Substance use classes and symptoms of anxiety and depression among Canadian secondary school students

Abstract

Introduction Few studies have assessed patterns of substance use among Canadian adolescents. This cross-sectional study examined substance use classes among Canadian secondary school students and associations with anxiety and depression. Methods This study used data from Year 6 (2017/18) of the COMPASS study. Students (n = 51 767) reported their substance use (alcohol, cannabis, cigarette and e-cigarette use) and anxiety and depression symptoms. We employed latent class analysis to identify substance use classes and multinomial logistic regression to examine how anxiety and depression were associated with class membership. Results Overall, 40% of students indicated having anxiety and/or depression (50% in females; 29% in males) and 60% of students reported substance use (60% in females; 61% in males). We identified three substance use classes: poly-use, dual use, and non-use. Females with both anxiety and depression had the highest odds of being in the poly-use class compared to the non-use class (odds ratio [OR] = 4.09; 95% confidence interval [CI]: 3.59–4.65) followed by females with depression only (OR = 2.65; 95% CI: 2.31–3.04) and males with both anxiety and depression (OR = 2.48; 95% CI: 2.19–2.80). Symptomatology was also associated with belonging to the dual use class except among males with anxiety only (OR = 1.13; 95% CI: 0.94–1.37). Conclusion Canadian secondary school students are engaging in dual and poly-substance use, and anxiety and depression were associated with such use. Females had a higher prevalence of anxiety and depression and should be a priority population for mental health programming.

Exploring the Bi-Directional Associations Between Poly-Substance Use and Symptoms of Anxiety and Depression Among a Large Sample of Canadian Adolescents

“…In contrast to our findings in the full sample, among students who used substances each year, we identified uni-directional effects with poly-substance being associated with increased anxiety in female students and increased anxiety and depression in male students from Wave 2 to Wave 3. Exploratory analysis from Wave 2 to Wave 3 (Supplementary Table 8, http://links.lww.com/CJA/A18) found that cigarette use may be partly driving this association, although it is important to note that previous research has also found an association between poly-use of alcohol and e-cigarettes and anxiety and depression 2 . These results are in part consistent with previous longitudinal research 13,14 .…”

“…[5][6][7][8][9] For instance, poly-substance use has been associated with elevated symptoms of depression and anxiety among adolescents aged 11 to 18 in crosssectional studies. 2,10 However, among studies that have examined depression symptoms at baseline and poly-substance use at follow-up, none have identified significant effects after controlling for covariates. 11,12 A small cohort study examined the effect in the opposite direction and identified that youth that used the highest number of substances had the highest depression scores at followup, although this study did not control for covariates.…”

“…Additionally, previous longitudinal studies have not explored sex differences even though previous crosssectional studies have identified important sex differences that should be further explored. 2,10 Patterns of polysubstance use, anxiety, and depression differ between female and male adolescents. 2,10,16 Female students report higher anxiety and depression symptoms [16][17][18][19] and these sex differences tend to increase across adolescence.…”

“…2,10 Patterns of polysubstance use, anxiety, and depression differ between female and male adolescents. 2,10,16 Female students report higher anxiety and depression symptoms [16][17][18][19] and these sex differences tend to increase across adolescence. 20,21 Conversely, male students typically report higher levels of poly-substance use, both more substances and higher frequency of use.…”

“…20,21 Conversely, male students typically report higher levels of poly-substance use, both more substances and higher frequency of use. 2,6,10 Adolescence is a critical developmental period as over half of mental disorder symptoms are thought to initiate during this time. 22 Having a better understanding of these relationships including any sexbased differences can help in tailoring prevention programming to different groups.…”