Adolescents With Substance Abuse Problems in Outpatient Treatment: A One-year Prospective Follow-up Study Focusing on Mental Health Problems and Gender Differences

Abstract Background: Although several studies have found a high incidence of coexisting mental health problems among adolescents with substance abuse problems, follow-up studies addressing how these conditions change over time are rare. The study will describe and analyze indications of mental health problems and how various risk factors predict outcomes one year after initial treatment contact. In addition, gender-specific risk factors are explored. Methods: A clinical sample of 455 adolescents (29% girls, median age 17 years) answered a structural interview at baseline and followed-up using official records one year after initiated treatment. Bivariate associations and logistic regressions were conducted to analyse the links between risk factors at the individual, social, and structural levels as well as links between various mental illness symptoms at treatment start and indications of mental health problems one year later were analysed. Results: The results show that mental health problems among adolescents largely persisted one year after start of outpatient care for substance abuse problems. Forty-two per cent of the sample displayed indications of mental health problems at one-year follow-up, and registrations for both outpatient treatment and psychiatric medication were more common among the girls. Girls also reported more mental illness symptoms at treatment start than boys did. Placement in foster care/residential home, depression and suicidal thoughts had significant predictive values regarding indications of mental health problems and cumulative effects were found for 6–10 co-occurring risk factors. Conclusions: Adolescents with experiences of placement in foster care/residential home, depression and suicidal thoughts at treatment start should yield attention among clinicians as these general risk factors could predict indication of mental health problems at one year follow-up effectively. Also, patients with more than six co-occurring risk factors were more vulnerable for continued mental health problems. Generally, girls displayed a greater mental health and psychosocial burden at treatment initiation and were more likely to show indication of mental health problems at follow-up. These results suggests that girls are more likely to get psychiatric out-treatment parallel to, or after, substance abuse treatment. We recommend further investigation of gender differences and gender-specific needs in substance use treatment.