We examined correlations between number of observations provided by each participant and all other study variables to assess whether attrition across waves was associated with levels of any of our study variables of interest. While socioeconomic status was correlated with greater retention in the sample , no other study variables were associated with attrition across waves. Data were structured treating age as time, and were analyzed in the 5-year span from age 17 to age 21.1 Moreover, noting positive skew in our binge drinking outcome, we further employed robust estimator that provided more accurate and robust parameter estimation for models of non-normal data compared to the standard maximum likelihood estimation and alternatives . Latent curve models with structured residuals were used to address primary hypotheses and were conducted separately for depression and anxiety. A schematic of the LCM-SRs employed are provided in Figure 1. LCM-SRs are an integration of random effects and cross-lagged panel models aimed at estimating lagged effects in longitudinal panel data at the within-person level. In contrast to standard cross-lagged methodologies, LCM-SRs can estimate temporally lagged associations between depression and binge drinking that are partitioned of between-person differences in these associations. This is achieved by specifying a latent curve model to account for between-person differences in level and change in longitudinal data while estimating auto-regressive and cross-lagged effects of time-dependent residuals, which have a purely within-person interpretation. In these models, we evaluated model fit using the adjusted χ2 difference test, where a non-significant result was an indication of adequate model fit. We supplemented this test with a number of alternative fit indices , including scaled variants of the comparative fit index and root mean square error of approximation . We included socioeconomic status and sex at baseline as covariates to control for between-person demographic factors that may be influencing levels of internalizing symptoms and binge drinking.

Socioeconomic status was measured using a modified version of the MacArthur Sociodemographic Questionnaire . In sensitivity analyses,cannabis vertical farming we replicated each LCM-SR separately for males and females to explore whether effects differed across sexes.2 All analyses were conducted in R using ‘lavaan’ . A significance threshold of 0.05 or better was required across analyses. Analyses were supplemented with post-hoc power simulations conducted using the pwrSEM application to determine whether LCM-SRs employed were sufficiently powered to detect targeted autoregressive and cross-lagged effects. Power was computed using the Monte Carlo method following steps provided in Wang and Rhemtulla, 2021 and Hancock and French, 2013. Namely, we specified a population LCM-SR based on the standardized variances and covariances between variables included within our model. Assuming this covariance structure, we modified effect sizes for target parameters within these models across a range of magnitudes to assess the minimum effect size needed to detect each target parameter. Then, we generated 1,000 samples assuming 831 observations for this model, fit our LCM-SR to each, and recorded the proportions in which the target parameters were different from 0 based on a significance threshold of α = 0.05. Results are summarized in Table 2. Between-person effects indicated socioeconomic status was associated with greater growth in HED over time, and that women reported higher depression and anxiety and more growth in HED than men. Auto regressive path parameters indicated that HED was positively associated with levels at the subsequent time point, indicating moderate year-to-year stability over the five-year study window. Addressing within-person effects, binge drinking marginally predicted depression among females . No other effects were significant. We note that confidence intervals for within-person effects were narrow for the associations between depression and anxiety symptoms and subsequent HED , demonstrating high precision in these null associations in the sample. We examined lagged associations between adolescent binge drinking, anxiety, and depression symptoms over five years in a large, diverse, prospectively followed sample of participants from the NCANDA study. While the self-medication hypothesis suggested that binge drinking behaviors may follow the presence of internalizing symptoms as a means of coping with negative affect, other theories have suggested binge drinking may disrupt social and cognitive functioning and may serve as a metabolic insult that predisposes youth towards the occurrence of depression and anxiety.

One underlying mechanism of the impact of binge drinking on the development of depression and anxiety has been explained in the literature as related to systemic and CNS inflammation that develops with increasing alcohol use and leads to subsequent psychiatric symptoms . Alternatively, shared between-person factors, such as environmental and peer influences, may drive relations between these co-developing constructs. We used latent curve models with structured residuals to test these hypotheses concurrently. Given equivocal evidence that internalizing symptoms and binge behaviors are linked in adolescence, we supported our findings with post-hoc power analyses to determine whether the NCANDA sample was sufficiently powered to detect these effects if they were present in our target population. Results demonstrated trending evidence that binge drinking predicted subsequent depression and anxiety among females, and no direct evidence that internalizing symptoms predicted later binge drinking. This suggests that although binge behaviors may increase later internalizing risk for females, it is likely that binge behaviors may develop largely independently from internalizing factors across this developmental period . Since we found a small and unidirectional relation between binge drinking and adolescent depressive or anxiety symptoms, results provided slight evidence favoring substance induced anxiety and depression models of internalizing risk . As such, results highlight that efforts aimed at preventing early initiation and hazardous or harmful alcohol use may have significant downstream effects on incidence of internalizing symptoms for females within the adolescent period. By contrast, we found little direct evidence of a self-medication model when analyzed at the within-person level. Though links between internalizing symptoms and binge drinking have been observed for adults , present findings may therefore indicate that early-onset internalizing symptoms represent a different developmental pathway unique from adult-onset symptoms that confer elevated substance use risk , or relatedly, that stronger associations have been found with more severe levels or extended histories of substance use and internalizing disorder .

Alternatively, consistent with the common-factor model, the effect sizes observed in this study may also imply minimal direct relation between these two conditions, such that associations observed between internalizing symptoms and binge behaviors may be better explained by common factors giving rise to each. For instance, a number of groups including Goodwin et al. found that after controlling for confounding factors , anxiety disorder was unrelated to all measures of substance use , and support by similar findings for confounding factors have been seen in a number of family and twin studies . In addition, several groups have proposed that genetic contributors and anxiety sensitivity render individuals susceptible to co-occurring anxiety and alcohol misuse ; similarly, common genetic factors have been identified as predisposing towards depression and alcohol dependence . While prior studies controlled for these between-person environmental and genetic factors directly, we analogously used a within-person design to partition factors that may be confounding associations. Employing this statistical approach provided evidence largely consistent with these prior findings, adding that we find only modest and unidirectional associations when sequenced over time. While the NCANDA study has major strengths of being a large, diverse, and prospectively followed sample, we note several limitations. First, episodic variation and measurement may be necessary to more accurately capture self-medication processes, such as in the application of weekly ecological momentary assessment methods ; the CDDR monthly binge drinking and Achenbach depressive symptom metrics from NCANDA may not have had the temporal sensitivity to capture these nuanced levels of association. Relatedly, some evidence suggests that while self-reported recall methods are reasonably accurate for adolescents and young adults at moderate levels , younger populations may under-estimate their alcohol consumption at higher levels of consumption . Thus, the present findings may reflect an underestimation of true binge drinking in the sample and may have tempered effect sizes observed in the present study. Second, it is also possible that other forms of substance use might have stronger links with internalizing pathology across this developmental period. Though our analyses focused primarily on testing theories of alcohol misuse in adolescence and young adulthood,drying cannabis examination of these effects across a wider range of substance outcomes may be a crucial extension of this research. Third, we note that several constraints were imposed on the estimated LCM-SRs in this study, including fixing cross-lagged and autoregressive parameters to equivalence across time.

As such, we encourage results to be replicated in future analyses, ideally in larger national samples of adolescent substance use such as the Adolescent Brain Cognitive Development Study . Fourth, the Youth and Adult Self-Report scales offer several advantages and limitations. Self-report intrinsically allows data to be gathered more easily since participants can describe their own symptoms, thus avoiding the need to meet or speak with a staff member. However, such reported symptoms can be less objective than reported symptoms from a trained, clinician staff member. Clinical scales such as the ASR/YSR capture a range of anxiety and depression symptoms that typically necessitate mental health intervention. This is both a strength and weakness in that we can capture lower level of symptoms, but are also gathering information on participants experiencing lesser symptoms than those having DSM-5 diagnostic criteria for a disorder such as major depressive disorder or generalized anxiety disorder. The ASR/YSR anxiety questionnaire as described in detail in the methods highlights that several different types of anxiety are probed in a mixed fashion, limiting generalizability and specificity to differentiate between types of anxiety disorders such as panic, specific phobias, separation, or generalized anxiety disorders using the results from this NCANDA study. Ferdinand et al. found that YSR anxiety scores predicted DSM-IV disorders only moderately while YSR depressive scores corresponded closely to DSM-IV major depressive disorder and dysthymia . Finally, very limited data was available for the NCANDA study for the context of each episode of binge drinking ; given social drinking factors may play a large role in predicting binge drinking engagement , drinking context could have an important impact on understanding our findings for the depression-binge drinking relationship. Our work provides an investigation of the interrelation between depression or anxiety and binge drinking in the large, diverse, and prospectively followed NCANDA sample. Our work is in line with other studies that have found minimal associations between depression or anxiety and binge drinking , and suggest that binge drinking may modestly predict later internalizing symptoms or that common factors may better explain links between these facets throughout adolescence. This may highlight the importance of simultaneous treatment of binge drinking and co-morbid depressive or anxiety disorders for both males and females. Future larger studies such as ABCD will be able to build on the early findings identified here. Mid-adolescence is a vulnerable developmental period for cigarette smoking uptake, the onset of mental health conditions, and the emergence of comorbid tobacco use and mental health problems . The over-representation of smoking among adolescents with mental health problems generalizes across various conditions , remains robust after controlling for confounders, and is mediated by theoretically-relevant factors suggesting a causal relation . The rapid emergence and appeal of novel tobacco and nicotine products such as electronic cigarettes raises the question as to whether the same adolescent subgroup with mental health problems is at risk for using these products . This is important to address because this population may be particularly vulnerable to nicotine addiction, given that neural plasticity during adolescence and neuropathology in psychiatric conditions can enhance the brain’s sensitivity to nicotine . E-cigarettes—electronic devices that deliver inhaled nicotine emulate the sensorimotor properties of conventional cigarettes—are gaining popularity among adolescents. According to 2014 estimates, past 30 day use of e-cigarettes is more common than conventional cigarettes among U.S. 8th- and 10th- graders, and many adolescent e-cigarette users have never tried conventional cigarettes . E-cigarettes may be an attractive alternative to conventional cigarettes among youth because of beliefs that they are less harmful, addictive, malodorous, and costly than conventional cigarettes . Furthermore, e-cigarettes come in flavors appealing to youth and may be easier to obtain than conventional cigarettes because of inconsistent enforcement of restrictions against sales to minors . Such factors may facilitate e-cigarette initiation in adolescents who would not otherwise smoke conventional cigarettes and may perhaps have fewer risk factors for smoking —including mental health problems.