Perceived Cognitive Competence, Depressive Symptoms and the Incidence of Alcohol-Related Problems in Urban School Children

Objective: This study is to test the hypothesis that poor perceived cognitive competence might signal an increased risk of subsequent alcohol-related problems in children. Method: A prospective epidemiologic study of elementary school students aged 9-13 years in Baltimore, Maryland, was undertaken. Perceived cognitive competence, peer use of alcohol, and other suspected risk characteristics for alcohol-related problems were assessed in 1990, among 1232 children with no prior history of problems associated with drinking alcohol. Occurrences of alcohol-related problems were assessed in subsequent annual interviews through 1994. Results: Four years later, 17.6% of these children are found to have developed one or more alcohol-related problems for the first time during the follow-up. Having depressive symptoms is associated with higher risk of developing alcohol-related problems while perceived cognitive competence is not (estimated Relative Risk (RR) = 1.6, 95% Confidence Interval (CI) 1.1-2.1 for depressive symptoms). The evidence from exploratory analyses suggests a possible interaction between depressive symptoms and perceived cognitive competence. Alcohol-related problems develop earlier for youths reporting both lower perceived cognitive competence and depressive symptoms relative to those with no depressive symptoms and high perceived cognitive competence. Furthermore, among children with at least one depressive symptom, having low or moderate perceived cognitive competence is associated with doubling the risk of developing alcohol-related problems relative to those with high cognitive competence (RR = 2.3, 95%CI 1.1-4.7 for low competence; RR = 2.1, 95%CI 1.2-3.9 for moderate competence). Conclusions: The evidence does not support a strong association between perceived cognitive competence and later alcohol-related problems. However, the exploratory search for interactions disclosed a possibility that depressive symptoms and poor perceived cognitive competence might combine to foster subsequent development of alcohol-related problems.