- "Negative emotionality" (NE) reflects a tendency toward depression, anxiety, and poor reaction to stress.
- Prior studies have shown that adolescents with alcohol use disorders (AUDs) self report more health problems than 'normal' adolescents do.
- A new study has found that adolescents with AUDs self report many more health problems than supported by laboratory and physical exam findings.
- These reported health problems seem to be predominantly of psychological origin or NE.
"Negative emotionality" (NE) is the antithesis of positive thinking. NE refers to a propensity toward depression and anxiety, and a tendency to react to stressful situations with unpleasant emotions. A study in the September issue of Alcoholism: Clinical & Experimental Research examines the relevance of NE to health problems self reported by adolescents with alcohol use disorders.
"Everyone has a degree of negative emotionality," said Duncan B. Clark, a psychiatrist, psychologist, director of the Pittsburgh Adolescent Alcohol Research Center, and lead author of the study. "This is not a disorder or a categorical trait; it is the degree to which an individual reports certain emotional characteristics."
Prior studies had shown that adolescents with alcohol use disorders (AUDs) tend to self report more health problems than 'normal' adolescents do. Self-reported health problems may also be considered health complaints. Information about the origin of these problems/complaints was less forthcoming, which prompted Clark and his colleagues to undertake their study.
"There are four likely explanations," said Clark. "One, these symptoms may be due to biomedical problems caused by alcohol. Two, they're related to cigarette smoking, also common in this group. Three, the complaints may be related to anxiety and depression, and may therefore be considered 'psychosomatic.' Four, adolescents with alcohol use disorders have relatively poor health maintenance and, therefore, more health problems as a result. We found evidence that all four of these mechanisms are operating."
Study participants (the average age was 16 years) were asked to self report health symptoms from 136 possibilities in 15 areas (such as sleep, heart and lungs, and neurology), have three serum liver enzyme levels measured, submit to physical examinations by a medical professional, and have their NE measured via questionnaires and an interview. Certain connections were immediately apparent among the group with AUDs. Symptoms linked to heart and lungs, such as shortness of breath, were correlated with smoking. The liver enzyme elevation, albeit modest, demonstrated a risk for liver injury. Abnormal oral exam results reflected poor health maintenance. However, said Clark, whereas laboratory and physical exam findings were relatively normal, self reported health problems or health complaints were highly elevated.
"Most of the complaint areas were highly correlated with negative emotionality," he said, "our index of anxiety and depression. The apparently small degree of organ disease or damage evident in the laboratory results and physical exams suggests that the health problems were predominantly of psychological origin. However, I would not go so far as to say these health problems were 'all in their head.' Anxiety and depression have been shown to cause demonstrable physical changes."
Alcohol use and associated problems typically begin during the teenage years, and often rise dramatically. In 1999, according to the 10th Special Report to the U.S. Congress on Alcohol and Health, 52 percent of 8th graders (14-year-olds) and 80 percent of 12th graders (18-year-olds) reported having used alcohol at least once. Research indicates that rates of AUDs also rise dramatically during adolescence, and are nearly as high as those of adults by the end of this period (18 years of age).
"Adolescents' alcohol involvement is occurring during a period of time when their bodies are still developing," said Sandra A. Brown, chief of psychology at the VA San Diego Healthcare System and professor of psychology and psychiatry at the University of California, San Diego. "Early and protracted alcohol use by teens can have both short and long term health effects. For example, in our studies of youth evaluated over a six-year period, we found that respiratory, and accident and trauma injuries, were particularly more prevalent among youth with alcohol use disorders than among youth with similar backgrounds but without alcohol use disorders. We've also found that health problems are more severe the longer that heavy alcohol use goes on during adolescence, and that girls report more adverse effects than boys. Clearly," she added, "alcohol use disorders during both adolescence and adulthood have important ramifications for an individual's medical health, mental health, and cognitive functioning."
"What this study highlights," said Brown, "is that negative emotions and alcohol use disorders go hand in hand. What remains to sort out is when those negative emotions are substance/alcohol induced, as they can be in adults, and when they are a factor that could lead someone to use alcohol, and consequently, have the health problems that were examined in the Clark study."
Co-authors of the Alcoholism: Clinical & Experimental Research paper included: Kevin G. Lynch and John E. Donovan of the Pittsburgh Adolescent Alcohol Research Center; and Geoffrey D. Block of the Department of Surgery at the University of Pittsburgh School of Medicine.
The study was funded by the National Institute on Alcohol Abuse and Alcoholism.