Using data from a longitudinal community study, this article describes the association between depressive symptoms in children (10–13 years old) and subsequent onset of alcohol use. Strengths of this study are its longitudinal nature and the young age of the sample at baseline, most of whom were alcohol naïve at that time, making possible this investigation of the impact of depressive symptoms on the onset of alcohol use. In addition, the study collected information on a wide range of risk factors for child psychopathology and substance use, thus allowing for a relatively precise assessment of the relationship between depressive symptoms and onset of alcohol use in children, adjusting for potentially confounding factors. Consistently, with 2 previous longitudinal studies,38,39
our study also found positive associations between depressive symptoms and initiation of alcohol use in childhood and adolescence. Our analyses, however, represent a further step toward a true understanding of this relationship, because we were able to take into account many of the risk and protective factors that may be related to both depression and alcohol use.
Our results indicate that adolescent depression and alcohol use do share some risk and protective factors, such as parental psychopathology, parenting styles, child exposure to violence, and child antisocial behavior. Most of these associations had already been reported in the literature.8,50,52–55,57–59,61–63
The relationship between depressive symptoms and alcohol use can be partially explained by these factors. When these factors were controlled for, the magnitude of the relationship between early depressive symptoms and subsequent onset of alcohol use was reduced.
In multivariate analyses, the relationship between early depressive symptoms and subsequent alcohol use remained significant after we adjusted for an array of potentially confounding factors. This finding is similar to those of previous studies of adults15,78,79
as well as youth.31,39,80
Because the association was still significant after controlling for many of the risk factors that are associated with both alcohol use and depressive symptoms, it is quite robust. In addition, child age, child sensation seeking, antisocial behaviors, and parental college education were also predictive of child alcohol use. The effects of parental psychopathology, parental monitoring, physical abuse, and exposure to violence were no longer significant here. Further analyses found that the relationship between parental psychopathology and child alcohol use became nonsignificant when child depressive symptoms were controlled for, indicating the possibility that the impact of parental psychopathology on child alcohol use was mediated by depression in the child.
Previous studies have shown that early onset of alcohol use is related to the development of alcohol abuse/dependence and other substance use problems.4–6,10
For example, an analysis of data from the National Longitudinal Alcohol Epidemiologic Survey found that individuals who had initiated drinking before the age of 15 years were more than twice as likely to be alcohol dependent at some time in their lives compared with those who began drinking at age 18 years and 4 times as likely to become dependent as those beginning drinking at age 21 years.10
A longitudinal study by Ellickson et al4
found that adolescents who had initiated alcohol use by grade 7 were much more likely to have multiple substance use problems by grade 12 compared with grade 7 nondrinkers.
The finding of the current study that early life depressive symptoms may lead to early onset of alcohol use indicates the importance of identifying and treating depressive symptoms in preadolescent children. Based on these results, future studies should examine the benefits of stimulating the use of coping strategies that do not involve substance use or abuse, particularly in children demonstrating early signs of depression, as a way of staving off alcohol abuse and dependence at a later stage.
Our results also indicate the importance of understanding the potential role of shared risk factors in the development of both depression and alcohol use. Community programs to improve parenting skills or reduce neighborhood violence may ultimately help in preventing depression, as well as alcohol use, in children. Programs aimed at preventing alcohol use in children should take depressive and other internalizing disorder symptoms into account.
This study is limited by the relatively short follow-up period, after which the only alcohol-related outcome measure that could be assessed was onset of alcohol use, rather than other more severe alcohol-related behaviors, such as alcohol use disorder or relapse to drinking after a period of abstinence. Another limitation of the study is the fact that the children in this study were all of Puerto Rican background. Caution should be used when generalizing the findings to other ethnic groups. Studies in other populations are needed to assess whether these findings apply to other groups.