|Year : 2023 | Volume
| Issue : 1 | Page : 47-52
Understanding the interplay of temperament and adolescent substance use: A case–control study
Anju Moni Rabha M.D., D.N.B 1, Kamala Deka M.D 2
1 Department of Psychiatry, Lakhimpur Medical College and Hospital, Chowkham, North Lakhimpur, Assam, India
2 Department of Psychiatry, Jorhat Medical College and Hospital, Jorhat, Assam, India
|Date of Submission||17-Dec-2022|
|Date of Decision||15-Feb-2023|
|Date of Acceptance||16-Feb-2023|
|Date of Web Publication||28-Mar-2023|
Anju Moni Rabha
North Lakhimpur - 787 001, Assam
Source of Support: None, Conflict of Interest: None
Background: Temperament is a relatively stable individual characteristic. Temperament predicts many consequential outcomes throughout life. Different dimensions of temperament lead to different patterns of responses to external stimuli. Dimensions such as activity level and negative emotionality are related to risk-promoting behavior like substance use in adolescents. Methods: In this cross-sectional study, we included 35 adolescents in the age group of 10–17 years. We included adolescents attending outpatient clinics and inpatient services who were diagnosed with mental disorders due to substance use according to ICD-10 diagnostic criteria. We also included 35 healthy controls. All study participants in the case and control groups were assessed using the Early Adolescent Temperament Questionnaire-Revised (EATQ-R) scale. Results: When temperament was assessed using the EATQ-R, the mean scores were highest for frustration, aggression, surgency, and depressed mood, but were lowest for shyness in the study group. While comparing temperament between the study group and the control group, significant differences were found between activation control (p < 0.05), aggression (p < 0.001), attention (p < 0.001), depressed mood (p < 0.05), fear (p < 0.001), inhibitory control (p < 0.001), shyness (p < 0.001), and surgency (p < 0.001). Conclusion: Temperament plays a significant rôle in adolescent substance use. Person-specific treatment can be designed to provide better care and management of patients in taking temperament into account.
Keywords: children, Early Adolescent Temperament Questionnaire-Revised, high-risk adolescents, substance dependence
|How to cite this article:|
Rabha AM, Deka K. Understanding the interplay of temperament and adolescent substance use: A case–control study. Taiwan J Psychiatry 2023;37:47-52
|How to cite this URL:|
Rabha AM, Deka K. Understanding the interplay of temperament and adolescent substance use: A case–control study. Taiwan J Psychiatry [serial online] 2023 [cited 2023 Jun 11];37:47-52. Available from: http://www.e-tjp.org/text.asp?2023/37/1/47/372637
| Introduction|| |
Temperament is defined as relatively stable individual differences in behavior, emotion, attention, self-regulation, and reactivity ,,. Temperament continues to develop as an adult personality, and predicts many consequential outcomes throughout life related to mental health, peer relations, and family relations . The five-factor model is a well-accepted concept of personality in adults. According to this model, adult personality is divided into five domains or factors such as neuroticism, introversion, openness, agreeableness, and conscientiousness . Similarly, the most commonly accepted theory of temperament is by Thomas and Chess : they divided temperament into nine dimensions, namely activity level, rhythmicity, distractibility, approach withdrawal, adaptability, attention span- persistence, intensity of reaction, threshold of responsiveness, and quality of mood.
The rôle of temperamental dimensions and substance use
In adults, multiple studies have established the rôle of personality in substance use and abuse. Studies have reported lower conscientiousness and higher neuroticism to be related to a higher risk of using cigarettes and alcohol ,. Whereas a few other studies reported higher extroversion to be associated with a higher risk of substance use ,. Different dimensions of temperament lead to different patterns of responses to external stimuli. Some dimensions are considered to be protective, whereas others are considered to increase the preponderance of particular patterns of behavior, such as substance use in adolescents. Protective dimensions of temperament are related to self-control, whereas poor self-control has been correlated with an underlying vulnerability for substance abuse. A study reported that activity level and negative emotionality are related to risk-promoting dimensions and poor self-control . Another study of adolescent substance use has reported that higher sociability is associated with a higher risk of substance initiation. A higher rate of reactivity was at a higher risk of cigarette and cannabis use . But studies examining the rôle of temperament in adolescent substance use are still scarce. Hence, in this study, we intended to test the hypothesis that temperament would play a crucial rôle in adolescent substance use by comparing temperament among adolescents with substance use and healthy adolescents.
| Methods|| |
We did this cross-sectional case–control study in a tertiary care institute. All the participants were recruited after from the patients and their parents. The study protocol was approved by the ethics committee of the institute (protocol number = ECNEW/INST/2020/1221, and date of approval = February 1, 2021), requiring to obtain informed consent from the study participants.
The study sample was recruited by purposive sampling for one year, from January 2021 to December 2021. We evaluated the rôle of temperament in adolescent substance use in 35 adolescents aged 10–17 years and 35 normal controls.
In this study, adolescents attending outpatient clinics and inpatient services who were diagnosed with mental disorders due to substance use according to ICD-10 diagnostic criteria. Those who did not give informed consent, intellectually disabled, or having severe medical comorbidity were excluded from the study.
Instruments for data collection
The study group was interviewed for sociodemographic profiles such as age, gender, marital status, education, occupation, religion, type of family, income, and locality. A clinical profile sheet specially designed for the study has been used to collect data for age at onset of illness, type of substance use, total duration of illness, duration of treatment, details of current treatment, duration of hospitalization, and frequency of hospital visits.
Early Adolescent Temperament Questionnaire-Revised
Temperament was assessed using the Early Adolescent Temperament Questionnaire-Revised (EATQ-R) . The EATQ-R is a revision of a 1992 instrument developed by Capaldi and Rothbart. The current questionnaire was created to specifically tap into adolescent experiences and is available in self-report and parent-report formats. The children's scale consists of 12 subscales for children, namely activation control, affiliation, attention, fear, frustration, high-intensity pleasure/surgency, inhibitory control, pleasure sensitivity, perceptual sensitivity, shyness, aggression, depressive mood, and 10 for parent form, as it does not have pleasure sensitivity, and perceptual sensitivity subscales. To use the same, approval was sought from the developer, and necessary adaptations and modifications were made to use the local language, which is Assamese.
Individuals in the control group were recruited by purposive sampling from those attending various outpatient services of the hospital and from the children of hospital staff after collecting assent. Adolescents were screened with the MINI screen for any psychopathology, and those found negative for any psychiatric disorder were included.
We described categorical variables with frequency and percentage, and continuous variables with mean and standard deviation. Comparisons were made using the Chi-square test and t-test if appropriate. The association of temperament and other variables was studied using Pearson's correlation coefficient and Spearman's correlation coefficient.
Statistical analysis was performed using the International Business Machine Statistical Package for the Social Science software version 24 for Windows (IBM SPSS, Inc. Armonk, New York, USA). The differences between the groups were considered different if the p-values were less than 0.05.
| Results|| |
The study includes 35 adolescents along with their parents attending a psychiatry care facility in a tertiary care center in the northeastern part of India, and 35 controls from different outpatient clinics, children of staff members. [Table 1] shows the demographic profile of study participants of patients and controls. The mean age of the study group was 16.4 years. Ninety-four percent were male. The majority (54%) studied more than the 10th class. Totally, 91% of the study group belonged to a nuclear family setup. The majority of the study group (60%) belonged to low socioeconomic status. A comparison of the study group with the healthy group reveals significant differences in occupation, family setup, and socioeconomic status.
[Table 2] is the clinical profile of patients between sexes. The mean starting age of the substance use in the study group was 12 years. The mean duration of substance use while coming for treatment was 4 years. The majority of patients were diagnosed with multiple drug use (43%), followed by disorders due to opioid use (31%) and disorders due to alcohol use (11%). The first substance exposure was alcohol for 28% of patients, followed by cannabis and tobacco ~27%. The majority of patients (51%) were admitted to the hospital for the first time for a substance abuse problem. While male and female patients were compared, significance was found in the age of onset and first substance exposure.
[Table 3] describes the temperament of both the groups between cases and controls. When the temperament was assessed with the EATQ-R, the mean scores were highest for domains of frustration, aggression, surgency, and depressed mood and lowest for shyness for the study group. [Table 4] describes temperament as per the case and parent's report. When temperament, according to parents of the study group, was evaluated, the highest score was recorded for domains of surgency followed by aggression and frustration and lowest for shyness. While comparing temperament between the study group and the control group, significant differences were found between domains of activation control, aggression, attention, depressed mood, fear, inhibitory control, shyness, and surgency [Table 3].
|Table 4: Correlation of temperament of the study group with demographic profile and clinical profile|
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[Table 4] summarizes the correlation of temperament of the study group with demographic profile and clinical profile. No significant correlation was found with the demographic profile of the patients and temperament, but significance was found between the age of onset of substance use and the affiliation domain of temperament, which means the desire for warmth and closeness with others, independent of shyness or extroversion according to the scale. First substance use was found to be significantly correlated with activation control, affiliation, fear, and surgency domains. Similarly, when a comparison of temperament was made between the study group and temperament reported by parents, then significance was found between the domains of affiliation, aggression, attention, depressive mood, frustration, inhibitory control, and surgency [Table 5].
| Discussion|| |
This was a case and control study, consisting of 35 healthy adolescents and 35 adolescents, with psychoactive substance use. The sociodemographic profile and clinical profile of our study sample [Table 1] were similar that of prior studies on adolescent substance use ,,.
Previous research, trying to understand the rôle of temperament and adolescent substance use, reported that higher sociability, higher reactivity, and lower persistence are associated with an increased risk of substance use in adolescents ,. Another study has reported that risk-taking dimensions such as higher activity levels, negative emotions, poor behavioral control, and increased novelty-seeking behavior can lead to a variety of high-risk behaviors, including substance use in adolescents ,,. Negative emotionality is the tendency to easily and intensely getting upset, and studies have reported that negative emotionality is strongly linked to poor self-control ,, and, in such conditions, substances can be used as a coping mechanism for various environmental stressors ,.
In this study, temperament was assessed with the EATQ-R scale. The scores of EATQ-R in adolescents in the substance use group and in the control group were assessed. The scores of adolescents with substance use were higher in aggression, frustration, surgency, or novelty-seeking behavior than in the control group [Table 3]. The subscales of aggression and frustration are factors of negative affect or negative emotionality, which have been strongly linked to adolescent substance use, as has been reported earlier ,,,. The novelty-seeking behavior is one of the most reported temperamental dimensions, and the finding of this study resonates with those of previous studies ,.
However, scores in activation control, attention, shyness, inhibitory control, and fear were lower in the case group than in the control group [Table 5]. Activation control, attention, shyness, inhibitory control, and fear are considered the protective factors of temperament against substance use. In the cases, there were significantly low scores in all the protective domains of the temperament making them vulnerable toward high-risk behavior ,. Among the case and control groups, significance was seen for most of the domains of the EATQ-R scale except for affiliation, pleasure sensitivity, and perceptual sensitivity.
Temperament was further evaluated from parents of the adolescent with psychoactive substance use. While comparing the temperament reported by both the groups [Table 4], significant correlations were found between affiliation (p < 0.001), aggression (p < 0.05), attention (p < 0.001), depressive mood (p < 0.001), frustration (p < 0.001), and surgency (p < 0.001). These results confirm the temperamental risk factors for adolescent substance use.
The sociodemographic profile did not have any correlation with temperament; however, in the clinical profile, the age of onset had a significant correlation with the affiliation domain of the scale. Affiliation is the desire for warmth and closeness with others, which can be explained by family relation, peer influences, or peer recognition during the adolescent period. As it has been confirmed by previous studies ,,,. First substance exposure was significantly correlated with activation control, affiliation, fear, and surgency. This finding confirms previous findings that high novelty-seeking behavior and behavioral inhibition are strongly associated with adolescent substance use ,,.
There was no previous similar study in this regard from India. This study again puts emphasis on the rôle of temperament in adolescent substance use in our country. Early evaluation of temperament in adolescents can identify the high-risk traits of temperament for prevention, early detection, and management of adolescent substance use. Temperament-based intervention may help us personalize management plans for adolescence, increase treatment success rates, reduce relapse rates in adolescence, and reduce substance use in adults, as has been stated in other countries .
The readers are cautioned not to overinterpret the study's findings because it has following four limitations:
- It was a single-centered hospital-based study with a purposive sampling, a cross-sectional study, with a small sample size.
- There were a limited number of female patients, and there was a possibility of selection bias due to the purposive sampling method. In the future, a multicenter study with a larger sample size, a community study, and a prospective study need to be done to reproduce the results.
- Because the adolescents already had a history of psychoactive substance use when the study was conducted, one cannot comment on the influence of substance use on temperamental change.
- The study did not evaluate the temperament reported by parents of the control group, as well as other risk factors such as parental substance use, high-risk environment, neighbourhood socioeconomic status, and family environment, were not evaluated in the study.
This study suggests that temperament has a unique rôle in adolescent substance use, which is a growing issue worldwide. In this study, a marked difference was found in temperament between the case and control groups. Different subscales of the temperament scale were found to be related to adolescent substance use, likely activation control, affiliation, surgency, and fear. Person-specific treatment, taking into account the role of temperament, can be designed to provide better care and wholesome management of patients, as well as prevention programs can be initiated for high-risk children.
| Financial Support and Sponsorship|| |
| Conflicts of Interest|| |
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]