THE ROLE OF MALTREATMENT-MENTAL HEALTH TYPOLOGY AND GENDER IN ADOLESCENT DISTRESS IN A SUBSTANCE USING OUTPATIENT POPULATION

The present study used K-means cluster analysis to classify adolescents receiving outpatient substance abuse treatment services using their self-reported childhood maltreatment experiences, adolescent alcohol and drug abuse and dependence symptoms and conduct disorder symptoms. A diverse, multi-ethnic sample of 394 adolescents (280 males, 114 females) was used in cluster analyses, conducted separately by gender, to describe gender differences in the patterning of component variables in homogenous subgroups of boys and girls. Identification of these subgroup differences provides important information for treatment planning purposes, and may help to identify types of male and female adolescents at high risk for maladaptive treatment outcomes, including premature treatment exit and relapse. Comparisons of 3-part, 4-part and 5-part cluster solutions indicated an optimal 3-part cluster solution for both male and female participants. The optimal solutions each included a large ‘Low Adversities’ group, reporting lower scores for both childhood maltreatment experiences and adolescent externalizing behaviors. Each optimal cluster solution also contained a ‘Multiple Adversities’ group, reporting the most extensive patterns of childhood maltreatment experiences and adolescent externalizing behaviors. Characteristics of the third cluster differed for boy and girls, but can be characterized as presenting with mixed patterns of childhood maltreatment experiences and adolescent externalizing behaviors, intermediate between the ‘Low Adversities’ and ‘Multiple Adversities’ groups. As a second step in the validation process for the cluster solutions, MANOVAs were used to examine between-cluster differences in levels of serious internalizing problems (overall distress, anxiety disorder symptoms and affective disorder symptoms) separately for boys and girls. Results documented significant relations between cluster membership and overall distress scores and affective disorder symptoms for girls, compared to significant between-cluster differences in anxiety disorder and affective disorder scores for boys. Girls reporting the highest distress scores were members of the ‘high Adversities’ cluster, characterized by severe experiences of abuse, and in particular, sexual abuse. Membership in the ‘High Adversities’ group for boys was associated with the highest mean scores for both anxiety disorder symptoms and affective disorder symptoms, suggesting a significant relation between maltreatment experiences and serious internalizing problems for boys, as well as girls. These results suggest that meaningful gender similarities and differences exist in relations among childhood maltreatment experiences, adolescent externalizing behaviors, and serious internalizing behaviors among adolescents receiving substance abuse treatment services. These results may have important implications for adolescents’ level of engagement in outpatient substance treatment and suggest a potential source of concern for efforts to reduce the likelihood of substance use slips and relapse.