A multinational study of psychosocial stressors and symptoms associated with increased substance use during the early wave of the COVID-19 Pandemic: The role of polysubstance use

Figures & data

Table 1. Main characteristics of the study participants

Characteristic (# of valid responses)	N (%)	M (SD)
Sex (n = 2899)
Male	870 (30)
Female	2023 (69.8)
Other	6 (0.2)
Marital status (n = 2879)
Never married	1219 (42.3)
Married	1387 (48.2)
Married but separated	41 (1.4)
Divorced and not remarried	207 (7.2)
Widowed and not remarried	25 (0.9)
Education level (n = 2880)
Primary school	18 (0.6)
Secondary school	354 (12.3)
Post-secondary/Tertiary school	2508 (87.1)
Current employment status (n = 2866)
Employed (full- or part-time)	1964 (68.5)
Student	471 (16.4)
Retired	156 (5.4)
Unemployed	275 (9.6)
Rural or urban nature of residence^a (n = 2872)
Urban area	1880 (65.5)
Urban cluster	769 (26.8)
Rural area	223 (7.8)
Has a chronic health condition^b (n = 2877)	931 (32.4)
Lost job or work hours were reduced^c (n = 2638)	607 (23.0)
Age (n = 2907)		38.7 (14.3)
Perceived stress during the pandemic (n = 2859)		3.1 (1.4)
Perceived uncertainty (n = 2859)		3.0 (1.6)
Depression and anxiety symptoms (PHQ-4^d) (n = 2781)		4.4 (3.4)
Perceived social isolation (n = 2858)		2.3 (1.7)
Perceived social support (n = 2858)		2.9 (1.4)
Resilience (BRS^e) (n = 2539)		3.4 (0.8)
Sleep quality (n = 2546)		1.5 (0.9)

All percentages were calculated as percent of valid responses for the variable in question. M = Mean; SD = standard deviation. ^a Urban area: Population more than 50,000: Urban cluster: Population between 2500 and 50,000; Rural area: Population less than 2500; ^b Responded “yes” to the dichotomous item “Do you have any chronic mental or physical health conditions?”. ^c Responded “yes” to the dichotomous item “I lost my job or my hours were significantly reduced because of the coronavirus”. ^d Depression and anxiety symptoms measured using PHQ-4 (4-item Patient Health Questionnaire (Kroenke et al., 2009)). ^e Resilience measured using BRS (Brief Resilience Scale; (Smith et al., 2008))

Table 2. Factors associated with increases in substance use during the early wave of the COVID-19 pandemic: Results of the bivariate and multivariate regressions

	Increase in nicotine use (multivariate n = 554)		Increase in alcohol use (multivariate n = 2190)		Increase in cannabis use (multivariate n = 400)
	OR (95%CI)	aOR (95%CI)	OR (95%CI)	aOR (95%CI)	OR (95%CI)	aOR (95%CI)
Age	0.99 (0.97; 1.00) *		0.98 (0.97; 0.98)***	0.98 (0.97; 0.99)***	0.97 (0.96; 0.99)**	0.98 (0.96; 0.99)**
Sex (Male vs Female)	0.70 (0.51; 1.03)*		0.85 (0.67; 1.07)*		0.98 (0.64; 1.51)
Marital status ^a	0.74 (0.52; 1.06)*		0.92 (0.75; 1.12)		0.58 (0.36; 0.95)**
Education level ^b	0.90 (0.59; 1.36)		1.38 (0.98; 1.94)*	1.77(1.18; 2.67)**	1.17 (0.69; 2.03)
Employment status ^c	1.5 (1.02; 2.21)**	1.67 (1.04; 2.69)**	1.2 (0.96; 1.48)*	1.40 (1.09; 1.80)**	1.01 (0.66; 1.53)
Nature of residence
Urban ^d	1.35 (0.66; 2.74)		1.09 (0.73; 1.64)		1.38 (0.62; 3.03)
Urban cluster ^d	1.57 (0.74; 3.31)*		1.39 (0.91; 2.12)*		1.05 (0.44; 2.53)
Chronic health condition (Yes vs No)	1.37 (0.97; 2.01)*		1.21 (0.99; 1.50)*		1.4 (0.92; 2.12)*
COVID-19 impact on employment^e	0.56 (0.35; 0.88)**	0.45 (0.27; 0.76)**	1.11 (0.87; 1.41)		1.64(1.03; 2.6)**
Perceived stress	1.22 (1.08; 1.38)***		1.24 (1.15; 1.33)***		1.18 (1.02; 1.36)**	1.20 (1.02; 1.40)**
Perceived uncertainty	1.20 (1.08; 1.34)***		1.27 (1.19; 1.36)***	1.16 (1.07; 1.26)***	1.05 (0.92; 1.20)
Perceived social isolation	1.18 (1.07; 1.31)***	1.19 (1.05; 1.35)**	1.16 (1.10; 1.24)***		1.13 (0.99; 1.28)**
Perceived social support	0.96 (0.85; 1.08)		0.92 (0.85; 0.98)**		0.96 (0.83; 1.12)
Depression and anxiety symptoms^f	1.10 (1.05; 1.16)***	1.10 (1.03; 1.16)**	1.1 (1.07; 1.13)***	1.06 (1.02; 1.10)**	1.07 (1.01; 1.13)**
Resilience^g	0.85 (0.65; 1.09)*		0.87 (0.77; 0.99)**		0.86 (0.64; 1.14)
Sleep quality	0.72 (0.58; 0.90)**		0.80 (0.71; 0.90)***		1.01 (0.79; 1.29)
Number of substances used	1.22 (0.96; 1.55)*		1.38 (1.18; 1.61)***		1.44 (1.01; 2.07)**	1.61 (1.08; 2.39)**
Nicotine use during the last 6 months			1.03 (0.80; 1.33)		1.45 (0.96; 2.19)*
Alcohol use during the last 6 months	1.14 (0.80; 1.64)				1.30 (0.71; 2.38)
Cannabis use during the last 6 months	1.5 (1.03; 2.25)**		2.14 (1.68; 2.73)***	1.82 (1.39; 2.39)***

Notes. OR = Crude Odds Ratio. aOR = Adjusted Odds Ratio. 95%CI = 95% Confidence Interval. Bold typeface indicates p ≤ .05. ^a Married vs (not married, married but separated, widowed and not remarried, or divorced and not remarried); ^b Post-secondary/ Tertiary school vs primary or secondary school; ^c Employed vs (unemployed, student, or retired); ^d urban area or urban cluster vs rural area; ^e Responded “yes” vs “no” to the dichotomous item “I lost my job or my hours were significantly reduced because of the coronavirus”; ^f Depression and anxiety symptoms measured using PHQ-4 (Kroenke et al., 2009).^g Resilience measured using BRS (Smith et al., 2008)

*p ≤ 0.25; **p ≤ 0.05; ***p ≤ 0.001

Table 3. Correlations between increased substances use among polysubstance users and comparison for correlations according to the number of substances used (2 vs. 3 substances)

a. Correlations among polysubstance users
	Increase in nicotine use	Increase in alcohol use	Increase in cannabis use
Increase in nicotine use	1	0.22** (n = 428)	0.22** (n = 187)
Increase in alcohol use		1	0.24** (n = 381)
Increase in cannabis use			1
b. Correlations among users of 2 substances
	Increase in nicotine use	Increase in alcohol use	Increase in cannabis use
Increase in nicotine use	1	0.20** (n = 276)	0.25 (n = 35)
Increase in alcohol use		1	0.16* (n = 229)
Increase in cannabis use			1
c. Correlations among users of 3 substances
	Increase in nicotine use	Increase in alcohol use	Increase in cannabis use
Increase in nicotine use	1	0.21** (n = 152)	.21** (n = 152)
Increase in alcohol use		1	.35** (n = 152)
Increase in cannabis use			1
d. Comparison for correlation among users of 2 substances vs. among users of 3 substances
	Increase in nicotine use	Increase in alcohol use	Increase in cannabis use
Increase in nicotine use		−0.17 (0.86) †	0.24 (0.81) †
Increase in alcohol use			−1.95 (0.05) †
Increase in cannabis use

* = significant at p < .05 2-tailed; ** = significant at p < .01 2-tailed

† Test statistic (2-tailed p) for r-to-Z comparison for correlation among users of 2 substances vs. among users of 3 substances

Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics, 50(6), 613–621. https://doi.org/10.1176/appi.psy.50.6.613

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Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine, 15(3), 194–200. https://doi.org/10.1080/10705500802222972

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Data availability statement

The datasets generated and analyzed for this study are available from the corresponding author on reasonable request.