Frontiers in Child and Adolescent Psychiatry (Nov 2024)

Anxiety and depressive symptoms as predictors of substance use initiation among adolescents living on and near a Tribal reservation in the Great Plains region of the U.S.

  • Caroline M. Barry,
  • Ashna Jagtiani,
  • Melvin D. Livingston,
  • Sierra Talavera-Brown,
  • Hannah LaBounty,
  • Eugena Atkinson,
  • Juli R. Skinner,
  • Kelli A. Komro

DOI
https://doi.org/10.3389/frcha.2024.1390793
Journal volume & issue
Vol. 3

Abstract

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IntroductionThis study examines the impacts of anxiety and depressive symptoms on subsequent initiation of alcohol use, cannabis use, and prescription opioid misuse among diverse adolescents attending high schools on or near a Tribal reservation in a rural Great Plains region of the U.S.MethodsIn collaboration with Emory University and a Great Plains Tribal nation's behavioral health organization, a community randomized trial of 20 high schools was conducted to prevent substance misuse. Surveys administered at four time points (fall and spring of 10th and 11th grade) included the GAD-7, PHQ-8, and items assessing lifetime alcohol use, cannabis use, prescription opioid misuse, and covariates (age, gender, race, and food insecurity). The analytic sample included students with data at two or more time points (n = 455) from control schools (k = 10). Approximately half of the sample identified as American Indian only or American Indian/White only, and 36%–39% as White only.ResultsAdjusted generalized estimating equations showed that every 5-point increase in anxiety symptoms was associated with 1.28 and 1.29 times the odds of initiating alcohol and cannabis use respectively the following semester. Similarly, every 5-point increase in depressive symptoms was associated with 1.25, 1.34, and 1.38 times the odds of initiating alcohol use, cannabis use, and prescription opioid misuse respectively the following semester.DiscussionResults show a consistent 25%–38% increased odds of certain types of substance use initiation following increases in anxiety and depressive symptoms among adolescents. Findings underscore the need for targeted prevention and intervention to address mental health issues among a historically marginalized population. Addressing mental health concerns earlier may mitigate later substance use risks and sequelae for rural and American Indian youth.

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