Substance use and psychological distress among school-going adolescents in 41 low-income and middle-income countries

Abstract

BackgroundSubstance use remains a public health problem worldwide, and it is particularly concerning among adolescents because of its harmful effects. There is a need to better understand the factors associated with adolescents’ substance use to inform policies for effective prevention. MethodsWe used data from the Global School-based Student Health Surveys. Data were collected by anonymous self-report questionnaires. This study is based on three questions assessing substance use and four questions assessing psychological distress. Logistic regression models were used to analyse associations between substance use and psychological distress. We calculated the pooled overall and regional estimates by random-effects meta-analysis. ResultsWe included 126,763 adolescents (boys, 44.7%; girls, 55.3%). Substance users tended to be older, male, physically attacked, in physical fighting, bullied; to experience psychological distress; and to have a higher socio-economic status. Alcohol use was consistently associated with medium and high psychological distress. In terms of four aspects of psychological distress, only suicidal ideation was consistently associated with the substance use components and all specific combinations of substance use. Additionally, the prevalence of alcohol use was higher than that of cigarette use and drug use. Region-wise analysis showed that substance use was associated with psychological distress in the African region, American region, South-East region and Western Pacific region. LimitationsThe cross-sectional data could not infer causality. ConclusionsThis study indicated that high levels of substance use were significantly associated with an increased likelihood of psychological distress among adolescents. In addition, age also had an effect on substance use.