au continuum des addictions, confirmant l’hypothèse initiale et l’intérêt d’un raisonnement transnosographique diagnostique et thérapeutique dans le champ des pathologies mentales. / Repeated Self-poisoning (RSP) constitute an under evaluated but growing public health problem, treated as a suicidal rather than an addictive behavior. Our work brings arguments by showing that suicides involving alcohol are mainly by self-poisoning and correspond to deliberate self-harm syndrome; repeat suicide attempters are identified by a neuroticism and anxious attachment typically found in addicts; even suicidal RSP shows addictive behavior involving medicines; the best predictor of self-poisoning is having thought about it. Conceptualized through a translational approach and supported by pharmacological arguments, we propose a multidimensional model of suicidal behaviors, that could integrate the continuum of addictive behaviors. This confirms the initial hypothesis and the viability of a transnosographic concept for diagnosis and treatment of mental illnesses.

Background. To examine the role of parental psychopathology and family environment for the risk of social anxiety disorder (SAD) in offspring from childhood to early adulthood, covering an observational period of 10 years. Method. A community sample of 1,395 adolescents (aged 14 to 17 years at baseline) was prospectively followed-up over the core high risk period for SAD onset. DSM-IV offspring and parental psychopathology was assessed using the Munich-Composite International Diagnostic Interview; direct diagnostic interviews in parents were supplemented by family history reports from offspring. Parental rearing was assessed by the Questionnaire of Recalled Rearing Behavior in offspring, family functioning by the McMaster Family Assessment Device in parents. Results. Parental SAD was associated with the offspring’s risk to develop SAD (OR = 3.3, 95%CI: 1.4-8.0). Additionally, other parental anxiety disorders (OR = 2.9, 95%CI: 1.4-6.1), depression (OR = 2.6, 95%CI: 1.2-5.4) and alcohol use disorders (OR = 2.8, 95%CI: 1.3-6.1) were associated with offspring SAD. Offspring’s reports of parental overprotection, rejection and lack of emotional warmth, but not parental reports of family functioning were associated with offspring SAD. Analyses of interaction of parental psychopathology and parental rearing indicated combined effects on the risk for offspring SAD. Conclusions. These findings extend previous results in showing that both parental psychopathology and parental rearing are consistently associated with the risk for offspring SAD. As independent and interactive effects of parental psychopathology and parental rearing may have already manifested in early adolescence, these factors appear crucial and promising for targeted prevention programs.

La présente recherche s'intéresse à l'adaptation d’adolescents vivant avec un parent ayant un trouble mental. Un premier objectif poursuivi était d’explorer les impacts positifs et négatifs reliés au fait de vivre dans ce contexte familial. Le second objectif visait à examiner les stratégies adaptatives utilisées par ces adolescents et leur perception quant à leur efficacité. La méthode qualitative a été choisie afin d’atteindre ces objectifs et s’inscrit dans le cadre de la théorie transactionnelle du stress de Lazarus et Folkman. Cinq adolescents ont été rencontrés en entrevue individuelle semi-structurée. Ils ont aussi rempli un questionnaire, le Kidcope, portant sur les stratégies d’adaptation. Les thèmes abordés en entrevue portaient sur leur fonctionnement aux plans personnel, social, scolaire et familial, sur le trouble mental de leur parent et leur perception des impacts sur leur vie. De plus, ils se sont exprimés quant aux apprentissages qu'ils retirent de leur expérience. / This research focuses on adolescents' adaptation when living with a parent who has mental illness. A first objective was to explore the positive and negative impacts of living with parental mental illness. A second objective was to examine their coping skills as well as their perception of the efficiency of theses coping skills. Qualitative method has been chosen to pursue these goals and relies on Lazarus and Folkman transactional stress theory. Five adolescents have been met in a semi-structured interview. They also filled a questionnaire on coping skills, the Kidcope. The themes were the social, scholar and familial functioning of these adolescents. They also discussed the parental mental illness, their perception of the impacts on their life and the learning they did through their experience.