Among 863 Spanish adolescents, girls showed significantly more mental health problems and higher rates of comorbidity between substance use and mental health disorders, with depression predicting cannabis use disorder and obsessive-compulsive symptoms predicting alcohol use disorder.
Adolescent mental health clinicians, substance use prevention designers, school counselors
Girls had significantly higher comorbidity between mental health and substance use disorders
What the researchers found
Girls presented significantly more mental health problems and higher prevalence of comorbidity between substance use and mental health disorders. Obsessive-compulsive symptoms and phobic anxiety predicted higher alcohol use disorder risk. Depression and the interaction between hostility and obsessive-compulsive disorder predicted higher cannabis use disorder risk.
Why it matters
Understanding that girls face higher comorbidity rates and that specific mental health symptoms predict specific substance use disorders can guide targeted prevention and early intervention strategies.
The numbers in context
863 adolescents (53.7% girls, mean age 16.62); girls had higher comorbidity prevalence; obsessive-compulsive symptoms and phobic anxiety predicted AUD; depression and hostility x OCD interaction predicted CUD
How the study worked
Cross-sectional study of 863 Spanish general-population adolescents (53.7% girls, mean age 16.62). Computerized battery assessed substance use frequency, Brief Symptom Inventory, Cannabis Problems Questionnaire, Rutgers Alcohol Problem Index, and DSM-IV-TR criteria for alcohol and cannabis use disorders. Binary logistic regressions examined predictors.
What this study cannot tell us
Cross-sectional design cannot establish causal direction between mental health and substance use. Spanish general-population sample may not generalize. Self-reported measures. DSM-IV-TR criteria used rather than DSM-5.
How to read the evidence
Adequate-sized cross-sectional study in a general population sample, but cannot determine causal direction.
When this study was published
Published in 2021.
The bigger picture
The finding that different mental health symptoms predict different substance use disorders (OCD/phobic anxiety for alcohol, depression/hostility for cannabis) suggests that substance-specific prevention approaches targeting underlying mental health vulnerabilities may be more effective than generic substance use prevention.
Questions still open
- Does treating specific mental health symptoms (depression, OCD) reduce the risk of developing the associated substance use disorder? Would longitudinal data confirm the directional pathways suggested here?
Common questions
Why did girls have more comorbidity?
Which mental health problems predicted cannabis use disorder?
Read the original research
Sex Differences in Comorbidity Between Substance Use and Mental Health in Adolescents: Two Sides of the Same Coin.
Psicothema, 33(1), 36-43
Citation
Fernández-Artamendi, Sergio; Martínez-Loredo, Víctor; López-Núñez, Carla. (2021). Sex Differences in Comorbidity Between Substance Use and Mental Health in Adolescents: Two Sides of the Same Coin.. Psicothema, 33(1), 36-43. https://doi.org/10.7334/psicothema2020.297
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