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Sm. Sci. Med. Vol. Z-1. No. IO. pp.863456. 1987 Printed in Great Britain. Ail rights reserved 0277-9j36,87 S3_04l+ 0.00 Copyright C 1987 Ptrgamon Jcarnals Ltd DEPRESSION IN SOLVENT ABUSERS ALLAX M. JACOBS’ and A. HA,MID GHODSE’ ‘Department of Psychological Medicine, Hospital for Sick Children, Great Ormond Street, London WCIN 3JH and *Department of Addiction Behaviour, St George’s Hospital, Blackshaw Road, Tooting, London SW 17, England Abstract-Previous studies mention that some solvent abusers have a depressed mood. This study sets out to determine in a formal way whether solvent abusers are more depressed than a comparison group of non-solvent abusers. Forty-seven consecutive admissions (all with delinquent histories) to the secure unit of a regional assessment centre for adolescent boys, who fulfilled certain criteria, were assessed. They- completed the General Health 28 item questionnaire (GHQ-28) and the Great Ormond Street (GO9 mood questionnaire. Thereafter, they were administered a semi-structured interview covering the following areas-solvent abuse data, educational data, demographic and family data, criminal history and other drug use data. Results showed that significantly more solvent abusers were depressed than non-solvent abusers as defined by GOS-mood scores of 25 or more (P< 0.05). Also, mean GHQ-28 total scores (Pc 0.02), GHQ-28 depression subscale scores (P < 0.02), and GOS-mood scores (P< 0.05) were significantly higher in the solvent abuse group. In conclusion, solvent abusers are more depressed than a comparison non-solvent abusing group. Key words-solvent abuse, depression, adolescence INTRODUCTION Sporadic abuse of solvents by children and adoles- cents was first reported (in America) in the 1950s. Glaser and Massengale’s [ 1] report of the widespread abuse of solvents by adolescents has been followed by many reports of widespread solvent abuse by young people in many parts of the world [2-4]. The young age of those abusing solvents is dis- tressing as it is a time when their personalities are still developing. Also solvent abuse has worrying mor- tality [S, 61 and morbidity [3,6] rates. A number of studies have suggested various rea- sons as to why adolescents abuse solvents with pri- mary depression suggested as one possible cause [7-91. However, none has systematically studied the presence of depression in this group. Therefore, we looked at a number of characteristics of boys at a regional assessment centre in West London, specifically examining for the presence of depressive symptoms, and comparing our tindings for the solvent abusers with the non-solvent abusers in this population. METHOD Consecutive admissions to the secure unit of a regional assessment centre for adolescent boys in West London were seen over a nine month period from November 1984. The boys in the unit are in the care of a local authority, on a place of safety order, or are remanded in care in relation to a criminal offence. (All in this study had a delinquent history.) They were in the unit because of a history/risk of absconding, because they were likely to injure themselves/others, and/or because they were being assessed prior to shortly appearing in court. Those who had not been in the unit for more than seven days were excluded to ensure a sufficient washout period for any drugs (especially solvents) that they might have been using up until admission. One refused to be interviewed and one was excluded as he did not understand the questions. They were all asked if they agreed to participate in an interview aimed at assessing the cause of their problems, but were not told of the specific drug interest of the investigation. The interview took about an hour. All were seen only by AMJ who fust gave each boy the following rating scales to complete: 1. GHQ-Z&-This is a self-report rating scale which screens for current psychiatric morbidity [lo]. iMann et of. [1 l] have validated its application to an adoles- cent population where the following scores apply: a GHQ total score of six or more indicates the presence of psychiatric disturbance. There are four subscales and a score of 16 or more on each indicates the presence of the disorder defined by that subs&e (one covers depressive symptomatology). 2. GOS-mood questionnaire-This is a 28 item self-report depression rating scale which is easy to understand and to answer and which has been vali- dated for application to an adolescent population [ 121.Respondents reply on a four point scale (never’, ‘sometimes’, ‘frequently’ or ‘nearly all the time’). It is used to assess whether adolescents are currently depressed with a score of 25 or more indicating this. The boys then responded to a questionnaire which took the form of a semi-structured interview. Data were collected on-solvent abuse, educational demo- graphic and family characteristics, criminal history and other drug use (including tobacco and alcohol). Sclare and Masterton’s criterion for solvent abuse [13] was used to determine who fell into the solvent abuse group, the remainder forming the comparison group. The criterion for solvent abuse was regular 863

Depression in solvent abusers

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Page 1: Depression in solvent abusers

Sm. Sci. Med. Vol. Z-1. No. IO. pp. 863456. 1987 Printed in Great Britain. Ail rights reserved

0277-9j36,87 S3_04l+ 0.00

Copyright C 1987 Ptrgamon Jcarnals Ltd

DEPRESSION IN SOLVENT ABUSERS

ALLAX M. JACOBS’ and A. HA,MID GHODSE’ ‘Department of Psychological Medicine, Hospital for Sick Children, Great Ormond Street, London WCIN 3JH and *Department of Addiction Behaviour, St George’s Hospital, Blackshaw Road, Tooting,

London SW 17, England

Abstract-Previous studies mention that some solvent abusers have a depressed mood. This study sets out to determine in a formal way whether solvent abusers are more depressed than a comparison group of non-solvent abusers. Forty-seven consecutive admissions (all with delinquent histories) to the secure unit of a regional assessment centre for adolescent boys, who fulfilled certain criteria, were assessed. They- completed the General Health 28 item questionnaire (GHQ-28) and the Great Ormond Street (GO9 mood questionnaire. Thereafter, they were administered a semi-structured interview covering the following areas-solvent abuse data, educational data, demographic and family data, criminal history and other drug use data. Results showed that significantly more solvent abusers were depressed than non-solvent abusers as defined by GOS-mood scores of 25 or more (P < 0.05). Also, mean GHQ-28 total scores (P c 0.02), GHQ-28 depression subscale scores (P < 0.02), and GOS-mood scores (P < 0.05) were significantly higher in the solvent abuse group.

In conclusion, solvent abusers are more depressed than a comparison non-solvent abusing group.

Key words-solvent abuse, depression, adolescence

INTRODUCTION

Sporadic abuse of solvents by children and adoles- cents was first reported (in America) in the 1950s. Glaser and Massengale’s [ 1] report of the widespread abuse of solvents by adolescents has been followed by many reports of widespread solvent abuse by young people in many parts of the world [2-4].

The young age of those abusing solvents is dis- tressing as it is a time when their personalities are still developing. Also solvent abuse has worrying mor- tality [S, 61 and morbidity [3,6] rates.

A number of studies have suggested various rea- sons as to why adolescents abuse solvents with pri- mary depression suggested as one possible cause [7-91. However, none has systematically studied the presence of depression in this group. Therefore, we looked at a number of characteristics of boys at a regional assessment centre in West London, specifically examining for the presence of depressive symptoms, and comparing our tindings for the solvent abusers with the non-solvent abusers in this population.

METHOD

Consecutive admissions to the secure unit of a regional assessment centre for adolescent boys in West London were seen over a nine month period from November 1984. The boys in the unit are in the care of a local authority, on a place of safety order, or are remanded in care in relation to a criminal offence. (All in this study had a delinquent history.) They were in the unit because of a history/risk of absconding, because they were likely to injure themselves/others, and/or because they were being assessed prior to shortly appearing in court. Those who had not been in the unit for more than seven

days were excluded to ensure a sufficient washout period for any drugs (especially solvents) that they might have been using up until admission. One refused to be interviewed and one was excluded as he did not understand the questions. They were all asked if they agreed to participate in an interview aimed at assessing the cause of their problems, but were not told of the specific drug interest of the investigation. The interview took about an hour.

All were seen only by AMJ who fust gave each boy the following rating scales to complete:

1. GHQ-Z&-This is a self-report rating scale which screens for current psychiatric morbidity [lo]. iMann et of. [1 l] have validated its application to an adoles- cent population where the following scores apply: a GHQ total score of six or more indicates the presence of psychiatric disturbance. There are four subscales and a score of 16 or more on each indicates the presence of the disorder defined by that subs&e (one covers depressive symptomatology).

2. GOS-mood questionnaire-This is a 28 item self-report depression rating scale which is easy to understand and to answer and which has been vali- dated for application to an adolescent population [ 121. Respondents reply on a four point scale (never’, ‘sometimes’, ‘frequently’ or ‘nearly all the time’). It is used to assess whether adolescents are currently depressed with a score of 25 or more indicating this.

The boys then responded to a questionnaire which took the form of a semi-structured interview. Data were collected on-solvent abuse, educational demo- graphic and family characteristics, criminal history and other drug use (including tobacco and alcohol).

Sclare and Masterton’s criterion for solvent abuse [13] was used to determine who fell into the solvent abuse group, the remainder forming the comparison group. The criterion for solvent abuse was regular

863

Page 2: Depression in solvent abusers

864 ALL.LK 41 JKOBS and A. H,WID GHODSE

Table I. Demographic. family and educational data

Solvent Non-sol\enr abusers (,V = 20) abusers (.\- = 27)

% (n ) OO (n)

(A) Age at latr birrhday (years)

I. Mean 14.85 Il.82 2. =SEM 0.232 0.100

(B) Parents marital status I. Married 25 (5) U.4(12) 2. Separated IO(?) II.1 (3) 3. Divorced SO(l0) 37.0 (10) 4. Never married IO (2) 7.4 (2) 5. Not known S(1) 0 (0)

(C) Educorion I. Those whose last educational provision

was not an ordinary or special school (e.g. was a community home with education) 55(11) 44.4(11)

2. Those who have been expelled from a school 70(14) 63(17)

abuse of solvents for a period of more than three months.

Data obtained were analysed using standard statis- tical methods. Continuous variables such as GHQ-28 and GOS-depression scores, some of the demo- graphic and family data, and the criminal data are expressed as means together with their SEMs, and were tested using r-tests. The rest of the results are analysed as categorical variables using chi-squared tests.

RESULTS

Forty-seven adolescent boys were seen of whom 20 fulfilled the criterion for solvent abuse. Only one of the 27 non-solvent abusers had ever inhaled solvents (on two occasions only).

Demographic, family and educational data (Table I)

There were no significant differences between the two groups, although the solvent abusers showed a small tendency toward a more disrupted family and educational life.

Places of residence. Only one solvent abuser (5%) had lived solely with his parent/parents in the past as against six of the non-solvent abusers (22.2%).

Family details. Father’s and mother’s mean age (in years) was 40.2 and 35.6 respectively in the solvent abusers. For the non-solvent abusers father’s and mother’s mean ages were 40.8 and 37.3 respectively.

Solvent abusers had a mean of 1.6 brothers and 1.5 sisters. Non-solvent abusers had a mean of 1.7 broth- ers and 1.5 sisters.

Ethnic background. place of birth, religion. Eighty- five percent (17) of solvent abusers and 74.1% (20) of non-solvent abusers were white. All (20) of the sol- vent abusers and 88.9% (24) of the non-solvent abusers were born in England. The most common religion reported was Protestant-30% (6) of solvent abusers and 37% (IO) of non-solvent abusers. Forty- five percent (9) of the solvent abusers and 25.9% (7) of the non-solvent abusers said they were not brought up in any religion.

Sohent abuse data

Twenty subjects fulfilled the criterion for solvent abuse. Of interest is that gas lighter fuel was the most popular substance used (Table 2). Sixty percent (12) inhaled solvents on three or more days per week, with 50% (10) inhaling for more than 5 hr per day and 35% (7) using nine or more cans/tubes/bottles per week. Seventy percent (14) reported inhaling solvents because they sometimes/always felt depressed. Seventy-five percent (15) usually shared their solvents with others although 65% (13) had inhaled alone on occasion. The most popular method used by 70% (14) for inhaling was from a plastic bag and 80% (16) usually inhaled out of doors. Sixty percent (12) last inhaled between eight days and three months prior to seeing AMJ.

Other drug use data

Besides solvents, more solvent abusers used other drugs/groups of drugs (including alcohol and tobacco) than non-solvent abusers. But, only four drugs out of a total of 11 enquired about, were used

Table 2. Trw of solvents and other drugs abused

Solvent abusers (IV = 20)

% (n )

(A) Sokenrs* I. Gas lighter fuel 80(16) 2. Glue/cement 75(15) 3. ‘Tippex’ thinner 70 (14)

(B) Use o/ other drugs I. Heroin 25 (5) 2. Amphetamines 65 (13) 3. Hallucinogens 55(11) 4. Alcohol 100 (20)

*Three most frequently used substances.

Non-solvent abusers (N = 27)

% (n)

- - -

0 (0) 22.2 (6)

7.4 (2) 74. I (20)

Significance of difference

- -

P < 0.05 P <O.OI P <O.OI P < 0.05

Page 3: Depression in solvent abusers

Depression in solvent abusers

Table 3. Results for GHQ-28 and GOS-mood questionnaire scores when catcgoriscd psychiatrically disturbed/not disturbed and as depressed/not depressed

Solvent Non-solvent abusers (.V = 20) abusers (N = 27) Significana of

% (n) 9% (n) difference

(.a) Psychiatrically disturbed 50(10) 25.9 (7) NS GHQ total score > 6 (P = 0.089)

(B) Depressed I. GOS-mood score > 25 55(11) 22.2 (6) P < 0.05 2. GHQ depression

subs&e score 2 16 15(3) 3.7 (I) (P =N:,7)

Table 4. Means and (+SEM) of GHQ-28 and GOS-mood questionnaire scores

Solvent Non-solvent abusers (N = 20) abusers (IV = 20) Signilicance of

Scale P (+SEM) .? (+SEM) F difference

I. GHQ total score 8.3 (7.5) 3.6 (5.1) 0.0152 P < 0.02 2. GHQ depression subscale score 6.9 (6.3) 2.9 (4.1) 0.0198 P < 0.02 3. GOS-mood score 26.4 (10.7) 19.5 (9.1) 0.0217 P < 0.05

865

by significantly more solvent abusers than non- solvent abusers (Table 2).

For both groups, the three most popular drugs (including solvents for the solvent abusing group) were cannabis, tobacco, and alcohol (in order of decreasing popularity).

Criminal data

Solvent abusers were first arrested at a significantly younger age than non-solvent abusers; 11.6 years as opposed to 13 years respectively (P c 0.05).

GHQ-28 and GOS-mood questionnaire results

On analysis of GHQ-28 total scores into psychiatrically disturbed/not disturbed categories, more solvent abusers were psychiatrically distrubed than non-solvent abusers with the differences nearing significance (Table 3).

Analysis of GOS-mood scores into depressed/not depressed categories revealed that significantly more solvent abusers were depressed than non-solvent abusers with a trend in the same direction when GHQ-28 depression subscale scores were analysed into the same categories (Table 3).

Means for GHQ-28 total scores, GHQ-28 depres- sion subscale scores, and GOS-mood scores were all significantly higher in the solvent abusing group (Table 4). This confirms the categorical analysis results in the two paragraphs above.

DISCL!SSION

We have demonstrated in this study that significantly more solvent abusers were depressed than a comparison group of non-solvent abusers.

A study of this type cannot prove cause and effect and this was not the intention. Solvent abuse and depression may be associated in a number of possible ways. As the solvent abusers were not intoxicated when assessed, it is unlikely that solvents were the direct cause of their depression. Also, the large number (70%) reporting that they inhaled solvents because they felt depressed makes it more likely that they were inherently depressed and used/use solvents as a form of self-medication. Another possible role

for solvents is that they might have uncovered a depressive illness in predisposed boys. Lastly, a general vulnerability factor may be important in that those with a depressive vulnerability may be over- represented in the solvent-abusing group.

Skuse and Burrell [9] point out that solvent abuse (in the population they looked at), indicated a dis- turbed and unhappy child who required urgent help. In the light of our findings, it is clear that assessment and, if necessary, treatment of associated depression should be considered when solvent abuse is identified.

Although this is a study of a selected population (and so cannot claim to represent the community at large), it has its advantages as the sample examined was a largely homogenous one. There were no significant differences between the two groups regard- ing demographic, family and educational variables with only a small tendency for the negative aspects of some of these to occur more in the solvent abusers. The only two significant differences between the groups were the mean age at first arrest and the use of certain drugs (Table 2). This, associated with a tendency for more solvent abusers to have abnormal GHQ total scores may indicate that this group is more generally disturbed (including being signifi- cantly more depressed). But these variables may interact in other ways. For example, there is an increased incidence of drug abuse by delinquents and young offenders [14]; and rearing of children in serious disharmonious families shows a substantial association with dehnquency [ 151. Again, one cannot make statements about cause and effect. Lastly, an additional interesting finding was that 42.6% (20 out of 47) of the boys had abused solvents-an un- expectedly large proportion.

Acknowledgemenu-The authors wish to thank the fohow- ing people at Stamford House, West London, for their co-operation: Mr Brian Hilton (Principal) and the boys and staff (especially Mr Trevor Wakefield) on the Secure Unit.

We are very grateful to Mr Ashok Bhat for his help with the processing and analysis of statistical data and for his useful advice generally. Thanks to Mrs Cynthia Scott for preparing the manuscript. Lastly, we thank Professor Philip Graham for his constructive comments throughout.

Page 4: Depression in solvent abusers

866 ALLAN IM. JACOBS and A

REFERENCES 8

HA.MD GHODSE

1.

2.

7.

Glaser H. H. and Massengale 0. N. Glue-sniffing in children. Deliberate inhalation of vaporized plastic cements. J. Am. med. Ass. 181, 30&303, 1962. 9

Susman R. W. and Kupperstein L. R. Bibliography on the inhalation of glue fumes and other toxic vapours. A substance abuse practice among adolescents. Inr. J. 10.

Addict. 3, 177-197, 1968. Watson J. M. Glue-sniffing in profile. Pracririoner 218, 255-259, 1977. II.

Herzberg J. L. and Wolkind S. N. Solvent sniffing in perspective. Br. J. Hosp. Med. 29, 72-76. 1983. Watson J. M. Morbidity and mortality statistics on solvent abuse. ,Med. Sci. Law 19. 246252. 1979. Anderson H. R., Macnair R. S. and Ramsey J. D. 12.

Epidemiolo_w: deaths from abuse of volatile substances: a national epidemiological study. Br. med. J. 290, 13.

304-307, 1985. Berry G. J.. Heaton R. K. and Kirby M. W. Neuro- 14.

psychological deficits of chronic inhalant abusers. In .Uanagement of the Poisoned Patient (Edited by 15.

Rumack B. H. and Temple A. R.), pp. 9-31. Princeton Science Press, N.J.. 1977.

Korman M., Trimboii F. and Semler I. A comparative evaluation of 162 inhalant users. .-lddicf. Behar. 5, 143-152. 1980. Skuse D. and Burrell S. A review of solvent abusers and their management by a child psychiatric out-patient service. Hum. Toxic. 1, 321-329, 1982. Goldberg D. Detecting psychiatric illness by question- naire. In &factdrle.v .Monograph, p. 22. Oxford Univer- sity Press, 1972. Mann A. H.. Wakeling A.. Wood K.. Monck E.. Dobbs R. and Szmukler G. Screening for abnormal eating attitudes and psychiatric morbidity in an un- selected population of 15-year-old schoolgirls. Psychol. Med. 13, 573-580. 1983. Dobbs R., Monck E. and Graham P. Unpublished data, 1986. Woolfson R. C. Psychological correlates of solvent abuse. Br. J. med. PsychoI. 55, 63-66. 1982. Noble P. J. Drug taking in delinquent boys. Br. med. J. 1, 102-106, 1970. Rutter M. and Giller H. Juwnile Delinquency: Trends and Perspectives. Penguin. Harmondsworth, 1983.