Trends in the co-occurrence of substance use and mental health symptomatology in a national sample of US post-secondary students from 2009 to 2019

Abstract

Objective: This study examined joint trends over time in associations between substance use (heavy drinking, cannabis, and cigarette smoking) and mental health concerns (depression, anxiety, and suicidal ideation) among US post-secondary students. Participants: Data came from 323,896 students participating in the Healthy Minds Study from 2009 to 2019, a national cross-sectional survey of US post-secondary students. Weighted two-level logistic regression models with a time by substance interaction term were used to predict mental health status. Results: Use of each substance was associated with a greater odds of students endorsing depression, anxiety, and suicidal ideation. Over time, the association with mental health concerns strengthened substantially for cannabis, modestly for heavy drinking, and remained stable for smoking. Conclusion: Given co-occurrence is common and increasing among post-secondary students, college and university health systems should prioritize early identification, psychoeducation, harm-reduction, and brief interventions to support students at risk.

Keywords:

• Alcohol
• cannabis
• college students
• mental health
• substance use

Conflict of interest disclosure

The authors have no conflicts of interest to disclose. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of United States and received approval from the Institutional Review Board of Advarra Institutional Review Board as well as approval/exemption from the IRBs at all participating colleges and universities.

Data access

Researchers can apply for access to the data used in this study on the following website: https://healthymindsnetwork.org/research/data-for-researchers/

Notes

1 See study documentation here: https://healthymindsnetwork.org/research/data-for-researchers/

2 Find SAS coding documentation here: https://documentation.sas.com/doc/en/pgmsascdc/9.4_3.4/statug/statug_glimmix_examples23.htm

Additional information

Funding

Jillian Halladay was supported by a Canadian Institutes of Health Doctoral Training Award. Christina E. Freibott is supported by NIDA grant T32-DA041898. Sarah Ketchen Lipson is supported by funding from the National Institutes of Health (NIH) [K01MH121515, 2020–2024] and the William T. Grant Foundation [Scholars Program, 2020–2025]. This study would not be possible without the student participants who lent their time and energy to completing the survey and their colleges and universities, which prioritized the need for collecting student mental health data.