Domestic violence and risk of internalizing and externalizing problems in adolescents living with relatives displaying substance use disorders

Vilela, Thaís dos Reis; Rocha, Marina Monzani da; Figlie, Neliana Buzi; Pillon, Sandra Cristina; Diehl, Alessandra; Mari, Jair de Jesus

doi:10.1590/0047-2085000000268

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Jornal Brasileiro de Psiquiatria

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ORIGINAL ARTICLE • J. bras. psiquiatr. 69 (2) • Apr-Jun 2020 • https://doi.org/10.1590/0047-2085000000268 copy

Domestic violence and risk of internalizing and externalizing problems in adolescents living with relatives displaying substance use disorders

Violência doméstica e risco de problemas de internalização e externalização em adolescentes com familiares apresentando transtornos por uso de substâncias

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To investigate the association between exposure to domestic violence and increased risk of internalizing and externalizing problems and substance use among adolescents living with relatives with substance use disorder (SUD) at a low-income community of São Paulo, Brazil.

Methods

A cross-sectional study was conducted with 102 adolescents aged 12-17 years (M = 14.2, SD = 1.7) who were living with relatives suffering from SUD. Outcomes were measured using the Youth Self-Report (YSR), psychosocial stress factors questionnaire, Drug Use Screening Inventory (DUSI) and Phrase Inventory of Intrafamily Child Abuse (PIICA).

Results

The sample presented high prevalence of emotional/behavioral problems with YSR’s scores in the clinical range for Internalizing Problems (24.5%), Externalizing Problems (21.6%), and Total Problems (26.5%). The presence of mental health problems predicted substance use (PR = 2.22; 95% CI = 1.2-4.13), and substance use predicted increased risk of mental health problems. Alcohol use predicted more than double the risk of emotional/behavioral problems (PR = 2.01; 95% CI = 1.08-3.76), while illicit drug use was associated with an almost threefold increase in the prevalence of Internalizing (PR = 2.87; 95% CI = 1.19-6.89) and Externalizing Problems (PR = 3.3; 95% CI = 1.35-8.04).

Conclusion

Adolescents of relatives with SUD are at risk of developing emotional and behavioral problems. These findings reinforce the need to develop public mental health policies, which include protective interventions to adolescents living in families affected by substance use disorders.

Substance-related disorders; adolescent behavior; violence exposure; domestic violence; low-income population

Variables	n (%)
Adolescent characteristics
Gender (female)	58 (56.9)
Ethnic group (non-white)	69 (67.6)
Brazil Economic Classification Criteria
Class B2	13 (12.7)
Class C	68 (66.7)
Class D	21 (20.6)
Religious background	73 (71.6)
Parents’ marital status
Married or living together	52 (51.0)
Psychosocial stress factors
Family stressful situations in the last 12 months
Psychiatric hospitalization	8 (7.8)
Family severe disease	23 (22.5)
Suicide	2 (2.0)
Suicide attempt	4 (3.9)
Problems with the law	8 (7.8)
Death of a family member	18 (17.6)
Physical aggression between family	28 (27.5)
Substance user characteristics
Number of substance abusers who coexist
One substance abuser	69 (67.6)
More than one substance abuser	30 (29.4)
Substance abuser member
Mother	7 (6.9)
Father	47 (46.1)
Mother and father	10 (9.8)
Brothers or sisters	4 (3.9)
Second-degree relatives	34 (33.3)
Substance consumed by addicted family
Alcohol	57 (57.0)
Illicit drugs	43 (43.0)
Substance use by the adolescent
Alcohol	26 (25.5)
Tobacco	5 (4.9)
Illicit drugs	3 (2.9)
Emotional and behavioral problems
Internalizing Problems	25 (24.5)
Externalizing Problems	22 (21.6)
Total Problems	27 (26.5)

Variables	Internalizing Problems				Externalizing Problems				Total Problems

	Clinical (%)	Non-clinical (%)	PR (95% CI)	p	Clinical (%)	Non-clinical (%)	PR (95% CI)	P	Clinical (%)	Non-clinical (%)	PR (95% CI)	p
Sociodemographic characteristics

Gender
Female	27.59	72.41	1.35 (0.66-2.76)	0.41	22.41	77.59	1.1 (0.52-2.33)	0.81	25.86	74.14	0.95 (0.5-1.82)	0.87
Male	20.45	79.55	1		20.45	79.55	1		27.27	72.73	1
Age group (years)
12 to 14	30.36	69.64	1.75 (0.83-3.67)	0.14	23.21	76.79	1.19 (0.56-2.52)	0.66	30.36	69.64	1.4 (0.71-2.75)	0.33
15 to 17	17.39	82.61	1		19.57	80.43	1		21.74	78.26	1
Ethnic group
White	24.24	75.76	0.98 (0.47-2.04)	0.97	9.09	90.91	0.33 (0.11-1.04)	0.06	18.18	81.82	0.6 (0.27-1.34)	0.21
Non-White	24.64	75.36	1		27.54	72.46	1		30.43	69.57	1
Economic status
Class B2	23.08	76.92	1.62 (0.38-6.84)	0.51	30.77	69.23	1.29 (0.42-3.95)	0.65	30.77	69.23	1.29 (0.42-3.95)	0.65
Class C	27.94	72.06	1.96 (0.64-5.96)	0.24	19.12	80.88	0.8 (0.32-1.99)	0.64	26.47	73.53	1.11 (0.47-2.63)	0.81
Class D	14.29	85.71	1		23.81	76.19	1		23.81	76.19	1
Religious background
No	13.79	86.21	1		24.14	75.86	1		20.69	79.31	1
Yes	28.77	71.23	2.09 (0.78-5.55)	0.14	20.55	79.45	0.85 (0.39-1.87)	0.69	28.77	71.23	1.39 (0.63-3.09)	0.42
Parents’ marital status
Married or living together	26.92	73.08	1.22 (0.62-2.43)	0.56	17.31	82.69	0.67 (0.31-1.42)	0.29	23.08	76.92	0.77 (0.4-1.48)	0.43
Single or divorced	22	78	1		26	74	1		30	70	1

Addicted family characteristics

Substance abuser member
Brothers	25	75	0.85 (0.14-5.02)	0.86	0	100	-	0.99	0	100	-	0.99
Mother/father/both	21.9	78.1	0.74 (0.37-1.49)	0.41	21.9	78.1	0.93 (0.43-1.99)	0.85	25	75	0.77 (0.41-1.47)	0.43
Other family member	29.41	70.59	1		23.53	76.47	1		32.35	67.65	1
Substance consumed
Illicit drugs	32.56	67.44	1.69 (0.85-3.34)	0.13	27.91	72.09	1.77 (0.82-3.81)	0.15	37.21	62.79	1.93 (1-3.72)	0.05
Alcohol	19.3	80.7	1		15.79	84.21	1		19.3	80.7	1

Substance use by the adolescent

Alcohol	30.77	69.23	1.38 (0.67-2.81)	0.38	34.62	65.38	2.02 (0.98-4.17)	0.06	42.31	57.69	2.01 (1.08-3.76)	0.03
Tobacco	40	60	1.69 (0.54-5.23)	0.36	60	40	3.06 (1.35-6.97)	0.01	60	40	2.43 (1.09-5.37)	0.03
Illicit drugs	66.67	33.33	2.87 (1.19-6.89)	0.02	66.67	33.33	3.3 (1.35-8.04)	<0.01	66.67	33.33	2.64 (1.11-6.29)	0.03

Family psychosocial stressors

Psychiatric hospitalization	37.5	62.5	1.60 (0.61-4.21)	0.34	12.5	87.5	0.56 (0.09-3.64)	0.54	37.5	62.5	1.47 (0.56-3.83)	0.43
Family severe disease	21.74	78.26	0.86 (0.36-2.04)	0.73	26.09	73.91	1.29 (0.57-2.91)	0.54	26.09	73.91	0.98 (0.45-2.14)	0.96
Suicide	50	50	2.08 (0.50-8.70)	0.31	50	50	2.38 (0.57-10.02)	0.24	100	0	-	-
Suicide attempt	75	25	3.34 (1.70-6.56)	<0.01	25	75	1.17 (0.2-6.64)	0.86	100	0	-	-
Problems with the law	50	50	2.24 (1.02-4.93)	0.04	12.5	87.5	0.56 (0.09-3.64)	0.54	50	50	2.04 (0.94-4.45)	0.07
Death of a family member	22.22	77.78	0.89 (0.35-2.28)	0.81	33.33	66.67	1.75 (0.8-3.85)	0.16	33.33	66.67	1.33 (0.63-2.83)	0.45
Aggression between family	25	75	1.03 (0.48-2.19)	0.94	25	75	1.23 (0.56-2.7)	0.6	35.71	64.29	1.55 (0.81-2.97)	0.18

	Disorders	n	Mean (SD)	PR (95% CI)	P
Internalizing Problems

Clinical	Cognitive	25	3.08 (1.55)	1.39 (1.14-1.71)	<0.01
	Emotional	25	7.96 (3.1)	1.16 (1.10-1.23)	<0.01
	Social	25	2.4 (1.12)	1.04 (0.79-1.35)	0.79
	Behavioral	25	5.28 (2.09)	1.16 (1.04-1.30)	<0.01
	Physical	25	0.68 (0.75)	1.90 (1.25-2.88)	<0.01
Non-clinical	Cognitive	77	1.99 (1.45)
	Emotional	77	4.87 (2.77)
	Social	77	2.32 (1.25)
	Behavioral	77	3.92 (2.36)
	Physical	77	0.32 (0.52)

Externalizing Problems

Clinical	Cognitive	22	2.91 (1.51)	1.28 (1.04-1.59)	0.02
	Emotional	22	8 (3.48)	1.15 (1.05-1.25)	<0.01
	Social	22	2.23 (1.27)	0.92 (0.66-1.27)	0.61
	Behavioral	22	6.23 (2.18)	–	–
	Physical	22	0.64 (0.66)	1.64 (1.02-2.62)	0.04
Non-clinical	Cognitive	80	2.08 (1.51)
	Emotional	80	4.98 (2.72)
	Social	80	2.38 (1.21)
	Behavioral	80	3.71 (2.11)
	Physical	80	0.35 (0.58)

Total Problems

Clinical	Cognitive	27	3.3 (1.41)	1.5 (1.24-1.81)	<0.01
	Emotional	27	7.81 (3.64)	1.11 (1.02-1.21)	0.01
	Social	27	2.22 (1.22)	0.91 (0.69-1.22)	0.54
	Behavioral	27	5.85 (2.09)	–	–
	Physical	27	0.74 (0.71)	2 (1.41-2.83)	<0.01
Non-clinical	Cognitive	75	1.88 (1.41)
	Emotional	75	4.84 (2.54)
	Social	75	2.39 (1.22)
	Behavioral	75	3.68 (2.19)
	Physical	75	0.29 (0.51)

Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro Av. Venceslau Brás, 71 Fundos, 22295-140 Rio de Janeiro - RJ Brasil, Tel./Fax: (55 21) 3873-5510 - Rio de Janeiro - RJ - Brazil
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[1] Address for correspondence: Thaís dos Reis Vilela. Departamento de Psiquiatria, Escola Paulista de Medicina da Universidade Federal de São Paulo. Rua Major Maragliano, 241, Vila Mariana – 04017-030 – São Paulo, SP, Brasil. E-mail: thaisvilela1@gmail.com