134 - Substance Misuse in Depressed Youth: Prevalence, Risk Factors, and Motivations

Publication Number: 1124.134

Michael S.. Toce, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; John J. Porter, Boston Children's Hospital, Boston, MA, United States; Jamie Lim, Boston Children's Hospital, Boston, MA, United States; Florence Bourgeois, Boston Children's Hospital, Boston, MA, United States

Background: The prevalence of youth with mental health challenges has increased dramatically in recent years, prompting the American Academy of Pediatrics to declare a National State of Emergency in Children's Mental Health in 2021. Youth with mental health conditions are more likely to engage in high-risk behaviors, which may include substance misuse.

Objective: To compare the prevalence of substance misuse and use disorder in youth with and without depression, and to explore motivations for substance misuse.

Design/Methods: This study is a retrospective cross-sectional analysis of adolescents (12-17 years) and young adults (18-25 years) ("youth") from the 2022 and 2023 National Survey on Drug Use and Health (NSDUH). We examined prevalence of prescription drug (pain relievers, e.g., opioids; tranquilizers, e.g., benzodiazepines; stimulants, e.g., dextroamphetamine; and sedatives, e.g., zolpidem) misuse and use disorder among youth with and without a major depressive episode in the past year. We used multivariate logistic regression models to test the association of a past year major depressive episode with prescription drug misuse or use disorder, controlling for sex, age, and insurance status. We also used logistic regression models to explore motivations for misuse of specific prescription drugs between those with and without a major depressive episode in the past.

Results: The 2022 and 2023 NSDUH included 23,541 and 27,894 adolescents and young adults, respectively, corresponding to an extrapolated estimate of 51,640,957 adolescents and 68,819,440 young adults. 2.8% and 1.4% of adolescents and 6.6% and 1.1% of young adults reported prescription drug misuse and use disorder, respectively (Table 1). Multivariate analysis showed that youth with a major depressive episode in the past year were 2.52 (95% CI, 2.13-2.98) and 3.01 (95% CI, 2.49-3.64) times more likely to report prescription drug misuse and prescription drug use disorder, respectively. Youth with a depressive episode in the past year were more likely to report using prescription pain relievers (OR 5.78; 95% CI, 2.60-12.84), tranquilizers (OR 6.53; 95% CI, 3.40-12.53), and sedatives (OR 10.84; 95% CI, 1.63-71.91) to help with feelings and emotions compared to those without past year depression (Table 2).

Conclusion(s): Youth suffering from depression are at significantly higher risk of both prescription drug misuse and use disorder. This use appears to be motivated in part by attempts to cope with the symptoms of depression, suggesting potential unmet mental health needs.

Table 1.
Demographic characteristics and prevalence of prescription drug misuse among youth with and without past year depression

Table 2.
Reasons for prescription drug misuse among youth with and without past year depression

Table 2.
Reasons for prescription drug misuse among youth with and without past year depression