Age-varying associations between substance use behaviors and depressive symptoms during adolescence and young adulthood

Abstract

Background: Substance use and depression often co-occur, complicating treatment of both substance use and depression. Despite research documenting age-related trends in both substance use and depression, little research has examined how the associations between substance use behaviors and depression changes across the lifespan.

Methods: This study examines how the associations between substance use behaviors (daily smoking, regular heavy episodic drinking (HED), and marijuana use) and depressive symptoms vary from adolescence into young adulthood (ages 12-31), and how these associations differ by gender. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we implemented time-varying effect models (TVEM), an analytic approach that estimates how the associations between predictors (e.g., substance use measures) and an outcome (e.g., depressive symptoms) vary across age.

Results: Marijuana use and daily smoking were significantly associated with depressive symptoms at most ages from 12 to 31. Regular HED was significantly associated with depressive symptoms during adolescence only. In bivariate analyses, the association with depressive symptoms for each substance use behavior was significantly stronger for females at certain ages; when adjusting for concurrent substance use in a multivariate analysis, no gender differences were observed.

Conclusions: While the associations between depressive symptoms and both marijuana and daily smoking were relatively stable across ages 12-31, regular HED was only significantly associated with depressive symptoms during adolescence. Understanding age and gender trends in these associations can help tailor prevention efforts and joint treatment methods in order to maximize public health benefit.

Keywords: Adolescence; Age-varying effects; Comorbidity; Depression; Substance use; Young adulthood.

Fig. 1

Past-week mean score on the 9-item CESD across ages 12 to 31 for males and females.

Fig. 2

Estimated prevalence of daily smoking, marijuana use, and regular heavy episodic drinking across ages 12 to 31 for males and females. Gray lines represent 95% confidence interval bounds.

Fig. 3

Age-varying coefficient functions depicting the bivariate associations between substance use behaviors and depressive symptoms for males and females. Gray lines represent 95% confidence interval bounds.

Fig. 4

Age-varying coefficient functions depicting the multivariate associations between substance use behaviors and depressive symptoms for males and females. Gray lines represent 95% confidence interval bounds.