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ISSN: 2378-5756
Journal of Psychiatry
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The Frequency of Co-occuring Disorders, Childhood Trauma and Selfesteem in the Parents of Substance Dependent Individuals

Suat Ekinci1* and Hasan Kandemir2

1Department of Psychiatry; Balıklı Rum Foundation Hospital, Addicton Service, İstanbul, Turkey

2Department of Child Psychiatry; Harran University, Şanlıurfa, Turkey

*Corresponding Author:
Suat Ekinci
Balıklı Rum Foundation Hospital
Addicton Service
Zeytinburnu//İstanbul, Turkey
Tel: +90 212 547 16 00
Fax: +90 212 51020 75
E-mail: [email protected]

Received Date: November 13, 2014; Accepted Date: January 25, 2015; Published Date: February 03, 2015

Citation: Ekinci S, Kandemir H (2015) The Frequency of Co-occuring Disorders, Childhood Trauma and Self-esteem in the Parents of Substance Dependent Individuals. J Psychiatry 18:240. doi: 10.4172/Psychiatry.1000240

Copyright: ©2015 Ekinci S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Substance dependence; Parents; Trauma; Co-occuring disorders.


It has been demonstrated that childhood traumas are a risk factor for psychiatric disorders [1-3]. Studies have shown that childhood emotional and physical abuse, sexual abuse, substance abuse, and low self esteem contribute to sexual and interpersonal relationship problems [4-6]. Substance dependent people frequently show a history of significant childhood trauma [7-9]. There are also many epidemiological studies that show high rates of psychiatric disorders co-occuring with substance dependency disorders [10,11]. During the treatment of dependent individuals, our observations that families of dependent patients are more likely to have co-occuring psychiatric diagnosis and complaints about childhood traumas in family interviews is motivated us to make this study. Despite all the studies that show high rates of childhood traumas and co-occuring disorders, parents of substance dependent have not been well studied. We believe that this is a gap in the literature that should be remedied.

The Goals of the Study

1. To research the incidence of childhood traumas and self-esteem problems in parents of substance dependent indivuduals.

2. To find the frequency of Axis 1 disorders among parents of individuals with substance dependency.



The study group was made up of the parents of 40 individuals who presented to the Private Balıklı Rum Hospital in Istanbul and were diagnosed according to DSMIV-TR criteria as substance dependent. All could read and write and agreed to participate in the study. A control group of 40 people was matched with the study group by sex and age, showed no Axis 1 diagnosis, and agreed to participate in the study. Those who did not agree to participate, who could not read or write, or who showed a psychotic disorder or a mental disability were excluded from the study. Local ethics committee aproval was obtained. All subjects were interviewed face to face by a clincian (S.E.).

Measurement instruments

PSD individuals and the control group were both administered a sociodemographic information form, a Beck Depression Inventory (BDI), a Beck Anxiety Inventory (BAI), Childhood Trauma Questionnaire (CTQ) and The Rosenberg Self-Esteem Scale RSS.

Sociodemographic Data Questionnaire: The researchers prepared and administered a questionnaire to determine each subject’s age, gender, education level, marital status, substances used, age at first substance use, and history of suicidal thoughts and attempts.

The Childhood Traumatic Experiences Questionnaire (CTEQ) : Bernstein et al. developed this instrument to measure traumatic experiences before the age of 18 [12]. This 40 item scale scored on a 5 point likert scale. It has three subscales: Emtional Abuse and Emotional Neglect (EA, EN) Physical Abuse (PA), Sexual Abuse (SA), The subscales are made up of EA/EN-19 items, PA 16 items, and SA 5 items. The Turkish version was found valid and reliable by Aslan and Alparslan [13]. The total points can vary from 40 to 200 points. A high score indicates frequent childhood traumatic experiences.

The Rosenberg Self-Esteem Scale (RSS): RSS was developed by Rosenberg [14]. It is made up of 63 items with 12 subscales. Each subscale is made up of 10 items, the first subscale measures self esteem. This study used the self esteem subscale. On this subscale 0-1 points are considered high, 2-4 points are considered average, and 5-6 points are considered low. The validity and reliability study of the Turkish version was conducted by Çuhadaroğlu [15].

Beck Depression Inventory (BDI): The Beck Depression Inventory was developed to measure adult risk for depression, the level of depression symptoms and their severity [16]. The Turkish validity and reliability study was done by Hisli [17] who identified the cut off point as [17].

Beck Anxiety Inventory (BAI): Beck et al. developed this self report scale to measure the frequency of Anxiety symptoms [18]. The scale is made up of 21 items scored on a 0-3 point likert scale. The Turkish version’s validity and reliability has been confirmed by Ulusoy et al. [19].

Statistical Analysis

The data were analyzed using the SPSS 13.0 package program for Windows. A chi-square test was used to evaluate the differences between categories. A t-test was used to evaluate the differences between the means of the two groups. A pearson correlation analysis was used to analyze the differences between the directions and levels of the relationships. The value of statitistical significance established for all the data was p<0.05.


No statistically significant differences were identified between the control and the Parents of Substance Dependent individuals (PSD) groups in terms of age, gender, education level and marital status (p>0.005) (Table 1).

Significance PDS (n:40)   CG (n: 40)
Age (mean+sd) 50.23 ± 7.10 47.78 ± 6.98 t=1.55
p=0.124     t=1.55
Gender (man/woman) ( 23/17) (23/17) χ2 =
Education level 8.50 ± 3.41 8.88 ± 3.69 t=-
Employment status;working 22 27 χ2=
not working 18 13  
Marital status married 32 36
χ2 =1.569p =0.21 divorced 8 4

Table 1: Parents of Substance Dependent and Control Groups compared according to Sociodemographic and Clinical variables.

In the PSD group at least 20 individuals were identified with Axis 1 diagnoses, (50%) In 4 individuals (10%) alcohol abuse disorder, 1 person (2.5%) substance dependency was found (Table 2). When the scores of the two groups were compared the PSD group’s BDI and BAI scores were higher and this difference was statistically significant. (p<0.001) (Table 3) When childhood traumatic experiences scores were compared the PSD group’s CTE total points and their physical and sexual abuse scale points were high at a statistically significant level (p<0.05). Emotional Abuse/Emotional Neglect scale scores did not show a signficant difference between the two groups (p>0.05) (Table 3).

M. Depression 9 (%22.5)
Dysthymic Disorder 4(%10)
GAD 4(%10)
OCD 1 (%2.5)
PTSD 2 (%5)
Alcohol abuse 2 (%5)
Alcoholdependency 2 (%5)
Substance dependency 1 (%2.5)

Table 2: PSD groups Axis 1 co-occuring disorders.

  PSD group Control group significance
Beck Depression Inventory 18.50 ± 13.17 5.48 ± 3.04 t=6.09
Beck Anxiety Inventory   17.08 ± 14.27 3.84 ± 2.25
Emtional abuse and emotional neglect 36.78 ± 10.10 33.65 ± 6.53 t=1.64
Pysical abuse      
p=0.023 28.35 ± 7.84 24.90 ± 5.21 t=2.31
Sexual abuse      
p=0.009 8.73 ± 3.13 7.15 ± 1.98 t=2.68
Childhood traumatic expereinces scale total scores 74.28 ± 19.45 65.25 ± 10.58 t=2.57
Rosenberg self-esteem scale 1.31 ± 0.80 65.25 ± 10.58 t=5.21

Table 3: Comparison of the points of the two groups.

There were 5 individuals in this study who were identified as having an alcohol or substance abuse disorder. When the 35 individuals without alcohol and substance abuse disorders scores on the childhood trauma scales were compared with the control group, a statistically significant difference between the two groups was found on the sexual abuse and phsycial abuse subscales. (in order t=2.342, p=0.022, t=2,351, p=0.021, t=2,426, p= 0.018). On the EA and EN subscales no significant differences were found (t=1,222, p=0.226).

In the PSD group statistically significant low levels of self esteem were identified (p<0.001) (Table 3).


Our study examined the childhood traumatic experiences, the self esteem and the Axis 1 co-occuring disorders of Parents of individuals with Substance dependency. High rates of physical and sexual abuse but not for emotional abuse and neglect were found among these PSD’s. Others have also found frequent substance dependence, and childhood abuse among substance dependent individuals [3,20-22]. We were not able to compare this with studies of PSD because they have not been studied. In this study there were 5 individuals with alcohol and substance use disorders. When compared with 35 controls without alcohol and substance abuse disorders we found that the results did not vary. In the PSD group we identified 32.5% affective disorders; 22.5% Major Depression and 10% dysthymic disorders. When Lubman et al. studied individuals with substance abuse disorders they identified a 27% rate of MD [23]. In inpatient studies, Hovens et al. identified 48% of substance dependent people showed dysthymic and other depressive disorders [24]. Deykin et al. identified 25% as having MD [25]. In our study we found a high rate of co-occuring affective disorders.

In a study conducted by Yüncü et al. of the frequency of co-occuring disorders among the parents of adults with Substance Abuse Disorders, at least 51.1% of them showed at least 1 additional Axis 1 diagnosis, 33% showed an affective disorder, 11.4% showed and alcohol or substance abuse disorder. In our study, in accord with previous studies, of the PSD group 32.5% showed an affective disorder, 12.5% showed an alcohol or substance abuse disorder. In our study we identified 3 people (7.5%) with GAD , which is a higher rate than in previous studies of substance dependent individuals and parents of substance abuse disorder individuals [23-26]. It is possible that this is due to the composition of our study group.

There are some limits of our study. We examined patients of inpatients. It is possible that a retrospective self-evaluation of childhood traumatic experiences could be seen as a limit. In order to overcome this limit it would be necessary to do prospective longitudinal studies.


In our study of parents of substance dependent individuals we found high rates of childhood sexual and phuysical abuse, co-occuring Axis 1 diagnoses and low levels of self esteeem. It is necessary to repeat these measurements with larger sized study groups. In this study, it is revealed that families of substance-dependent patients have high incidence of childhood traumas even without dependency. In the treatment of dependent patients, we suggested that it is required to consider there might be hight rates of co-occuring psychiatric diagnosis and childhood traumas in families of these patients and therapeutic interventions would be needed.


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