Adolescence is a period of pivotal change in brain development. It accompanied by profound cognitive-behavioral, somatic and psychic changes with increased vulnerability to risk taking. This work explores the current state of consumption of the main psychoactive substances (PAS), (tobacco, cannabis, alcohol) among schoolchildren, their interrelationships and the possible links with psychological suffering of anxious or depressive type. The study is a descriptive and analytical transversal type, carried out by a self-questionnaire and two neuropsychological tests evaluating depressive symptomatology: Adolescent Depression Rating Scale (ADRS) patient version in 10 items, and The Hospital Anxiety and Depression Scale (HADS), among 714 high school students aged 15 to 21 years, in Kenitra, Morocco. The results show that the population of adolescents who use psychoactive substances appears to be more depressed and more anxious than non-users. The prevalence of regular consumption of the three psychoactive substances is significant between girls and boys (p < 0.000), and shows that for: tobacco is 16.38% (14.52% girls, 85.47% boys); cannabis is 6.72% (1.7% girls, 95.83% boys); and alcohol is 5.88% (2.56% girls, 92.86% boys). These results encourage an emphasis on the school’s role in early detection of adolescent-specific pathologies such as anxiety and depression. As well as the development of strategy of prevention of consumption of the PAS, and the care of the pupils presenting anxious or depressive symptomatology. In addition, further longitudinal studies would be needed to establish causal links among anxiety, depression, and PAS use.
Adolescence is a period of pivotal change in brain development. It accompanied by profound cognitive-behavioral, somatic and psychic changes with increased vulnerability to risk taking. Otherwise, according to studies conducted in the United States and Australia, depressive disorders affect between 11% and 48% of adolescents with a disorder related to the use of a psychoactive substance and anxiety disorders affect between 7% and 40% [
Several studies in Morocco have focused on assessing the prevalence of psychoactive substance use in different populations of school-aged adolescents and studying its relation to socio-economic and cultural characteristics [
The study is a descriptive and analytical transversal type. It was built in the Kenitra city, Morocco, covering an area of 76 km2, it is the fourth industrial city of the country, in the North West of Morocco, with more than one million inhabitants. It took place in January 2018. The protocol given to each subject consisted of a self-questionnaire, and two neuropsychological tests: Adolescent Depression Rating Scale (ADRS), and The Hospital Anxiety and Depression Scale (HADS).
The sample consists of 714 (430 boys and 284 girls) subjects of adolescents population from high schools of different sectors. The mean age was 17.39 years (SD = 1.47), range: 15 and 21 years (
Distribution of sample by sex and age | ||||
---|---|---|---|---|
n | % | Mean of age (SD) | Extended | |
Girls | 284 | 39.8 | 17.42 (1.27) | 15 - 21 |
Boys | 430 | 60.2 | 17.38 (1.60) | 15 - 21 |
Total | 714 | 100 | 17.39 (1.47) | 15 - 21 |
divided into three sections: modern letters, experimental sciences (biology, geology, physics, and chemistry) and mathematical sciences.
For ethical considerations, participants informed of the anonymity of the study and the possibility of refusal to participate. While the self-questionnaire explained the interest of the study, its anonymity and the possibility of refusal of participation. The agreement of the provincial delegates of the Ministry of National Education and Vocational Training and the directors of the establishments concerned was obtained.
The questionnaire on the collection of data on participants, with 31 items, recorded the student’s sociodemographic information and the taking of different PAS (tobacco, alcohol, cannabis).
The scale measures the depressive intensity. It intended specifically for adolescents aged 13 to 20 years [
Zigmond’s self-questionnaire, and Snaith (1983) [
This study took place in high schools in the Kenitra city of Morocco. We collected the data in the form of group handouts in a school classroom with 20 students, in the presence of the investigator with the objective explanation of the study. Both tests were translated into Arabic and, if necessary, some questions were explained in simple terms and accessible to all (in dialectal Arabic). To avoid any bias, a period outside exams, parties and school holidays was chosen. The investigation began on January 13, 2018 and lasted 6 days.
Coding, processing and statistical analysis of the data were done with Excel 2013 software and SPSS V.17 software. The statistical tests used were: χ2 and Student’s t-test. The tests were considered significant for a degree of significance “p” less than or equal to 0.05.
Regular consumption of tobacco is 16.38% (14.52% are girls and 85.47% are boys); cannabis is 6.72% (1.7% are girls and 95.83% are boys); and alcohol is 5.88% (2.56% are girls and 92.86% are boys). The χ2 test allowed us to highlight a significant difference between girls and boys regarding the prevalence of consumption of the three PAS (
From the scale, anxiety and depression scores were found to be higher among student consumers (M = 16.57 ± 5.87 (0 - 28)) than non-users (M = 14.4 ± 4.60 (0 - 27)). Student’s t test allowed us to show a significant difference between non-consumers and consumers (t = 4.309, p < 0.000) (
Anxious symptomatology is more present in consumers than in non-consumer subjects (t = 8.669, p < 0.001), the majority of non-consumers (81.28%) do not have an anxiety disorder, compared to 54.7% of tobacco users, 70.83% of cannabis users and 69.05% of alcohol users. One-tenth (10.83%) of non-consumers have suspicious anxiety disorders, compared to 29.06% of tobacco users and 20.83% of cannabis users and 21.43% of alcohol users; and only 7.89% of non-consumers with anxiety disorders, compared to 16.04% of tobacco users, 8.33% of cannabis users and 9.52% of alcohol users (
Regular consumption | Consumption of psychoactive substances | |||||||
---|---|---|---|---|---|---|---|---|
Total | GIRLS | BOYS | ||||||
n = 714 | n = 284 (39.8%) | n = 430 (60.2%) | ||||||
n | % | n | % | n | % | χ2 | p | |
Tobacco | 117 | 16.38 | 17 | 14.52 | 100 | 85.47 | 37.231 | 0.000 |
Cannabis | 48 | 6.72 | 2 | 1.7 | 46 | 95.83 | 27.24 | 0.000 |
Alcohol | 42 | 53.88 | 3 | 2.56 | 39 | 92.86 | 19.838 | 0.000 |
HADS and consumption of psychoactive substances | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Non-Consumers | Regular consumers | |||||||||
n = 545 (76.33%) | n = 169 (23.66%) | |||||||||
Tobacco | Cannabis | Alcohol | ||||||||
n = 117 (39.8%) | n = 48 (39.8%) | n = 42 (39.8%) | ||||||||
HADS | n | % | n | % | n | % | n | % | t | p |
Anxiety Disorders | 8.669 | <0.001 | ||||||||
Absence of anxiety disorder | 443 | 81.28 | 64 | 54.70 | 34 | 70.83 | 29 | 69.05 | ||
Suspicious anxiety disorder | 59 | 10.83 | 34 | 29.06 | 10 | 20.83 | 9 | 21.43 | ||
Severe anxiety disorder | 43 | 7.89 | 19 | 16.24 | 4 | 8.33 | 4 | 9.2 | ||
Depressive disorders | 6.763 | <0.001 | ||||||||
Absence of depressive disorders | 439 | 80.55 | 54.99 | 47.00 | 32 | 66.67 | 27 | 64.29 | ||
Suspicious depressive disorders | 72 | 13.21 | 40 | 34.19 | 10 | 20.83 | 9 | 21.43 | ||
Severe depressive disorders | 34 | 6.24 | 22 | 18.80 | 6 | 12.50 | 6 | 14.29 |
The results of this work show that consumer subjects appear more depressed than non-consumers (t = 6.763, p < 0.001): the majority of non-consumers (80.55%) do not have depressive disorder, compared to about half (47.53%) of tobacco users, about two-thirds (66.67%) of cannabis users and 64.29% of alcohol users. Otherwise, just over one-tenth (13.21%) of non-consumers have suspicious depressive disorders compared to just over one-third (34.19%) of tobacco users and about one-fifth (20.83%) of cannabis users and 21.43% of consumers; and a small proportion (6.24%) of non-consumers have proven depressive disorders, compared with 18.8% of tobacco users, 12.5% of cannabis users and 14.29% of alcohol users (
Almost half of teenagers with PAS have a depressive tendency (t = 4.701, p < 0.001), as 46.14% had a score above 4 on the ADRS scale. A confirmed depression (ADRS score ≥ 8) was found in only 8.28% of adolescents and only 54.43% presented no risk of depressive disorders. Regarding non-users, 62.01% do not present any risk of depression, 22.94% present a moderate risk and only 6.05% present a significant risk to depression (
The present school-based survey of 714 secondary school students qualifying for the Kenitra region aimed to explore the current state of consumption of the main psychoactive substances (tobacco, cannabis, alcohol) among schoolchildren, their relationships reciprocal and possible links with psychological suffering of anxious or depressive type. Moreover, the results collected have made it possible to establish a profile of the consumers of psychoactive substances.
ADRS and consumption of psychoactive substances | ADRS and consumption of psychoactive substances | |||||
---|---|---|---|---|---|---|
Non-Consumers | Regular consumers | |||||
n = 545 (76.33%) | n = 169 (23.66%) | |||||
ADRS | t | p | ||||
Absence of risk | 388 | 62.01 | 92 | 54.43 | 4.701 | 0.001 |
Moderate risk | 125 | 22.94 | 64 | 37.86 | ||
High risk | 32 | 5.87 | 14 | 8.28 |
Indeed, the adolescent population studied, appears more depressed and more anxious and show levels of consumption of high psychoactive substances.
The prevalence of smoking in the group of adolescents in the Kenitra region is 16.38%. This prevalence is similar to that of school-based studies, particularly among secondary school and college students, who show smoking prevalence ranging from 6.5% to 15.4% [
Studies of the prevalence of psychoactive substance use clearly show that not all types of psychoactive substances consumed in the same way or at the same age. This is all the more important to take into account that the trajectory of changes in consumption depends on the type of psychoactive substance consumed [
The two tests selected for the search for depressive syndrome (HADS and ADRS), are designed to identify a depressive syndrome in adolescents and measure its intensity. They give an assessment of the depressive symptomatology according to three cases: absence of disorders or of risk, susceptible disorders or moderate risk and severe disorders or risk.
However, whatever the test administered, our study, like most surveys conducted in children and adolescents, shows prevalences affirming the existence of depressive symptomatology at this period of life. Thus, for the non-consumer population the absence of depressive symptomatology estimated between 41.10% and 80.55%; suspicious disorders between 13.21% (HAD-D) and 22.94% (ADRS) and severe disorders at 6.24% (HAD-D). However, for teenagers, the absence of disorders concerns 66.67% (HAD-D); suspicious disorders at 20.83% (HAD-D); while severe disorder is estimated to be between 8.28% (ADRS). These results remain close to that of the national survey of the Ministry of Public Health, which reported that 48.9% of Moroccans suffer or have already suffered from mental disorders [
Although the depressive signs are present in the adolescent population as in the literature, the lack of data concerning Moroccan adolescents suffering from such a disorder doesn’t allow comparing the results obtained with other adolescents presenting the same socio-cultural framework. Moreover, depressive and anxiety disorders represent the most frequent psychiatric diagnosis in children and adolescents [
Otherwise, a comparison of the two groups of adolescents studied reveals that the presence of anxious symptomatology is significantly greater in teenagers who use PAS (p = 0.001). This result is confirmed by numerous studies [
While in France in 2014, it is estimated that a quarter of adolescents aged 17 had a depressive syndrome (moderate for 20.8% and severe for 5.3% of them) [
The comorbidity between depressive symptomatology and PAS consumption has been the subject of several epidemiological studies [
On the other hand, many studies highlight the co-occurrence of depressive disorders and a significant consumption of psychoactive substances in adolescence [
Otherwise, the observation of criteria of anxiety and depression is more frequent among smokers than non-smokers [
This finding does not contradict the positive links between cannabis use and the presence of depressive symptomatology both in the present work and in other studies such as that of Troisi which showed that the frequency of psychiatric disorders, especially depressive disorders and anxious, was correlated with the importance of cannabis use in young adults [
This work will increase the scientific evidence on the links between anxiety-depressive disorders and ASA consumption in schooled adolescents in the city of Kenitra, by providing important points of reflection regarding the psychic vulnerability of adolescent PAS consumers.
These results encourage an emphasis on the school’s role in early detection of adolescent-specific pathologies such as anxiety and depression. As well as the development of the strategy of prevention of the consumption of the PAS, and the care of the pupils presenting anxious or depressive symptomatology. In addition, further longitudinal studies would be needed to establish causal links between anxiety, depression, and PAS use.
El Malki, I.C., Echerbaoui, I., Mammad, K., El Madhi, Y. and Ahami, A.O.T. (2018) Anxiety-Depressive Profile in Adolescent Consumers of Psychoactive. Open Journal of Medical Psychology, 7, 13-25. https://doi.org/10.4236/ojmp.2018.72002