Does cannabis use in adolescence predict self-harm or suicide? Results from a Finnish Birth Cohort Study.

OBJECTIVE: Longitudinal studies examining the association between adolescent cannabis use and self-harm are rare, heterogeneous and mixed in their conclusions. We study this association utilizing a large general population-based sample with prospective data. METHODS: The Northern Finland Birth Cohort 1986 (n = 6582) with linkage to nationwide register data was used to study the association of self-reported cannabis use at age 15-16 years and self-harm and suicide death until age 33 (until year 2018), based on register information. Cox regression analysis with Hazard Ratios (HR) and 95% confidence intervals (CI) was used. Psychiatric disorders, parental psychiatric disorders and other substance use were considered as confounders. RESULTS: In all, 6582 (49.2% male) were included in the analysis, and 377 adolescents (5.7%) reported any cannabis use until the age of 15-16 years. Based on register information, 79 (55.7% male) had visited in health care services due to self-harm, and 22 (90.1% male) had died by suicide. In crude analyses, adolescent cannabis use was associated with self-harm (HR = 3.93; 95% CI 2.24-6.90). The association between cannabis use and self-harm remained statistically significant after adjusting for sex, psychiatric disorders at baseline, frequent alcohol intoxications, other illicit drug use, and parental psychiatric disorders (HR 2.06; 95% CI 1.07-3.95). In contrast, the association of cannabis use with suicide did not reach statistical significance even in crude analysis (HR 2.60; 95% CI 0.77-8.78). CONCLUSION: Cannabis use in adolescence may increase risk of self-harm independent of adolescent psychopathology and other substance use.

Alcohol use in adolescence as a risk factor for overdose in the 1986 Northern Finland Birth Cohort Study.

BACKGROUND: Overdoses and poisonings are among the most common causes of death in young adults. Adolescent problem drinking has been associated with psychiatric morbidity in young adulthood as well as with elevated risk for suicide attempts. There is limited knowledge on adolescent alcohol use as a risk factor for alcohol and/or drug overdoses in later life. METHODS: Here, data from The Northern Finland Birth Cohort 1986 study with a follow-up from adolescence to early adulthood were used to assess the associations between adolescent alcohol use and subsequent alcohol or drug overdose. Three predictors were used: age of first intoxication, self-reported alcohol tolerance and frequency of alcohol intoxication in adolescence. ICD-10-coded overdose diagnoses were obtained from nationwide registers. Use of illicit drugs or misuse of medication, Youth Self Report total score, family structure and mother's education in adolescence were used as covariates. RESULTS: In multivariate analyses, early age of first alcohol intoxication [hazard ratios (HR) 4.5, 95% confidence intervals (CI) 2.2-9.2, P < 0.001], high alcohol tolerance (HR 3.1, 95% CI 1.6-6.0, P = 0.001) and frequent alcohol intoxication (HR 1.9, 95% CI 1.0-3.4, P = 0.035) all associated with the risk of overdoses. Early age of first intoxication (HR 5.2, 95% CI 1.9-14.7, P = 0.002) and high alcohol tolerance (HR 4.4, 95% CI 1.7-11.5, P = 0.002) also associated with intentional overdoses. CONCLUSIONS: Alcohol use in adolescence associated prospectively with increased risk of overdose in later life. Early age of first intoxication, high alcohol tolerance and frequent alcohol intoxication are all predictors of overdoses.

Gender-Specific Drinking Contexts Are Associated With Social Harms Resulting From Drinking Among Australian Young Adults at 30 Years.

AIMS: Understanding contexts in which social harms from drinking occur can help develop context-based harm reduction efforts. However, there is little knowledge of specific drinking contexts where such harms occur and whether these are gender or age specific. We aimed to investigate associations of a range of drinking contexts and social harms from drinking among young adults at age 30. METHODS: We used data from 2187 30-year-old adults. Latent constructs of gender-specific drinking contexts were created using factor analysis. We performed multivariate logistic regression between drinking contexts and a range of social harms from drinking, separately by gender. RESULTS: After accounting for social roles and binge drinking, gender-specific solitary drinking contexts ('home drinking' for men and 'daytime drinking' for women) were positively associated with marital problems and problems with other family members and friends. Conversely, 'social drinking' was not. Work-related drinking among men was associated with marital/intimate relationship problems and friendship problems. After accounting for mental health symptoms, women's home drinking was associated with marital problems. CONCLUSION: We found that experiences of social harms from drinking at 30 years differ depending on the drinker's gender and context. Our findings suggest that risky contexts and associated harms are still significant among 30-year-old adults, indicating that a range of gender-specific drinking contexts should be represented in harm reduction campaigns. The current findings also highlight the need to consider gender to inform context-based harm reduction measures and to widen the age target for these beyond emerging adults.

Social Drinking Contexts and Their Influence on Problematic Drinking at Age 30.

Aims: Understanding the social contexts in which problematic drinking occurs can inform prevention strategies. In this article, we investigate gender-specific social contexts associated with problematic drinking and depression among adults aged 30 years. Because depression has been consistently linked with harmful alcohol consumption, we will also examine its association with drinking contexts. Methods: We used data from 2490 young adults who completed the 30-year follow-up phase of the Mater-University of Queensland Study of Pregnancy and its Outcomes, a prospective study commenced in 1981. Exploratory and confirmatory factor analyses were used to identify latent constructs of drinking contexts stratified by gender, with subsequent regression analysis to assess the role of these contexts in problematic drinking (measured using the Alcohol Use Disorders Identification Test). Results: Six distinct drinking contexts were identified, which differed by gender, three for men and three for women. For both men and women, "social drinking", was associated with problematic drinking. "Home drinking" was also common to men and women but associations with problematic drinking differed, being risky only among men. "Daytime drinking" (women) was associated with risk but "work-related drinking" (men) was not. Both "home drinking" (men) and "daytime drinking" (women) were linked to depression symptoms. Conclusion: Specific contexts appeared to be associated with problematic drinking for both sexes. Among both men and women, "social drinking" was associated with problematic drinking. Both "home drinking" (men) and "daytime drinking" (women) contexts, were associated with problematic drinking and depressive symptoms. Targeted alcohol-focused interventions need to address co-occurring mental health issues.

Gender differences in social harms from drinking among young Australians: findings from the Mater University Study of Pregnancy and its Outcomes.

Background: Despite the growing interest in investigating social harms from drinking, little is known about drinkers' reports of these harms and their gender differences among Australian young adults at age 30. We aimed to examine gender differences of social harms from drinking as reported by drinkers.Methods: 2,200 young adults at age 30 with complete data on social harms from drinking were drawn from the 30-year follow-up of the Mater-University of Queensland Study of Pregnancy. Measures included percentages of 11 past-year drinkers' self-reported social harms stratified by gender. Logistic regression was used to examine associations between gender and each social harm, accounting for relevant confounding.Results: More than one in five young adults (22%) reported at least one social harm in the past year. Among binge drinkers, 44% reported at least one social harm. After adjustments for social roles and binge drinking, we found no gender differences on several self-reported social harms: friendship problems, people criticizing drinking, non-marital family problems, employment problems, and alcohol-fuelled fights. However, men were more likely to report spousal threats to leave, drink-driving legal problems and financial problems.Conclusions: Our findings demonstrate that young adults are still vulnerable to risky drinking at age 30 and the social harm resulting from drinking. Thus, alcohol prevention campaigns should target this age group and include women in their focus. Strategies aiming to reduce alcohol-related harms, such as screening in clinical settings for risky drinking and alcohol-related harms, followed by motivational behavior interventions, could be beneficial among these vulnerable groups.

The association between experiencing discrimination and physical and mental health among people who inject drugs.

BACKGROUND: Discrimination can be a daily issue in the lives of people who inject drugs (PWID). However, the extent to which discrimination is related to the health of PWID remains unclear. METHODS: Data focusing on discrimination against PWID and potential health correlates were collected as part of the 2013 Illicit Drug Reporting System, a national survey with 887 PWID recruited in all Australian states and territories. Experience of discrimination, its setting, perceived reason and outcome, were self-reported by participants. The Kessler-10 scale and the mental component score of the Short Form 12-Item Health Survey were used to measure mental health. Physical health was assessed using the physical component score of the Short Form 12-Item Health Survey, specifically questions assessing injecting related problems and risk behaviour. Poisson and multinomial regression analyses were performed. Models were adjusted for socio-demographic and drug-related covariates. FINDINGS: PWID reported experiencing discrimination in pharmacies, hospitals, government services and doctors/prescribers. The most commonly reported instances of discrimination were being refused service and experiencing abuse and/or violence. Experience of discrimination was associated with mental and physical health indicators. PWID who experienced discrimination were more likely to report high or very high mental distress (ARRR = 2.4, CI95 = 1.5-3.6) and mental health problems (ARRR = 1.4, CI95 = 1.2-1.7). The mental functioning (ARRR = 1.3, CI95 = 1.1-1.4) and physical functioning (ARRR = 1.1, CI95 = 1.1-1.4) of PWID, who experienced discrimination, were also more likely to be below Australian population mean scores. CONCLUSION: Self-reported experience of discrimination was associated with poor mental and physical health amongst PWID.

Frequent experience of discrimination among people who inject drugs: Links with health and wellbeing.

BACKGROUND: Previous research has shown that people who inject drugs (PWID) experience discrimination on a regular basis. This study explores the relationships between discrimination against PWID and health and wellbeing. METHODS: Data on discrimination against PWID and their health and wellbeing were drawn from the Illicit Drug Reporting System collected in Australia in 2016. The Personal Wellbeing Index was used to measure wellbeing, and the Kessler-10 scale was used to measure psychological distress. Experience of overdose, injecting related illnesses, diseases, and risky injecting behaviour were also assessed. We fitted multivariate logistic regression models adjusted for socio-demographic, imprisonment history, and drug-related factors. RESULTS: Of the 796 participants included in the study, the majority who reported experiencing discrimination were male (65%), heterosexual (89%), and unemployed (89%). Thirty percent of the sample (n = 238) reported they had never experienced discrimination because of their injecting drug use. Seventeen percent of participants had not experienced discrimination in the twelve months prior to the interview, 24% experienced discrimination monthly, 16% experienced discrimination weekly, and 13% experienced discrimination daily or more. Frequent discrimination was associated with increased odds of overdosing, injecting related illnesses and diseases, mental health issues, and poor wellbeing. Among those who reported experiencing discrimination, females and those who identified as Indigenous were found to have poorer health and wellbeing outcomes. CONCLUSIONS: Our findings highlighted that frequent discrimination may lead to worse health and wellbeing among PWID. If our findings are supported by other research, policies aimed at reducing discrimination against PWID may be warranted or improved.

Predictors of comorbid polysubstance use and mental health disorders in young adults-a latent class analysis.

AIM: The co-occurrence of mental health and substance use disorders adds complexity to already-significant health burdens. This study tests whether mental health disorders group differently across substance use disorder types and compares associations of early factors with the development of differing comorbidities. DESIGN: Consecutive antenatal clinic attendees were recruited to the longitudinal Mater-University of Queensland Study of Pregnancy (MUSP). Mother/offspring dyads were followed over 21 years. SETTING: Mater-Misericordiae Public Hospital, Brisbane, Australia. PARTICIPANTS: MUSP offspring with maternal baseline information (n = 7223), offspring behaviour data at 14 (n = 4815) and psychiatric diagnoses at 21 (n = 2575). MEASUREMENTS: The Composite International Diagnostic Interview yielded life-time diagnoses of mental health (MH) and substance use (SU) disorders for offspring, then latent class modelling predicted membership of polydisorder groups. We fitted the resulting estimates in multinomial logistic regression models, adjusting for maternal smoking, drinking and mental health, adolescent drinking, smoking and behaviour and mother-child closeness. FINDINGS: Fit indices [Bayesian information criterion (BIC) = 12 415; Akaike information criterion (AIC) = 12 234] from LCA supported a four-class solution: low disorder (73.6%), MH/low SU disorder (10.6%), alcohol/cannabis/low MH disorder (12.2%) and poly SU/moderate MH disorder (3.5%). Adolescent drinking predicted poly SU/MH disorders [odds ratio (OR) = 3.34, 95% confidence interval (CI) = 1.42-7.84], while externalizing predicted membership of both SU disorder groups (ORalcohol/cannabis = 2.04, 95% CI = 1.11-3.75; ORpolysubstance = 2.65, 95% CI = 1.1-6.08). Maternal smoking during pregnancy predicted MH (OR = 1.53, 95% CI = 1.06-2.23) and alcohol/cannabis-use disorders (OR = 1.73; 95% CI = 1.22-2.45). Low maternal warmth predicted mental health disorders only (OR = 2.21, 95% CI = 1.32-3.71). CONCLUSIONS: Mental health disorders are more likely in young adults with polysubstance use disorders than those with alcohol/cannabis use disorders. Predictors of comorbid mental health/polysubstance use disorders differ from those for alcohol/cannabis use disorders, and are detectable during adolescence.

Individual, school-related and family characteristics distinguish co-occurrence of drinking and depressive symptoms in very young adolescents.

INTRODUCTION AND AIMS: Alcohol misuse and depressed mood are common during early adolescence, and comorbidity of these conditions in adulthood is associated with poorer health and social outcomes, yet little research has examined the co-occurrence of these problems at early adolescence. This study assessed risky and protective characteristics of pre-teens with concurrent depressed mood/early alcohol use in a large school-based sample. DESIGN AND METHODS: School children aged 10-14 years (n = 7289) from late primary and early secondary school classes in government, Catholic and independent sectors participated with parental consent in the cross-sectional Healthy Neighbourhoods Study. Key measures included depressed mood, recent alcohol use, school mobility, family relationship quality, school engagement and coping style. Multinomial logistic regression analyses were used to identify school and family-related factors that distinguished those with co-occurring drinking and depressive symptoms from those with either single condition. Gender and school-level interactions for each factor were evaluated. RESULTS: Co-occurring conditions were reported by 5.7% of students [confidence interval (CI)95 5.19, 6.19]. Recent drinkers were more likely than non-drinkers to have symptoms consistent with depression (odds ratio 1.80; CI95 1.58, 2.03). Low school commitment was associated with co-occurring drinking/depressive symptoms (odds ratio 2.86; CI95 2.25, 3.65 compared with null condition). This association appeared to be weaker in the presence of adaptive stress-coping skills (odds ratio 0.18; CI95 0.14, 0.23). CONCLUSIONS: We have identified factors that distinguish pre-teens with very early co-occurrence of drinking and depressed mood, and protective factors with potential utility for school-based prevention programmes targeting these conditions. [Salom CL, Kelly AB, Alati R, Williams GM, Patton GC, Williams JW. Individual, school-related and family characteristics distinguish co-occurrence of drinking and depressive symptoms in very young adolescents. Drug Alcohol Rev 2016;35:387-396].

Familial factors associated with development of alcohol and mental health comorbidity.

BACKGROUND AND AIMS: Co-occurring mental health and alcohol problems appear to be associated with greater health burdens than either single disorder. This study compares familial and individual contributions to development of comorbid alcohol/mental problems and tests whether these differ from single disorders. DESIGN: Women (n = 6703) were recruited during pregnancy to the longitudinal Mater-University of Queensland Study of Pregnancy (MUSP). Mother/offspring dyads were followed over 21 years. SETTING: Mater-Misericordiae Public Hospital, Brisbane, Australia. PARTICIPANTS: Primary offspring from the MUSP with full psychiatric information at 21 years and maternal information at age 14 (n = 1755). MEASUREMENTS: Structured interviews at age 21 yielded a four-category outcome using mental health and alcohol modules of the Composite International Diagnostic Interview (no disorder, alcohol only, mental health only and comorbid alcohol/mental health). Multinomial logistic regression models were adjusted for gender, maternal mental health and substance use, family environment and adolescent behaviour. FINDINGS: Maternal smoking [odds ratio (OR) = 1.56; 95% confidence interval (CI) = 1.09-2.22 versus no-disorder] and low mother-offspring warmth (OR = 3.19; 95% CI = 1.99-5.13) were associated with mental health/alcohol comorbidity in young adults, as were adolescent drinking (OR = 2.22; 95% CI = 1.25-3.96), smoking (OR = 2.24; 95% CI = 1.33-3.77) and attention/thought problems (OR = 2.04; 95% CI = 1.18-3.52). Some differences were seen from single disorders. In a subsample with paternal data, fathers' drinking problems (OR = 2.41; 95% CI = 1.10-5.29) were more associated strongly with offspring mental health/alcohol comorbidity than both single disorders (P < 0.05). CONCLUSIONS: Maternal smoking and low mother-child warmth appear to be related to alcohol, mental health and comorbid disorders at age 21, possibly via constituent alcohol and mental health disorders. Adolescent drinking and attention/thought problems appear to be associated with comorbid disorders but not with individual alcohol and mental health disorders.

Substance use and mental health disorders are linked to different forms of intimate partner violence victimisation.

BACKGROUND: Substance and mental health disorders convey significant health burdens and impair interpersonal relationships. We tested associations between comorbid substance and mental health disorders and different forms of intimate partner violence (IPV) experienced by young adults. METHOD: Mothers (n = 6703) were recruited during pregnancy to the longitudinal Mater-University of Queensland Study of Pregnancy. Mother/offspring dyads were followed up from birth to 21 years. Offspring with complete psychiatric data at 21 years who reported having had an intimate partnership were included (n = 1781). Participants' experiences of psychological, physical and severe combined IPV were assessed at 21 years using a summarised form of the Composite Abuse Scale. We used the Composite International Diagnostic Interview to obtain lifetime diagnoses of mental health and substance disorders. Multivariable logistic regression models of each IPV form were adjusted for individual, family and neighbourhood factors during adolescence, and for other forms of IPV. RESULTS: We have shown specific links between different forms of IPV experienced and individual substance and mental health disorders. Mental health disorders were related to all three forms of IPV, while alcohol disorders were linked to psychological IPV (ORAUD = 1.86; 1.21-2.86) and illicit substance disorders to physical IPV (ORSUD = 2.07; 1.25-3.43). The co-occurrence of related disorders was strongly linked to psychological and physical IPV. CONCLUSIONS: Intimate partner violence was experienced by both men and women. Substance and mental health disorders were associated with specific forms of IPV victimisation, suggesting that screening IPV clients and mental health/substance disorder patients for the converse problems may be important for intervention planning.

Associations between self-reported symptoms of prenatal maternal infection and post-traumatic stress disorder in offspring: evidence from a prospective birth cohort study.

OBJECTIVE: Consistent evidence has linked a range of prenatal maternal infections with psychotic disorders in later life. However, the potential for this exposure to impact more common disorders requires further investigation. METHODS: Participants came from the Mater University Study of pregnancy, a longitudinal, pre-birth cohort study which recruited pregnant mothers from a Brisbane hospital between 1981 and 1984. At age 21, 2439 offspring completed the CIDI-Auto. Multivariate logistic regression was used to investigate associations of self-reported symptoms of prenatal infection with a range of DSM-IV anxiety and affective diagnoses, while also testing for gender interactions. RESULTS: In multivariate analyses, self-reported symptoms of prenatal genital infection predicted Post-traumatic stress disorders (OR=2.38, 95% CI: 1.14, 4.95) and social phobias (OR=1.93, 95% CI: 1.03, 3.61), in addition to evidence for a gender interaction by which males (OR=6.04, 95% CI: 2.00, 18.30) but not females were at greater risk for PTSD. Further analyses among those with PTSD revealed the relationship to be stronger when excluding those not exposed to trauma (OR=3.21, 95% CI: 1.53, 6.72). LIMITATIONS: We were unable to clinically or serologically verify the presence and the type of prenatal genital infection. CONCLUSION: This is the first study to show an association between self-reported symptoms of prenatal genital infections and two highly prevalent anxiety disorders among adult offspring. The relationship with PTSD was particularly strong and suggested that the exposure may primarily impact PTSD in males. Further research with the capacity to assess a fuller-range of specific prenatal infections is warranted to evaluate the potential of reducing the prevalence of these disorders.

Does early socio-economic disadvantage predict comorbid alcohol and mental health disorders?

BACKGROUND: Alcohol and mental health disorders are highly prevalent in the general population, with co-occurrence recognised as a major public health issue. Socio-economic factors are frequently associated with both disorders but their temporal association is unclear. This paper examines the association between prenatal socio-economic disadvantage and comorbid alcohol and mental health disorders at young adulthood. METHODS: An unselected cohort of women was enrolled during early pregnancy in the large longitudinal Mater-University of Queensland Study of Pregnancy (MUSP), at the Mater Misericordiae Public Hospital in Brisbane, Australia. The mothers and their offspring were followed over a 21 year period. Offspring from the MUSP birth cohort who provided full psychiatric information at age 21 and whose mothers provided socioeconomic information at baseline were included (n=2399). Participants were grouped into no-disorder, mental health disorder only, alcohol disorder only or comorbid alcohol and mental health disorders according to DSM-IV diagnoses at age 21 as assessed by the Composite International Diagnostic Interview. We used multivariate logistic regression analysis to compare associations of disorder group with single measures of prenatal socio-economic disadvantage including family income, parental education and employment, and then created a cumulative scale of socioeconomic disadvantage. RESULTS: Greater socio-economic disadvantage was more strongly associated with comorbidity (OR 3.36; CI95 1.37, 8.24) than with single disorders. This relationship was not fully accounted for by maternal mental health, smoking and drinking during pregnancy. CONCLUSION: Multiple domains of socio-economic disadvantage in early life are associated with comorbid alcohol and mental health disorders.

Do young people with comorbid mental and alcohol disorders experience worse behavioural problems?

This article examines whether young individuals in the general population with comorbid alcohol use and mental health disorders experience worse internalizing and externalizing behaviour problems than those with single disorders. A large cohort of women at the Mater Misericordiae Hospital in Brisbane, Australia, was enroled during pregnancy in a longitudinal study. Mother/offspring dyads were followed over 21 years. At age 21, offspring behaviour problems were examined using the Young Adult Self Report, alcohol and mental health disorders with the Composite International Diagnostic Interview. Associations between comorbidity and behaviour problems were assessed using multinomial logistic regression, accounting for life-course factors. Twelve per cent of young adults had alcohol/mental health DSM-IV disorders with significant temporal overlap. A further 16% had alcohol disorders only and 23% mental health disorders only. The comorbid group scored significantly higher on total and externalizing behaviour problems but not internalizing behaviour problems. Stronger associations of aggression/delinquency with comorbidity were not fully accounted for by factors known to influence separate development of mental health and alcohol disorders. Young adults with comorbid alcohol/mental health disorders experience more, and more severe, behavioural problems than those with single disorder types, indicating an increased burden from comorbidity, with implications for treatment and public order.

Misuse of pharmaceuticals by regular psychostimulant users is linked to mental health problems / El uso indebido de psicofármacos entre los usuarios regulares de psicoestimulantes está relacionado con problemas de salud mental

Abstract: Introduction: Misuse of pharmaceutical drugs, particularly by young people, is an issue of rising concern. Poly-substance use is common among regular psychostimulant users (RPU), and mental health problems are associated with pharmaceutical misuse, but RPU do not generally acknowledge their use as problematic. Objective: To examine links between mental health and misuse of non-prescription pharmaceuticals in a group of regular users of illicit psychostimulants. Method: Face to face structured interviews were conducted in April 2015 with 763 regular users of illicit psychostimulants as part of the Annual Ecstasy and Related Drugs Reporting System study in Australia. Results: At least half of the RPU in this study reported extra-medical or misuse of pharmaceuticals in the last six months in addition to regular use of illicit psychostimulants. Higher levels of psychological distress were recorded for RPU who also reported recent illicit use of opioids, antidepressants, benzodiazepines, or over-the-counter (OTC) codeine. Recent misuse of benzodiazepines or OTC codeine was associated with self-reported mental health problems and having attended a mental health professional. Those reporting recent misuse of opioids were at increased risk of mental health problems and more likely to record high levels of psychological distress, but less likely to have received prescription medications for their mental health problem. Discussion and conclusion: Regular users of illicit psychostimulants who also misuse pharmaceuticals are at increased risk of mental health problems, even after accounting for their use of illicit psychostimulants. Screening of this group for mental health problems is recommended.

Resumen: Introducción: El uso indebido de psicofármacos, particularmente entre los jóvenes, es un tema de creciente preocupación. El policonsumo de sustancias es común entre los usuarios regulares de psicoestimulantes (URP), y, pese a que hay problemas de salud mental asociados con el uso indebido de medicamentos, los URP generalmente no reconocen su consumo como problemático. Objetivo: Examinar las relaciones entre la salud mental y el uso indebido de psicofármacos no prescritos en un grupo de URP. Método: Se realizaron entrevistas cara a cara con 763 URP como parte del Estudio Anual del Sistema de Reporte de Éxtasis y Drogas Relacionadas en Australia. Resultados: Al menos la mitad de los URP en este estudio informaron el uso extramédico o indebido de psicofármacos en los últimos seis meses, además del uso regular de psicoestimulantes ilícitos. Se hallaron niveles más altos de distrés psicológico para los URP, quienes también informaron de un uso ilícito reciente de codeína, opiáceos, antidepresivos o benzodiazepinas sin prescripción médica. El uso indebido reciente de codeína o benzodiazepinas sin prescripción se asoció a problemas autorreportados de salud mental y a asistencia a consulta con un profesional de salud mental. Aquellos que informaron el uso indebido reciente de opioides mostraron mayor riesgo de problemas de salud mental y mayor probabilidad de registrar altos niveles de distrés psicológico, pero menor probabilidad de haber recibido psicofármacos prescritos para su problema de salud mental. Discusión y conclusión: Los URP que también consumen indebidamente psicofármacos están en mayor riesgo de presentar problemas de salud mental, incluso después de considerar su consumo de psicoestimulantes ilícitos. Se recomienda una evaluación por tamizaje para problemas de salud mental en este grupo.