COMMENTARY: Exploring the Complex Links between Violence, Mental Health, and Substance Abuse - from Correlates, through Risk Factors, towards Causal Pathways

By Mikton, Christopher; Tonmyr, Lil et al. | Advances in Mental Health, October 1, 2012 | Go to article overview

COMMENTARY: Exploring the Complex Links between Violence, Mental Health, and Substance Abuse - from Correlates, through Risk Factors, towards Causal Pathways


Mikton, Christopher, Tonmyr, Lil, Scott, Debbie, Advances in Mental Health


This special issue addresses an important and under-researched area: the complex relations between violence - child maltreatment and selfdirected violence in particular - and mental health and substance abuse problems - with a special focus on adolescent populations. Through complex and still poorly understood pathways, each can act as a determinant of the other, as several of these papers suggest. Child maltreatment is a risk factor for mental health, substance abuse, and further violence, including for instance youth violence, dating violence and self-directed violence. Mental health problems, in turn, can lead to substance abuse and self-directed violence. And in their turn, substance abuse problems can result in violence and mental health problems. In spite of high rates of child maltreatment and mental health and substance abuse problems in most parts of the world, resources to respond to and prevent these problems too often remain scarce. In recent times in high-income countries they have come under threat of being cut, while in low- and middle-income countries resources are generally sorely lacking.

Although these articles have a wide-ranging - almost disparate - focus, several key themes recur throughout them. These include child maltreatment and its far-reaching consequences; the importance of arriving at a differentiated picture of the determinants of negative outcomes and the difficulty of teasing out the specific pathways to them; issues of measurement and data quality; the implications the findings have for response and prevention; and adolescence as period when mental health and substance abuse problems often manifest themselves and as an important time for intervention. We will return to these themes after a brief overview of these papers and also explore some of the challenges these papers highlight.

Frederick, Kirst, and Erickson (2012) recruited 150 street involved youth and found that death rates are more than eleven times higher than the general population, with suicide and drug overdoses major contributors. Their multivariate analysis which examined both proximal and distal variables found that street involved youth were more likely to report suicidal ideation and attempts if they reported depression; that non-suicidal self-harming behavior predicted suicidal ideation controlling for depression; and that being bullied at school had an impact on suicidal ideation, which operated through depression and self-harm. Bivariate analysis found that those children who had been sexually abused were more likely to attempt suicide than those who had not been abused (Frederick et al., 2012). The authors pointed out, however, that due to the cross-sectional nature of their data, causality cannot be inferred.

Lloyd and Campbell (2012) tried to establish if there was an association between drug of choice and mental health diagnoses in a homeless Australian population. The authors conducted a review of the community health records of 54 clients of a health outreach team to identify mental health diagnosis and information on substance abuse. No significant association was found and while this may be related to the small sample size, the authors also noted that the quality of documentation within the records is variable. The authors did, however, call attention to the importance of sustained, effective prevention and treatment responses for this vulnerable population faced with multiple physical and mental problems and social disadvantages.

Hamilton, Wekerle, Paglia-Book, and Mann (2012) found that youth with child welfare involvement reported more psychological distress and delinquency than those without such involvement. Furthermore, the study reached the intriguing conclusion that high school connectedness - i.e., the belief among students that teachers and other adults within the school care about them as individuals and about their learning - reduced depressed mood and anxiety, but not delinquency in child welfare involved youth. …

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