Mental health and maladaptive coping associated with substance use among medical students

Abstract

Introduction: Substance use is a frequent maladaptive coping strategy among medical students exposed to high academic and emotional demands.

Objective: To analyze the association between alcohol, tobacco, and electronic cigarette use and symptoms of anxiety, stress, and depression as possible maladaptive coping mechanisms, considering perceived social support as an effect modifier among medical students.

Method: A cross-sectional study was conducted between October 2023 and January 2024 among 862 medical students in Mexico City. A self-administered questionnaire was used to collect information on substance use, and the DASS-21 instrument was applied to assess symptoms of depression, anxiety, and stress. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the association between substance use and psychosocial factors, adjusting for sex, academic year, socioeconomic status, and grade point average.

Results: Recent alcohol use (80.3%), binge drinking (41.7%), smoking (9.6%), and electronic cigarette use (27.1%) were highly prevalent. Anxiety was associated with binge drinking (OR = 1.40; 95% CI: 1.03–1.90), electronic cigarette use (OR = 1.58; 95% CI: 1.06–2.37), and smoking (OR = 2.73; 95% CI: 1.51–4.95). Stress was associated with binge drinking (OR = 2.48; 95% CI: 1.79–3.45), electronic cigarette use (OR = 1.94; 95% CI: 1.31–2.85), and smoking (OR = 2.58; 95% CI: 1.63–4.10). Depression was linked to all outcomes, including alcohol consumption (OR = 1.59; 95% CI: 1.11–2.27), binge drinking (OR = 1.68, 95% CI: 1.26–2.24), electronic cigarette (OR = 1.52, 95% CI: 1.05–2.19), and smoking (OR = 1.85, 95% CI: 1.16–2.96). Associations tended to be stronger among participants reporting low social support, although the interaction was not statistically significant.

Conclusion: Substance use represents a maladaptive coping pattern associated with mental health problems. Interventions are needed to strengthen institutional support and promote adaptive coping strategies among medical students.