Educational inequalities in the co-occurrence of mental health and substance use problems, and its adult socio-economic consequences: a longitudinal study of young adults in a community sample

• Published in: Public health (London) Vol. 127; no. 8; pp. 745 - 753
• Main Authors: Lee, J.O, Herrenkohl, T.I, Kosterman, R, Small, C.M, Hawkins, J.D
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-08-2013
• Subjects: Adult; Anxiety Disorders - epidemiology; Cannabis; Comorbidity; Depressive Disorder - epidemiology; Diplomas; Educational Status; Female; Follow-Up Studies; Health inequalities; Health Status Disparities; High schools; Humans; Infectious Disease; Internal Medicine; Male; Mental health; Prospective Studies; Social Class; Socio-economic status; Socioeconomic Factors; Socioeconomic status; Substance abuse; Substance use disorder; Substance-Related Disorders - epidemiology; Symptoms; Young Adult; Substance use disorder; Socio-economic status; Comorbidity; Health inequalities; Mental health
• ISSN: 0033-3506; 1476-5616
• DOI: 10.1016/j.puhe.2013.04.005

Abstract Objectives To examine the relationship between the co-occurrence of mental health and substance use problems and socio-economic status (SES). Study design A prospective longitudinal study of 808 males and females followed to age 30. Methods Survey data were used to derive latent classes (profiles) of mental health (depression, anxiety) and substance use (alcohol, nicotine, and marijuana [cannabis]) problems at age 27. Analyses examined the associations of these profiles with earlier educational attainment (high school diploma) and indicators of SES at age 30. Results Latent Class Analysis produced four profiles: a low disorder symptoms group, a licit substance use disorder symptoms group (alcohol and nicotine), a mental health disorder symptoms group, and a comorbid group. Earning a high school diploma by age 21 decreased the odds of belonging to the comorbid group or the licit substance use disorder symptoms group when compared to the low disorder symptoms group. These disorder profiles also were found to adversely impact subsequent adult SES. The adverse impact was more evident in income maintenance and wealth accumulation by age 30 than market or non-market labour force participation. Conclusions Earning a high school diploma lessens the risk of co-occurring mental health and substance use problems which contribute to economic instability in young adulthood. Findings underscore the importance of public health programmes to reduce the incidence of mental health and substance use problems and their associated high costs to individuals and to society.