Depression in Substance-Dependent Delinquents PAULA D. RIGGS, M.D., STEVEN BAKER, M.D., SUSAN K. MIKULICH, B.A., SUSAN E. YOUNG, M.A., AND THOMAS J. CROWLEY, M.D. ABSTRACT Objective: Depression often is comorbid with conduct disorder. The purpose of this study is to assess whether, among youths with conduct disorder, those with depression differ in other ways from those without depression. Method: Ninety- nine delinquent boys (aged 13 through 19 years) were evaluated with the Diagnostic Interview Schedule for Children and other instruments. All boys had conduct disorder and substance use disorders. Results: Staff-rated and self-rated depression scores correlated significantly. Twenty-one boys had major depression and/or dysthymia. Depressed boys had more substance dependence diagnoses and were more likely to have attention-deficit hyperactivity disorder, posttraumatic stress disorder, and anxiety disorders, compared with the nondepressed boys. Depressed boys tended to develop conduct symptoms earlier than did the nondepressed boys. Depression scores did not change after at least 4 weeks of abstinence, for either depressed or nondepressed boys. Conclusions: Depressed delinquents have more substance dependence diagnoses, tend to initiate behavioral problems at an earlier age, have increased anxiety and attentional problems, and more trauma effects, than nondepressed delinquents. Depression does not appear to be related to substance intoxication, since it is not alleviated after 4 weeks of abstinence. Such boys may require combined psychiatric and substance treatment. J. Am. Acad. Child Ado/esc. Psychiatry, 1995, 34, 6:764-771. Key Words: depression, conduct disorder, substance use disorder, comorbidity, adolescents. Depression is common among youths with both con- duct disorder (CD) and substance problems (Kovacs et aI., 1988; Puig-Antich, 1982; Robins and McEvoy, 1990; Zoccolillo, 1992). But does comorbid depression signal more severe CD or substance use disorder, or the presence of additional psychiatric disorders? Will such depression abate with abstinence? Is self-report of adolescent depression valid when compared with clinician ratings? The prevalence of depression in referred groups of children and adolescents with CD is 15% to 24% (Alessi et al., 1984; Chiles et al., 1980; Kashani et al., 1982); it is greater than in those without CD (2% to 8%) (Zoccolillo, 1992). Epidemiological studies of Accepted November 22. 1994. From the Department of Psychiatry, Addiction Research and Treatment Service, University of Colorado Health Sciences Center, Denver. This study was supported by grant DA06941 from the National Institute on Drug Abuse. Reprint requests to Dr. Riggs, Director ofPsychiatric Services for Adolescents, Addiction Research and Treatment Service, University of Colorado Health Sciences Center, 4200 East Nimh Avenue, C268-35, Denver, CO 80262. 0890-8567/95/3406-0764$03.00/0©1995 by the American Academy of Child and Adolescent Psychiatry. 764 nonreferred community samples support similar rates of depression in CD (Angold and Costello, 1993; Zoccolillo, 1992). Attention-deficit hyperactivity disor- der (ADHD) (Biederman et al., 1991; Bukstein et al., 1989) and anxiety disorders (Zoccolillo, 1992) also may be more prevalent among youths with CD than among those without CD. Few studies have assessed correlates of depression while simultaneously assessing CD and substance use disorder. Few, and sometimes conflicting, data describe de- pressions comorbid with CD, compared with depres- sions without CD. Depressions with CD may be more severe (Carlson and Cantwell, 1980) and longer lasting (Marriage et al., 1986), and they may be characterized by less mania/hypomania, less fatigue, lower anxiety, fewer obsessive-compulsive symptoms, more suicidal ideation, less psychosis, less family history of depression (Puig-Antich et aI., 1989), and more conduct symptoms (Puig-Antich, 1982), compared with those without CD. Depression in CD may also begin earlier (Robins and Price, 1991; Zoccolillo, 1992). Other studies, however, find no differences in the characteristics of depressions with CD compared with depressions with- out CD (Harrington et al., 1991; Kovacs er al., 1988). J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 34:6, JUNE 1995