De la sensibilité différentielle à la diathèse-stress dans la prédiction de la consommation de substances à l’adolescence : interactions entre l’environnement familial et le tempérament au cours du développement

Les interactions personne-environnement dans la prédiction de la consommation de substances peuvent être interprétées selon plusieurs modèles théoriques. Le modèle de la diathèse-stress propose que certains individus (p.ex., individus impulsifs) aient une consommation de substances plus élevée que leurs pairs lorsqu’exposés à des environnements négatifs. Le modèle de la sensibilité différentielle propose que ces mêmes individus aient également une consommation de substances plus faible que leurs pairs lorsqu’exposés à des environnements positifs. L’objectif principal de la présente thèse est d’examiner les modèles de la diathèse-stress et de la sensibilité différentielle dans le contexte d’interactions entre le tempérament et l’environnement familial dans la prédiction de la consommation de substances à l’adolescence. Elle comporte quatre articles, soit une recension systématique des écrits, deux articles empiriques et une perspective. Le premier article présente une revue systématique de la littérature sur les interactions entre le tempérament et l’environnement familial dans la prédiction de la consommation de substances et des comportements extériorisés à l’adolescence. Les résultats montrent que les interactions entre le tempérament et l’environnement familial mesurés à l’enfance appuient le modèle de la sensibilité différentielle alors que les interactions entre ces facteurs mesurés à l’adolescence appuient le modèle de la diathèse-stress. Les analyses a posteriori concernant l’appui des modèles étant limitées sur le plan méthodologique, les deux articles suivants examinent ces effets a priori. Le deuxième article examine les interactions entre le tempérament (impulsivité et contrôle inhibiteur à 6 ans) et les pratiques parentales (pratiques maternelles coercitives à 6 ans et supervision parentale à 14 ans) dans la prédiction de la fréquence de consommation d’alcool à 15 ans. Les résultats montrent qu’une interaction entre l’impulsivité et les pratiques coercitives appuie le modèle de la sensibilité différentielle, ce qui appuie les conclusions de la revue de littérature. Le troisième article examine les interactions entre la personnalité (impulsivité et recherche de sensations à 15 ans) et la supervision parentale à 15 ans dans la prédiction de la fréquence de consommation d’alcool et de drogues à 15 et 17 ans. Les résultats montrent que les interactions entre l’impulsivité et la supervision parentale appuient le modèle de la sensibilité différentielle alors que les interactions entre la recherche de sensations et la supervision parentale appuient la diathèse-stress. Ainsi, le changement développemental observé dans la revue de littérature est appuyé avec l’impulsivité, mais la recherche de sensations pourrait s’avérer un facteur capturant la sensibilité aux environnements positifs et négatifs plus tard dans le développement. Le quatrième article va au-delà des comportements extériorisés et de la consommation de substances et propose comment le modèle de la sensibilité différentielle pourrait s’appliquer à l’étiologie du trouble de la personnalité limite. L’article présente comment plusieurs caractéristiques personnelles associées au trouble de la personnalité limite (p.ex., réactivité émotionnelle, impulsivité) pourraient refléter une sensibilité aux environnements positifs et négatifs. Suite à ces quatre articles, la discussion de la thèse aborde des points clés tels : une révision de la notion de vulnérabilité, l’importance de la prévention ciblée et l’importance d’analyser de façon détaillée les effets d’interaction.Person-environment interactions predicting substance use can be interpreted according to several developmental theoretical models. The diathesis-stress model suggests that certain individuals (e.g., impulsive individuals) would have higher substance use levels compared to their peers when they are exposed to negative environments. The differential susceptibility model suggests that these same individuals would also have lower substance use levels than their peers when exposed to positive environments. The main objective of this thesis is to examine the diathesis-stress and differential susceptibility models in the context of interactions between temperament and the familial environment when predicting adolescent substance use. It includes four articles, i.e., one systematic literature review, two empirical studies and one perspective paper. The first article presents a systematic literature review on the interaction between temperament and the familial environment in the prediction of adolescent substance use and externalizing behaviors. Results show that interactions between temperament and the familial environment measured in childhood support the differential susceptibility model while interactions between temperament and the familial environment measured in adolescence support the diathesis-stress model. Since the a posteriori analyses for the models were limited methodologically, the next two articles examined the patterns of interactions a priori. The second article examines the interaction between temperament (impulsivity and inhibitory control at 6 years) and parenting practices (maternal coercive parenting at 6 years and parental knowledge at 14 years) in the prediction of alcohol use frequency at 15 years. Results show that an interaction between impulsivity and coercive parenting supports the differential susceptibility model. Thus, results support the findings of the literature review. The third article examines the interactions between personality (impulsivity and sensation seeking at 15 years) and parental knowledge at 15 years in the prediction of binge drinking frequency and drug use frequency at 15 and 17 years. Results show that the interactions between impulsivity and parental knowledge support the differential susceptibility model whereas the interactions between sensation seeking and parental knowledge support the diathesis-stress model. Thus, the developmental shift observed in the literature is supported for impulsivity, but sensation seeking could be a characteristic capturing sensitivity to positive and negative environments later in development. The fourth article offers a perspective that goes beyond adolescent externalizing behavior and substance use and proposes how the differential susceptibility model could apply to borderline personality disorder. The article presents how several personal characteristics associated with borderline personality disorder (e.g., emotional reactivity, impulsivity) could be markers of a sensitivity to positive and negative environments. Following these four articles, the discussion addresses key points such as: a revision of the notion of vulnerability, the importance of targeted prevention and the importance of thorough analyses of interaction effects

Commentary : On the importance of looking at nonlinearity and developmental effects – a reflection on Flom et al. (2017)

By examining both linear and curvilinear associations between mental development and activity level, the study by Flom et al. (Journal of Child Psychology and Psychiatry, 2017) highlights the importance of going beyond linear associations in psychological fields of research. Results from Flom et al. (Journal of Child Psychology and Psychiatry, 2017) also raise interesting questions for future research. First, studies should look at variables that may explain the associations between activity level and mental development, such as self‐regulation and attention. Second, longitudinal changes in the strength of the association between activity level and mental development should be examined to determine when this association is at its strongest. Finally, longitudinal research looking at bidirectional effects is needed to confirm the direction of the associations between activity level and mental development. Answers to these questions will allow the identification of the best targets and developmental periods for interventions to take place

Differential susceptibility to the environment and borderline personality disorder

Evolutionary models of psychopathology can shed light on gene-environment interactions. Differential susceptibility to the environment means that heritable traits can have positive or negative effects, depending on environmental context. Thus, traits that increase risk for mental disorders when the environment is negative can be adaptive when the environment is positive. This model can be applied to borderline personality disorder, with predictors such as emotional dysregulation and impulsivity seen as temperamental variations leading to negative effects in an unfavorable environment but to positive effects in a favorable environment. This model may also be useful in conceptualizing the mechanisms of effective therapy for borderline personality disorder

The interaction between temperament and the family environment in adolescent substance use and externalizing behaviors : support for diathesis–stress or differential susceptibility?

Both individual and environmental factors predict externalizing behaviors and substance use (EB-SU); however, different patterns of interaction among these factors may have different implications. This review first examines how temperament and the family environment interact in the prediction of adolescent EB-SU. Second, studies are reviewed according to two theoretical models: (1) diathesis–stress, i.e., certain individual characteristics are linked to vulnerability and later problems in adverse environments; (2) differential susceptibility, i.e., these characteristics are linked to susceptibility, predicting problems in adverse environments, but also better than average outcomes in good environments. Fourteen studies focusing on the prediction of EB-SU at ages 12–18 were selected through a literature search. Results showed that certain temperament traits (high levels of impulsivity and disinhibition; low levels of effortful control, negative affect, fearfulness and shyness), hereby designated as “adventurous” disposition, were associated with higher levels of EB-SU in adverse family environments. Some studies also showed that children with “adventurous” temperament traits in positive environments had the lowest levels of EB-SU. This suggests that prevention of EB-SU might target family factors such as parenting and focus on children with “adventurous” temperament traits. Further, studies that supported the differential susceptibility model were those assessing temperament and the family environment in childhood and studies that supported the diathesis–stress model assessed these variables in adolescence. It is thus possible that some of these “adventurous” temperament traits, with regard to EB-SU, would be indicators of susceptibility to both enriched and adverse environments in childhood but no longer in adolescence, when they would only be indicators of vulnerability to adverse environments

The interactive effects of parental knowledge with impulsivity and sensation seeking in adolescent substance use

This study examined whether interactions of parental knowledge of adolescent’s whereabouts with impulsivity and sensation seeking in the prediction of adolescent substance use supported the diathesis–stress or differential susceptibility model in 230 15-year old adolescents (53% girls). Interactions between impulsivity and parental knowledge supported the diathesis–stress model with high impulsivity as a vulnerability factor: when impulsivity was higher, low levels of parental knowledge were associated with higher levels of substance use. Interactions between sensation seeking and parental knowledge supported differential susceptibility with low sensation seeking as a susceptibility factor; low parental knowledge was associated with higher substance use and high parental knowledge with lower substance use when sensation seeking was lower. Our results show that impulsivity and sensation seeking should be considered independently. Results support previous research suggesting that impulsivity in adolescence may act as a vulnerability factor and suggests that low sensation seeking may be a susceptibility factor

Academic, socioeconomic and interpersonal consequences of cannabis use : a narrative review

This article reviews the literature on the association between cannabis use (CU) and psychosocial functioning, operationalized here as academic achievement, economic prospects, social relationships and quality of life. So far, study results have been inconsistent. To clarify whether CU has an impact on psychosocial functioning, this article mainly reviewed prospective and longitudinal studies published since 2000 and examined whether studies controlled for confounding factors (e.g. socio-demographics, other substance use, psychopathology, social environment). The review suggested that when confounding variables are controlled for, the association between CU and psychosocial outcomes is generally small or non-significant. When significant associations remain, they are for chronic, dependent or early onset CU specifically, suggesting that the frequency of use and age of onset may be necessary elements to detect persistent, however small, psychosocial consequences. These results illustrate the importance of controlling for intra- and inter-individual differences to examine the link between CU and later psychosocial functioning. Results also suggest that policy and prevention efforts should consider targeting the individual and environmental factors (e.g. early academic and cognitive functioning, social disadvantage, family functioning, personality, smoking) that account for much of the association between CU and later psychosocial problems, rather than, or in addition to, CU itself

Differential susceptibility to environmental influences : Interactions between child temperament and parenting in adolescent alcohol use

Temperament and parental practices (PP) are important predictors of adolescent alcohol use (AU); however, less is known about how they combine to increase or decrease risk of AU. This study examined whether age 6 temperament (i.e., impulsivity and inhibitory control) interacted with age 6 coercive PP and/or age 14 parental monitoring to predict AU at 15 years among 209 adolescents. Results showed that low parental monitoring was associated with more frequent AU and that coercive PP interacted with impulsivity to predict AU. This interaction was examined as a function of two models that were not studied before in the prediction of AU: the diathesis-stress model (i.e., impulsive children are more "vulnerable" to adverse PP than those with an easy temperament); and the differential susceptibility model (i.e., impulsive children are also more likely to benefit from good PP). Results supported the differential susceptibility model by showing that impulsive children were not only at higher risk for AU when combined with high coercive PP but also benefit from the absence of coercive PP. This supports the suggestion that the conception of certain temperament characteristics, or in this case impulsivity, as a "vulnerability" for adolescent AU, may need revision because it misrepresents the malleability it may imply

Age of cannabis use onset and adult drug abuse symptoms : a prospective study of common risk factors and indirect effects

Objective: The present study examined (1) whether the associations between cannabis use (CU) age of onset and drug abuse by 28 years remain when controlling for risk factors in childhood, adolescence and early adulthood; and (2) developmental pathways from early risk factors to drug abuse problems. Method: Participants from a longitudinal sample of low SES boys (N=1030) were followed from 6 to 28 years. Self-reported CU onset between 13 and 17 years of age and drug abuse symptoms by 28 years were examined. Results: The odds of developing any drug abuse symptoms by 28 years were reduced by 31% for each year of delayed CU onset (OR = 0.69). Cannabis, alcohol and other drug frequency at 17 years mediated this association. Still, even when taking that frequency of use into account, adolescents who started using cannabis before 15 years were at higher risk of developing drug abuse symptoms by age 28. Significant indirect effects were found from early adolescent delinquency and affiliation with deviant friends to drug abuse symptoms at 28 years through CU age of onset and substance use frequency at 17 years. Conclusions: Results suggest more clearly than before that prevention programs should aim at delaying CU onset in order to prevent or reduce drug abuse in adulthood. Furthermore, prevention programs targeting delinquency and/or affiliation with deviant friends in childhood or early adolescence could indirectly reduce substance abuse in adulthood without addressing substance use specifically

The 3D-Transition study : objectives, methods, and implementation of an innovative planned missing data design

The prevalence of mental health problems represents a significant burden on school and community health resources as early as preschool. Reducing this burden requires a better understanding of the developmental mechanisms linking children’s early vulnerabilities with mental health after the transition to formal schooling. The 3D-Transition study (2017-2021; ClinicalTrials.org ID: NCT04873518) follows 939 participants from a pregnancy cohort in Québec (Canada) as they transition to kindergarten and first grade to examine these mechanisms. Biannual assessments include questionnaires from two parents as well as teachers, parent-child observations, anthropometric measurements, and age-sensitive cognitive assessments. Salivary cortisol is also collected on 11 days over a 16-month period in a subsample of 384 participants to examine possible changes in child salivary cortisol levels across the school transition, and their role in difficulties observed during the transition. A combination of planned missing data designs is implemented to reduce participant burden, where incomplete data is collected without introducing bias after the use of multiple imputation. The 3D-Transition study will contribute to an evidence-based developmental framework of child mental health from pregnancy to school age. In turn, this framework can help inform prevention programs delivered in health care settings during pregnancy, childcare centers, preschools, and schools

Romantic Relationship Quality and Mental Health in Pregnancy During the COVID-19 Pandemic

Introduction: Social capital is important for good mental health and the quality of close relationships is one key indicator of social capital. Examining the association between relationship quality and mental health may be particularly important during pregnancy as mental health concerns during this period pose significant risk to families. The COVID-19 pandemic has contributed to increased mental health problems among pregnant individuals. The resulting lockdown protocols of the pandemic has also disrupted larger social networks and couples spent more time together in the context of ongoing chronic stress, highlighting the particular importance of romantic relationship quality. This study explored longitudinal associations between relationship satisfaction, depression, and anxiety among pregnant individuals during the first wave of the COVID-19 pandemic. Methods: Pregnant individuals (n = 1842) from the Pregnancy During the Pandemic Study were surveyed monthly (April-July 2020). Depression and anxiety symptoms, and relationship satisfaction were self-reported. Cross-lagged panel models were conducted to examine bidirectional associations between relationship satisfaction and mental health symptoms over time. Results: Relationship satisfaction was significantly correlated with depression and anxiety at all time points. Longitudinally, relationship satisfaction predicted later depression and anxiety symptoms, but depressive and anxiety symptoms did not predict later relationship satisfaction. Discussion: This study suggests that poor relationship satisfaction was linked to subsequent elevations in prenatal depressive and anxiety symptoms during the COVID-19 pandemic. Relationship enhancement interventions during pregnancy may be a means of improving the mental health of pregnant individuals, and interrupting transgenerational transmission, during times of prolonged psychological distress.Social Sciences and Humanities Research Council (SSHRC)Alberta Innovates - Research GrantCanadian Institutes of Health Research (CIHR)Othe