The long arm of parental addictions: The association with adult children’s depression in a population-based study
Introduction
In 2010, approximately 22.1 million Americans were diagnosed with alcohol and/or drug abuse (United States Department of Health and Human Services, 2010). In total, 7.0% of the American population aged 12 and older was abusing alcohol or alcohol dependent, while 2.8% was abusing illicit drugs (United States Department of Health and Human Services, 2010). Alcohol and drug addiction have a direct impact on the health and well-being of both the individuals who use these substances and their children. Previous research has shown that 7.3 million children under the age of 18 live with a parent who misuses alcohol and 2.1 million children live with a parent who abuses illicit drugs (Substance Abuse and Mental Health Services Administration, 2009). For the purposes of this study, exposure to “parental addiction” is defined as growing up in a household with one or more parents whose drugs or alcohol use has caused problems for the family.
There are numerous intergenerational consequences of drug and alcohol addiction. Studies demonstrate that the offspring of addicts are more likely to adopt self-destructive behaviors themselves, such as substance abuse and suicidal behaviors (Christoffersen and Soothill, 2003, Harter, 2000, Mathew, 1993). Adult children of addicted parents are also more likely to experience social maladjustment (Harter and Taylor, 2000, Mathew, 1993) and have higher rates of psychopathology (Balsa et al., 2009, Corte and Becherer, 2007, Christoffersen and Soothill, 2003, Wilens, 2002, Harter, 2000, Mathew, 1993), including depression (Corte and Becherer, 2007, Chen and Weitzman, 2005, Anda et al., 2002, Harter, 2000). The latter is the focus of this study.
It is not entirely clear how exposure to parental addictions is linked to the eventual onset of depression. Genetic explanations are highly plausible, given the hereditable basis of both addiction and depression (Lau and Eley, 2010, Li and Burmeister, 2009) and the genetic overlap between the two conditions (Edwards et al., 2012). However, it is also possible that the pathway to depression is less straightforward. For example, several researchers have shown that the relationship between parental addictions and depression can be explained by co-occurring adverse childhood experiences, such as abuse (Anda et al., 2002, Harter, 2000, Harter and Taylor, 2000). This finding is consistent with the knowledge that children whose parents are addicted to either drugs or alcohol are more likely to be exposed to abuse (Anda et al., 2002, Harter, 2000, Harter and Taylor, 2000), in addition to several other negative childhood circumstances, including parental separation and divorce (Hussong et al., 2008, Anda et al., 2002) and poverty (Hussong et al., 2008). Also, depression is higher among adults who have experienced these adverse childhood experiences: abuse (Fergusson et al., 2008, Widom et al., 2007, Brown et al., 1999), parental divorce (Pelkonen et al., 2008, Wauterickx et al., 2006) parental unemployment and childhood poverty (Najman et al., 2010). In other words, it is possible that the pathway to depression may be via exposure to other adverse childhood experiences not specific to parental addictions.
A review of the literature suggests that there may be several other groups of factors that help explain the relationship between parental addictions and adult depression, including negative health behaviors, socioeconomic status (SES) and other stressors. Each cluster of potential explanatory factors will be considered in brief below.
It is possible that the association between parental addictions and depression can be explained by the uptake of negative health behaviors. Adult children of alcoholics and drug addicts are more likely to develop nicotine dependence and begin using nicotine at an earlier age than adult children who were not exposed to parental addictions (Marmorstein et al., 2009, Cuijpers and Smit, 2002). They are also at an increased risk for abusing alcohol (Marmorstein et al., 2009, Chen and Weitzman, 2005, Anda et al., 2002) and illicit substances (Marmorstein et al., 2009, Chassin et al., 1999). They may also have a higher body mass index and engage in less physical activity than adults whose parents did not abuse substances when they were children (Felitti et al., 1998). Maladaptive health behaviors are also linked to higher rates of depression. Both alcohol consumption (Bazargan-Hejaz et al., 2008; Anda et al., 2002, Felitti, 1993) and cigarette smoking (Kinnunen et al., 2006, Brown et al., 2000) are associated with depressive symptoms. Physical inactivity (de Moor et al., 2006, Kinnunen et al., 2006) and obesity (Atlantis and Baker, 2008, Carpenter et al., 2000) are also related to higher levels of adult depression.
Low socioeconomic status (SES) may explain, at least in part, the relationship between parental addictions and depression. Adult children of alcoholics and addicts have been shown to experience a greater variety of academic problems and financial stressors than their counterparts with non-addicted parents (Hussong et al., 2008). Depression is associated with low SES, measured by education level (Miech and Shanahan, 2000) and poverty (Butterworth et al., 2009).
Finally, it may be that general stress and specific life stressors experienced in adulthood help explain the connection between exposure to parental addiction in childhood and later depression. Compared to individuals whose parents did not abuse substances, adult children of alcoholics report a lower level of marital satisfaction (Kearns-Bodkin and Leonard, 2008) and appear to experience higher levels of marital conflict and divorce (Harter, 2000). Individuals exposed to parental addictions may also be at an increased risk for health problems in adulthood (Balsa et al., 2009, Pecukonis, 2004). Daily levels of stress and specific life stressors, such as separation/divorce and health problems, have each been associated with depression (Gibb et al., 2011, Kendler et al., 1995, Romans et al., 2011).
While there is substantial evidence indicating that women have higher rates of depression than men (Velde et al., 2010, Leach et al., 2008, Grigoriadis and Robinson, 2007, Kuehner, 2003), it is unclear how gender influences the relationship between parental addictions and depression. Girls and boys may respond differently to parent-related distress starting in mid-adolescence (Crawford et al., 2001). In particular, it has been shown that parental distress is linked to higher rates of internalizing symptoms in girls than boys (Crawford et al., 2001). That being said, research has yet to demonstrate consistent gender differences in depression among adult children of addicted parents. Some studies report that women whose parents were dependent on alcohol and drugs are more likely to exhibit depressive symptoms than men (Corte and Becherer, 2007), while others suggest depressive symptoms vary by gender of the child and of the parent (Chen and Weitzman, 2005). Finally, some studies have found no differences in depression outcomes by gender (Belliveau and Stoppard, 1995). Further exploration of gender differences in depression among adult children of parents with addictions is needed.
The goals of this study build on the review of the literature as follows. The first goal is to determine if there is an association between exposure to parental addictions in childhood and adult depression. If an association exists, the second goal is to assess whether it varies by gender. The third goal is to determine if the association is accounted for by any or all of the four clusters of potential explanatory factors (i.e., adverse childhood experiences, adult health behaviors, adult socioeconomic status and other stressors).
Section snippets
Data source and sample
This research used regionally representative data from the 2005 Canadian Community Health Survey (CCHS) (Statistics Canada, 2005). This survey provides estimates of health determinants, health status, and health system utilization at sub-provincial, provincial, and national levels. The CCHS uses a multi-staged stratified cluster design, in which the ‘household’ is the final sampling unit. In the selected households, a person designated as knowledgeable is asked to provide basic demographic
Results
Fully 15.2% of the sample had been exposed to parental addiction during childhood (n=877) and 4.6% was currently classified as being depressed. The percentage of depression was much higher for those who had a parent that used drugs and alcohol compared to their peers with non-addicted parents (9.3% vs. 3.9%). Table 1 provides a complete description of the sample according to exposure to parental addictions.
The logistic regression analysis confirmed a relationship between parental addiction and
Discussion
This study found that exposure to parents using drugs and alcohol during childhood is associated with 69% higher odds of depression, even when controlling for a variety of demographic, childhood, health-related and psychosocial factors. As expected, the absolute prevalence of depression was higher in women than men; however, our analyses indicated that the relationship between parental addiction and adult depression did not vary by gender. While some previous studies have found that health and
Acknowledgment
This research was undertaken, in part, thanks to support for the first author from the Sandra Rotman Endowed Chair in Social Work. The authors would like to thank Rachel Zhou for her assistance with the preparation of this manuscript.
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