Symptoms of anxiety and depression in childhood and use of MDMA: prospective, population based study

BMJ 2006; 332 doi: (Published 06 April 2006) Cite this as: BMJ 2006;332:825
  1. Anja C Huizink, assistant professor (a.c.huizink{at},
  2. Robert F Ferdinand, psychiatrist1,
  3. Jan van der Ende, assistant professor1,
  4. Frank C Verhulst, professor1
  1. 1 Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam/Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, Netherlands
  1. Correspondence to: A C Huizink
  • Accepted 10 January 2006


Objective To investigate whether using ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is preceded by symptoms of behavioural and emotional problems in childhood and early adolescence.

Design Prospective, longitudinal, population based study.

Setting The Dutch province of Zuid-Holland. Participants A sample of 1580 individuals, followed up across a 14 year period, from childhood into adulthood.

Main outcome measures The first assessment took place in 1983 before MDMA appeared as a recreational drug in the Netherlands and included the child behaviour checklist to obtain standardised parents' reports of their children's behavioural and emotional problems. Use of the drug was assessed with the composite international diagnostic interview 14 years later.

Results Eight syndrome scales of childhood behaviour were examined. Scores in the deviant range for the scales designated as anxious or depressed in childhood were significantly related to use of MDMA in adolescents and adults, resulting in an increased risk (hazard ratio 2.22, 95% confidence interval 1.20 to 4.11, P = 0.01).

Conclusions Individuals with childhood symptoms of anxiety and depression may have an increased tendency to use MDMA in adolescence or young adulthood. Its effects are supposed to include enhanced feelings of bonding with other people, euphoria, or relaxation. Especially individuals with symptoms of anxiety or depression may be susceptible to these positive effects.


  • Contributors ACH wrote the first draft of the manuscript, performed part of the statistical analyses, and coordinated the present study. RFF reviewed the first draft of the manuscript in detail. JvdE performed part of the statistical analyses and was responsible for the coordination of the data collection of the Zuid-Holland sample. FCV conceived the study and supervised the project. All authors interpreted the findings of this manuscript regarding their own specific field of expertise; RFF and FCV are experts in the field of child and adolescent psychiatry, and JvdE is an expert in statistical analyses of epidemiological studies. All authors helped to conceptualise ideas, interpret findings, and review drafts of the manuscripts. ACH is guarantor.

  • Funding The data collection of the Zuid-Holland sample was financially supported by grant number 002827230 from the Health Research and Development Council, Netherlands (Zorgonderzoek Nederland).

  • Competing interests None declared.

  • Ethical approval The Dutch human subjects committee approved this study, and each assessment phase of this study was approved by the Committee for Medical Ethics, Erasmus Medical Center/Sophia Children's Hospital.

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