High school students who report using alcohol, cannabis or nicotine at higher risk for suicidal thoughts and other mental health disorders

BOSTON –High school students who reported using cannabis, alcohol, or nicotine were more likely to have thoughts about suicide, feel depressed or anxious, have unusual experiences, and exhibit inattention or hyperactivity, according to recent survey-based study conducted by researchers at Massachusetts General Hospital (MGH) and the University of Minnesota.

The study, which is published in JAMA Pediatrics, included 2022–2023 survey results from more than 15,000 high school students across Massachusetts.

“We sought to determine whether substance use was dose-dependently associated with various psychiatric symptoms in a large sample if high school students, and whether these associations differed depending on the type of substance used,” says senior author Randi M. Schuster, PhD, an associate professor of psychology in the Department of Psychiatry at MGH and the director of School-Based Research and Program Development within MGH’s Center for Addiction Medicine.

Schuster and her colleagues found that alcohol use, cannabis useand nicotine use were each associated with an increased prevalence of suicidal thoughts as well as depression/anxiety symptoms, psychotic experiences, and attention deficit hyperactivity disorder symptoms.

For example, thoughts of suicide were approximately five-times more prevalent among high school students who used substances daily or near daily compared with those who did not.

Increases in psychiatric symptoms were detected even among adolescents with relatively low levels of use. The investigators’ findings were replicated when they examined responses from a national survey conducted in 2021.

“Our study’s results highlight the prevalence of psychiatric co-morbidities among young people who use substances, and they lend strong support for the notion that screening, prevention, intervention and policy efforts need to comprehensively address targets beyond substance use alone,” says lead author Brenden Tervo-Clemmens, PhD, an assistant professor at the University of Minnesota Medical School. “Also, these efforts may not need to necessarily be specific to a given substance, but rather reflect the multifaceted mental health needs of all adolescents who use substances.”

Schuster is currently heading up a study that will survey individual students over time to provide additional insights into the relationship and timing of substance use and psychiatric symptoms, which could help investigators develop interventions to better safeguard adolescents’ mental health.

Additional authors include Jodi M. Gilman, PhD; A. Eden Evins, MD; Kate H. Bentley, PhD; Matthew K. Nock, PhD; and Jordan W. Smoller, MD.

This work was funded by the Massachusetts Department of Public Health, the National Institute on Drug Abuse, and the American Psychological Foundation.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.