Abstract
Mental health problems, alcohol misuse, and drug misuse are prevalent in postsecondary students. However, the links between mental health, alcohol, and drug use are tangled. The present study examined alcohol use and drug use as predictors of psychological distress in postsecondary students at a large metropolitan Canadian university. An online survey was used to collect data from 3288 undergraduate students using the Alcohol Use Disorders Identification Test (AUDIT), the Drug Abuse Screening Test (DAST), and the Kessler Psychological Distress Scale (K-10). There was a significant correlation between high-risk level alcohol use and moderate-to-severe mental distress (r = .422, 95% CI = .200–.602, p < .0005) and between intermediate-to-severe drug abuse and moderate-to-severe mental distress (r = .144, 95% CI = .011–.272, p = .034). The AUDIT score and gender were significantly associated with moderate-to-severe mental distress (χ2 = 94.288, p < .0005). The DAST score and gender were also significantly associated with moderate-to-severe mental distress (χ2 = 89.757, p < .0005) when referenced to the “no mental disorder” group. Heavy drinking and a high-risk level of drug use were both associated with psychological distress. The associations between the effects of alcohol and drug use on mental health might differ according to gender.
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Alati, R., Lawlor, D. A., Najman, J. M., Williams, G. M., Bor, W., & O'Callaghan, M. (2005). Is there really a ‘J-shaped’ curve in the association between alcohol consumption and symptoms of depression and anxiety? Findings from the Mater-University study of pregnancy and its outcomes. Addiction, 100(5), 643–651.
American College Health Association. (2016). American college health association-National College Health Assessment II: Canadian reference group executive summary spring 2016. Hanover: American College Health Association.
American College Health Association. (2019). American college health association-National College Health Assessment II: Canadian reference group executive summary spring 2016. Hanover: American College Health Association.
Andrews, G., & Slade, T. (2001). Interpreting scores on the Kessler psychological distress scale. (K10). Australian and New Zealand Journal of Public Health, 25(6), 494–497.
Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., et al. (2016). Mental disorders among college students in the World Health Organization world mental health surveys. Psychological Medicine, 46(14), 2955–2970.
Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). The alcohol use disorders identification test: guidelines for use in primary health care (2nd ed.). Geneva: World Health Organization.
Barry, K. L., & Fleming, M. F. (1993). The alcohol use disorders identification test (AUDIT) and the SMAST-13: predictive validity in a rural primary care sample. Alcohol and Alcoholism, 28(1), 33–42.
Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106(5), 906–914.
Burns, S., Jancey, J., Crawford, G., Hallett, J., Portsmouth, L., & Longo, J. (2016). A cross sectional evaluation of an alcohol intervention targeting young university students. BMC Public Health, 16, 610. https://doi.org/10.1186/s12889-016-3314-4.
Caldwell, T. M., Rodgers, B., Jorm, A. F., Christensen, H., Jacomb, P. A., Korten, A. E., & Lynskey, M. T. (2002). Patterns of association between alcohol consumption and symptoms of depression and anxiety in young adults. Addiction, 97(5), 583–594.
Chinneck, A., Thompson, K., Mahu, I. T., Davis-MacNevin, P., Dobson, K., & Stewart, S. H. (2018). Personality and prescription drug use/misuse among first year undergraduates. Addictive Behaviors, 87, 122–130. https://doi.org/10.1016/j.addbeh.2018.07.001.
Cocco, K. M., & Carey, K. B. (1998). Psychometric properties of the drug abuse screening test in psychiatric outpatients. Psychological Assessment, 10(4), 408–414.
Colby, S. M., Swanton, D. N., & Colby, J. J. (2012). College students' evaluations of heavy drinking: the influence of gender, age, and college status. Journal of College Student Development, 53(6), 797–810.
Daeppen, J. B., Yersin, B., Landry, U., Pécoud, A., & Decrey, H. (2000). Reliability and validity of the alcohol use disorders identification test (AUDIT) imbedded within a general health risk screening questionnaire: results of a survey in 332 primary care patients. Alcoholism: Clinical and Experimental Research, 24(5), 659–665.
Das, J. K., Salam, R. A., Arshad, A., Finkelstein, Y., & Bhutta, Z. A. (2016). Interventions for adolescent substance abuse: an overview of systematic reviews. Journal of Adolescent Health, 59(4), S61–S75.
DeMartini, K. S., & Carey, K. B. (2012). Optimizing the use of the AUDIT for alcohol screening in college students. Psychological Assessment, 24(4), 954–963.
Esmaeelzadeh, S., Moraros, J., Thorpe, L., & Bird, Y. (2018). The association between depression, anxiety and substance use among Canadian post-secondary students. Neuropsychiatric Disease and Treatment, 14, 3241–3251. https://doi.org/10.2147/ndt.s187419.
Fassaert, T., De Wit, M. A. S., Tuinebreijer, W. C., Wouters, H., Verhoeff, A. P., Beekman, A. T. F., & Dekker, J. (2009). Psychometric properties of an interviewer-administered version of the Kessler Psychological Distress scale (K10) among Dutch, Moroccan and Turkish respondents. International Journal of Methods in Psychiatric Research, 18(3), 159–168.
Fleming, M. F., Barry, K. L., & Macdonald, R. (1991). The alcohol use disorders identification test (AUDIT) in a college sample. International Journal of the Addictions, 26(11), 1173–1185.
Fløvig, J. C., Vaaler, A. E., & Morken, G. (2009). Substance use at admission to an acute psychiatric department. Nordic Journal of Psychiatry, 63(2), 113–119.
Foulds, J. A., Wells, J. E., Lacey, C. J., Adamson, S. J., Sellman, J. D., & Mulder, R. T. (2013). A comparison of alcohol measures as predictors of psychological distress in the New Zealand population. The International Journal of Alcohol and Drug Research, 2(1), 59–67.
French, M. T., Roebuck, M. C., McGeary, K. A., Chitwood, D. D., & McCoy, C. B. (2001). Using the drug abuse screening test (DAST-10) to analyze health services utilization and cost for substance users in a community-based setting. Substance Use & Misuse, 36(6–7), 927–943.
Graham, K., Massak, A., Demers, A., & Rehm, J. (2007). Does the association between alcohol consumption and depression depend on how they are measured? Alcoholism: Clinical and Experimental Research, 31(1), 78–88.
Gratz, K. L., Conrad, S. D., & Roemer, L. (2002). Risk factors for deliberate self-harm among college students. American Journal of Orthopsychiatry, 72(1), 128–140.
Greenfield, S. F., Trucco, E. M., McHugh, R. K., Lincoln, M., & Gallop, R. J. (2007). The women's recovery group study: a stage I trial of women-focused group therapy for substance use disorders versus mixed-gender group drug counseling. Drug and Alcohol Dependence, 90(1), 39–47.
Greenfield, S. F., Back, S. E., Lawson, K., & Brady, K. T. (2010). Substance abuse in women. Psychiatric Clinics of North America, 33(2), 339–355.
Hallett, J., Howat, P. M., Maycock, B. R., McManus, A., Kypri, K., & Dhaliwal, S. S. (2012). Undergraduate student drinking and related harms at an Australian university: web-based survey of a large random sample. BMC Public Health, 12(1), 37.
Hides, L., Lubman, D. I., Devlin, H., Cotton, S., Aitken, C., Gibbie, T., & Hellard, M. (2007). Reliability and validity of the Kessler 10 and patient health questionnaire among injecting drug users. Australian & New Zealand Journal of Psychiatry, 41(2), 166–168.
Holloway, K. R., Bennett, T. H., Parry, O., & Gorden, C. (2014). Characteristics and consequences of prescription drug misuse among university students in the United Kingdom. Journal of Substance Use, 19(1–2), 156–163.
Hudson, A., Thompson, K., MacNevin, P. D., Ivany, M., Teehan, M., Stuart, H., & Stewart, S. H. (2018). University students’ perceptions of links between substance use and mental health: a qualitative focus group study. Emerging Adulthood, 6(6), 399–410.
Iwamoto, D. K., Corbin, W., Takamatsu, S., & Castellanos, J. (2018). The association between multidimensional feminine norms, binge drinking and alcohol-related problems among young adult college women. Addictive Behaviors, 76, 243–249.
Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Miech, R. A. (2016). Monitoring the future national survey results on drug use, 1975–2015: volume II, college students and adults ages 19–55. Institute for Social Research, The University of Michigan: Ann Arbor, MI.
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., … Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976.
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S. L. T., Manderscheid, R. W., Walters, E. E., & Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189.
Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244.
Kilpatrick, D. G., Ruggiero, K. J., Acierno, R., Saunders, B. E., Resnick, H. S., & Best, C. L. (2003). Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the national survey of adolescents. Journal of Consulting and Clinical Psychology, 71(4), 692–700.
Kokotailo, P. K., Egan, J., Gangnon, R., Brown, D., Mundt, M., & Fleming, M. (2004). Validity of the alcohol use disorders identification test in college students. Alcoholism: Clinical and Experimental Research, 28(6), 914–920.
Lipson, S. K., Zhou, S., Wagner III, B., Beck, K., & Eisenberg, D. (2016). Major differences: variations in undergraduate and graduate student mental health and treatment utilization across academic disciplines. Journal of College Student Psychotherapy, 30(1), 23–41.
Lo, C. C., Monge, A. N., Howell, R. J., & Cheng, T. C. (2013). The role of mental illness in alcohol abuse and prescription drug misuse: gender-specific analysis of college students. Journal of Psychoactive Drugs, 45(1), 39–47.
Low, N. C., Lee, S. S., Johnson, J. G., Williams, J. B., & Harris, E. S. (2008). The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings. Family Practice, 25(5), 321–327.
Maisto, S. A., Carey, M. P., Carey, K. B., Gordon, C. M., & Gleason, J. R. (2000). Use of the AUDIT and the DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychological Assessment, 12(2), 186–192.
McGee, R., & Kypri, K. (2004). Alcohol-related problems experienced by university students in New Zealand. Australian and New Zealand Journal of Public Health, 28(4), 321–323.
McGorry, P. D., Purcell, R., Hickie, I. B., & Jorm, A. F. (2007). Investing in youth mental health is a best buy. Medical Journal of Australia, 187(S7), S5–S7.
McGorry, P., Bates, T., & Birchwood, M. (2013). Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. The British Journal of Psychiatry, 202(S54), S30–S35.
McLafferty, M., Lapsley, C. R., Ennis, E., Armour, C., Murphy, S., Bunting, B. P., Bjourson, A. J., Murray, E. K., & O'Neill, S. M. (2017). Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland. PLoS One, 12(12), e0188785.
McPherson, M., Casswell, S., & Pledger, M. (2004). Gender convergence in alcohol consumption and related problems: issues and outcomes from comparisons of New Zealand survey data. Addiction, 99(6), 738–748.
Mikolajczyk, R. T., Maxwell, A. E., Naydenova, V., Meier, S., & El Ansari, W. (2008). Depressive symptoms and perceived burdens related to being a student: survey in three European countries. Clinical Practice and Epidemiology in Mental Health, 4(1), 19.
Morisano, D., Babor, T. F., & Robaina, K. A. (2014). Co-occurrence of substance use disorders with other psychiatric disorders: implications for treatment services. Nordic Studies on Alcohol and Drugs, 31(1), 5–25.
Naicker, K., Galambos, N. L., Zeng, Y., Senthilselvan, A., & Colman, I. (2013). Social, demographic, and health outcomes in the 10 years following adolescent depression. Journal of Adolescent Health, 52(5), 533–538.
Parker, J. D., Summerfeldt, L. J., Hogan, M. J., & Majeski, S. A. (2004). Emotional intelligence and academic success: examining the transition from high school to university. Personality and Individual Differences, 36(1), 163–172.
Pedrelli, P., Nyer, M., Yeung, A., Zulauf, C., & Wilens, T. (2015). College students: mental health problems and treatment considerations. Academic Psychiatry, 39(5), 503–511.
Pedrelli, P., Shapero, B., Archibald, A., & Dale, C. (2016). Alcohol use and depression during adolescence and young adulthood: a summary and interpretation of mixed findings. Current Addiction Reports, 3(1), 91–97.
Pereira, G., Wood, L., Foster, S., & Haggar, F. (2013). Access to alcohol outlets, alcohol consumption and mental health. PLoS One, 8(1), e53461.
Quello, S. B., Brady, K. T., & Sonne, S. C. (2005). Mood disorders and substance use disorder: a complex comorbidity. Science & Practice Perspectives, 3(1), 13–21.
Reinert, D. F., & Allen, J. P. (2007). The alcohol use disorders identification test: an update of research findings. Alcoholism: Clinical and Experimental Research, 31(2), 185–199.
Richter, L., Pugh, B. S., Peters, E. A., Vaughan, R. D., & Foster, S. E. (2016). Underage drinking: prevalence and correlates of risky drinking measures among youth aged 12–20. The American Journal of Drug and Alcohol Abuse, 42(4), 385–394.
Rickwood, D., George, A., Parker, R., & Mikhailovich, K. (2011). Harmful alcohol use on campus: impact on young people at university. Youth Studies Australia, 30(1), 34–40.
Roberts, S. J., Glod, C. A., Kim, R., & Hounchell, J. (2010). Relationships between aggression, depression, and alcohol, tobacco: implications for healthcare providers in student health. Journal of the American Academy of Nurse Practitioners, 22(7), 369–375.
Rotermann, M., & Langlois, K. (2015). Prevalence and correlates of marijuana use in Canada, 2012. Health Reports, 26(4), 10–15.
Sahai, H., & Khurshid, A. (1996). Statistics in epidemiology: methods, techniques and applications. Boca Raton: CRC Press.
Shield, K. D., Rylett, M., Gmel, G., Gmel, G., Kehoe-Chan, T. A., & Rehm, J. (2013). Global alcohol exposure estimates by country, territory and region for 2005—a contribution to the comparative risk assessment for the 2010 global burden of disease study. Addiction, 108(5), 912–922.
Silvestri, M. M., Knight, H., Britt, J., & Correia, C. J. (2015). Beyond risky alcohol use: screening non-medical use of prescription drugs at National Alcohol Screening day. Addictive Behaviors, 43, 25–27.
Skinner, H. A. (1982). The drug abuse screening test. Addictive Behaviors, 7(4), 363–371.
Stallman, H. M. (2010). Psychological distress in university students: a comparison with general population data. Australian Psychologist, 45(4), 249–257.
Statistics Canada. (2017). Canadian tobacco alcohol and drugs (CTADS): 2015 summary. Retrieved from https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey/2015-summary.html.
Steel, Z., Marnane, C., Iranpour, C., Chey, T., Jackson, J. W., Patel, V., & Silove, D. (2014). The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. International Journal of Epidemiology, 43(2), 476–493.
Stockwell, T., Beirness, D., Butt, P., Gliksman, L., & Paradis, C. (2012). Canada’s low-risk drinking guidelines. Canadian Medical Association Journal, 184(1), 75–75.
Substance Abuse and Mental Health Services Administration. (2017). Results from the 2016 national survey on drug use and health: detailed tables. Rockville: Center for Behavioral Health Statistics and Quality.
Tanner-Smith, E. E., & Lipsey, M. W. (2015). Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis. Journal of Substance Abuse Treatment, 51, 1–18.
Tavolacci, M. P., Ladner, J., Grigioni, S., Richard, L., Villet, H., & Dechelotte, P. (2013). Prevalence and association of perceived stress, substance use and behavioral addictions: a cross-sectional study among university students in France, 2009–2011. BMC Public Health, 13(1), 724.
Tembo, C., Burns, S., & Kalembo, F. (2017). The association between levels of alcohol consumption and mental health problems and academic performance among young university students. PLoS One, 12(6), e0178142.
Vasiliadis, H. M., Chudzinski, V., Gontijo-Guerra, S., & Préville, M. (2015). Screening instruments for a population of older adults: the 10-item Kessler psychological distress scale (K10) and the 7-item generalized anxiety disorder scale (GAD-7). Psychiatry Research, 228(1), 89–94.
Villarosa, M. C., Madson, M. B., Zeigler-Hill, V., Noble, J. J., & Mohn, R. S. (2014). Social anxiety symptoms and drinking behaviors among college students: the mediating effects of drinking motives. Psychology of Addictive Behaviors, 28(3), 710–718.
Weitzman, E. R. (2004). Poor mental health, depression, and associations with alcohol consumption, harm, and abuse in a national sample of young adults in college. The Journal of Nervous and Mental Disease, 192(4), 269–277.
Wu, P., Goodwin, R. D., Fuller, C., Liu, X., Comer, J. S., Cohen, P., & Hoven, C. W. (2010). The relationship between anxiety disorders and substance use among adolescents in the community: specificity and gender differences. Journal of Youth and Adolescence, 39(2), 177–188.
Yudko, E., Lozhkina, O., & Fouts, A. (2007). A comprehensive review of the psychometric properties of the drug abuse screening test. Journal of Substance Abuse Treatment, 32(2), 189–198.
Zeigler, D. W., Wang, C. C., Yoast, R. A., Dickinson, B. D., McCaffree, M. A., Robinowitz, C. B., & Sterling, M. L. (2005). The neurocognitive effects of alcohol on adolescents and college students. Preventive Medicine, 40(1), 23–32.
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Chang, WP., Stuart, H. & Chen, SP. Alcohol Use, Drug Use, and Psychological Distress in University Students: Findings from a Canadian Campus Survey. Int J Ment Health Addiction 20, 2366–2381 (2022). https://doi.org/10.1007/s11469-021-00519-w
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DOI: https://doi.org/10.1007/s11469-021-00519-w