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Examining the Association and Directionality between Mental Health Disorders and Substance Use among Adolescents and Young Adults in the U.S. and Canada—A Systematic Review and Meta-Analysis

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School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
2
FRCP, Faculty, Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(12), 543; https://doi.org/10.3390/jcm7120543
Received: 17 November 2018 / Revised: 5 December 2018 / Accepted: 11 December 2018 / Published: 13 December 2018
(This article belongs to the Section Psychiatry)
Background: The purpose of this systematic review was to examine the association and directionality between mental health disorders and substance use among adolescents and young adults in the U.S. and Canada. Methods: The following databases were used: Medline, PubMed, Embase, PsycINFO, and Cochrane Library. Meta-analysis used odds ratios as the pooled measure of effect. Results: A total of 3656 studies were screened and 36 were selected. Pooled results showed a positive association between depression and use of alcohol (odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.24–1.83), cannabis (OR = 1.29, 95% CI: 1.10–1.51), and tobacco (OR = 1.65, 95% CI: 1.43–1.92). Significant associations were also found between anxiety and use of alcohol (OR = 1.54, 95% CI: 1.19–2.00), cannabis (OR = 1.36, 95% CI: 1.02–1.81), and tobacco (OR = 2.21, 95% CI: 1.54–3.17). A bidirectional relationship was observed with tobacco use at baseline leading to depression at follow-up (OR = 1.87, CI = 1.23–2.85) and depression at baseline leading to tobacco use at follow-up (OR = 1.22, CI = 1.09–1.37). A unidirectional relationship was also observed with cannabis use leading to depression (OR = 1.33, CI = 1.19–1.49). Conclusion: This study offers insights into the association and directionality between mental health disorders and substance use among adolescents and young adults. Our findings can help guide key stakeholders in making recommendations for interventions, policy and programming. View Full-Text
Keywords: depression; anxiety; alcohol; cannabis; tobacco; adolescents; young adults; U.S.; Canada depression; anxiety; alcohol; cannabis; tobacco; adolescents; young adults; U.S.; Canada
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MDPI and ACS Style

Esmaeelzadeh, S.; Moraros, J.; Thorpe, L.; Bird, Y. Examining the Association and Directionality between Mental Health Disorders and Substance Use among Adolescents and Young Adults in the U.S. and Canada—A Systematic Review and Meta-Analysis. J. Clin. Med. 2018, 7, 543. https://doi.org/10.3390/jcm7120543

AMA Style

Esmaeelzadeh S, Moraros J, Thorpe L, Bird Y. Examining the Association and Directionality between Mental Health Disorders and Substance Use among Adolescents and Young Adults in the U.S. and Canada—A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2018; 7(12):543. https://doi.org/10.3390/jcm7120543

Chicago/Turabian Style

Esmaeelzadeh, Sarvenaz, John Moraros, Lilian Thorpe, and Yelena Bird. 2018. "Examining the Association and Directionality between Mental Health Disorders and Substance Use among Adolescents and Young Adults in the U.S. and Canada—A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 7, no. 12: 543. https://doi.org/10.3390/jcm7120543

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