Se gio Fe nández-A amendi, Víc o Ma ínez-Lo edo, and Ca la López-Núñez
36
Despi e he subs an ial unc ional impai men associa ed wi h
he coexis ence o SUD and MHD in adolescen s (Robe s e al.,
2007), and ecen ecommenda ions o in eg a e hei ca e (B ewe
e al., 2017), esea ch on adolescen como bidi y is s ill sca ce and
inconclusi e (Skogen e al., 2014). Among he subs ances used
by adolescen s, alcohol and cannabis p esen some o he highes
p e alences (Plan Nacional Sob e D ogas, 2019), aising conce n
gi en he inc eased isk o u he alcohol and cannabis use diso de s
(Duncan e al., 2015). I is es ima ed ha 20% o adolescen s may
expe ience a men al heal h p oblem du ing hei adolescence
(Wo ld Heal h O ganiza ion, 2003). Da a indica es ha 7.4% o
child en be ween 3 and 17 ha e a beha io al diso de , 7.1% ha e
a diagnosis o anxie y, and up o 3.2% ha e dep ession (Ghandou
e al., 2018). In Spain, 3.2% o boys and 4.8% o gi ls be ween 15
and 24 yea s o age ha e a men al diso de . Pa icula ly, 1.1% o
boys and 1.4% o gi ls ha e a dep essi e diso de , and 1.1% o
boys and 3.0% o gi ls ha e an anxie y diso de (Minis e io de
Sanidad, Consumo y Bienes a Social, 2017).
The associa ion be ween adolescen d inking and ex e nalizing
p oblems has been widely epo ed (Bousoño Se ano e al.,
2019; Colde e al., 2013; Colde e al., 2017; S andheim e al.,
2011; Pede sen e al., 2018). Di e en s udies also indica e ha
a signi i can associa ion exis s in adolescen s be ween d inking
(Gonzál ez e al., 2020), p oblem d inking (Chhoa e al., 2019),
high- isk d inking (Ri che e al., 2016) and dep ession; and
be ween alcohol use (Ri che e al., 2016), high- isk d inking
(Villa osa e al., 2014), alcohol abuse (Low e al., 2008) and anxie y.
Also, highe p e alence o alcohol use diso de s (AUD) has been
epo ed among adul s wi h obsessi e-compulsi e diso de (Gen il
e al., 2009). Al hough a clea and consis en associa ion be ween
in e nalizing symp oms and alcohol use p oblems is s ill no
ISSN 0214 - 9915 CODEN PSOTEG
Copy igh © 2021 Psico hema
www.psico hema.com
Sex Di e ences in Como bidi y Be ween Subs ance Use and Men al
Heal h in Adolescen s: Two Sides o he Same Coin
Se gio Fe nández-A amendi1, Víc o Ma ínez-Lo edo2, and Ca la López-Núñez1
1 Uni e sidad Loyola Andalucía, and 2 Uni e sidad de Za agoza
Abs ac Resumen
Backg ound: This s udy aims o e alua e sex di e ences in alcohol
and cannabis use and men al heal h diso de s (MHD) in adolescen s,
and o e alua e he p edic i e ole o men al heal h diso de s o alcohol
and cannabis use diso de s (AUD and CUD espec i ely). Me hod:
A sample o 863 adolescen s om he gene al popula ion (53.7% gi ls,
Mage = 16.62, SD = 0.85) comple ed a compu e ized ba e y including
ques ions on subs ance use equency, he B ie Symp om In en o y, he
Cannabis P oblems Ques ionnai e o Adolescen s – Sho e sion, he
Ru ge s Alcohol P oblem Index and he DSM-IV-TR c i e ia o AUD and
CUD. Bi a ia e analyses and bina y logis ic eg essions we e pe o med.
Resul s: Gi ls p esen ed signi i can ly mo e men al heal h p oblems and
a highe p e alence o como bidi y be ween SUD and MHD. Obsessi e-
compulsi e symp oms and phobic anxie y indica ed a highe isk o AUD,
whe eas dep ession and in e ac ion be ween hos ili y and obsessi e-
compulsi e diso de indica ed a highe isk o CUD. Conclusions:
Como bidi y be ween SUD and MHD is high among adolescen s, and
signi i can ly highe among gi ls.
Keywo ds: Alcohol, cannabis, men al heal h, gende di e ences, adoles-
cen s.
Di e encias de Sexo en Como bilidad en e Consumo de Sus ancias
y Salud Men al en Adolescen es: Dos Ca as de la Misma Moneda.
An eceden es: el obje i o de es a in es igación es e alua las di e encias
de sexo en el uso de cannabis y alcohol y en as o nos de salud men al
TSM en adolescen es, y el ol p edic i o de los TSM sob e los as o nos
po uso de alcohol y cannabis (TUA y TUC, espec i amen e). Mé odo:
una mues a de 863 adolescen es de la población gene al (53,7% chicas,
edad media = 16.62, DT = 0,85) comple a on una ba e ía in o ma izada
sob e la ecuencia de uso de sus ancias, el In en a io B e e de Sín omas,
el Cues iona io de P oblemas po Consumo de Cannabis - e sión b e e,
el Índice de Ru ge s de P oblemas con el Alcohol y los c i e ios DSM-IV-
TR pa a el TUA y TUC. Se ealiza on análisis bi a iados y de eg esión
logís ica bina ia. Resul ados: las chicas p esen a on signi i ca i amen e
más p oblemas de salud men al y mayo p e alencia de como bilidad
en e TUS y TSM. El as o no obsesi o-compulsi o (TOC) y la ansiedad
óbica indica on un mayo iesgo de TUA, mien as que la dep esión y
la in e acción en e hos ilidad y TOC indica on mayo iesgo de TUC.
Conclusiones: la como bilidad en e TUS y TSM es al a en e los
adolescen es, y signi i ca i amen e mayo en e las chicas.
Palab as cla e: alcohol, cannabis, salud men al, di e encias de géne o,
adolescen es.
Psico hema 2021, Vol. 33, No. 1, 36-43
doi: 10.7334/psico hema2020.297
Recei ed: Augus 10, 2020 • Accep ed: Oc obe 10, 2020
Co esponding au ho : Se gio Fe nández-A amendi
Depa amen o de Psicología
Uni e sidad Loyola Andalucía
41704 Dos He manas (Spain)
e-mail: [email p o ec ed]
Sex Di e ences in Como bidi y Be ween Subs ance Use and Men al Heal h in Adolescen s: Two Sides o he Same Coin
37
e iden (Homman e al., 2016), i has been associa ed wi h sel -
medica ion pu poses (Fos e e al., 2018). This is no su p ising
since he isk o addic ion in adolescen s has been linked o poo
emo ional egula ion (Co nellà-Fon e al., 2020). O he s udies
ha e ailed o de ec signi i can associa ions be ween alcohol and
in e nalizing p oblems (Pede sen e al., 2018).
Cannabis use has been consis en ly associa ed o ex e nalizing
p oblems (e.g., G i i h-Lende ing e al., 2011; Pede sen e al.,
2018). I has been also epea edly associa ed wi h in e nalizing
p oblems in adolescen s, such as dep ession (Rasic e al., 2013)
and anxie y (Kedzio & Laebe , 2014). O he s udies ha e
ailed o de ec signi i can associa ions be ween cannabis use
and in e nalizing symp oms (G i i h-Lende ing e al., 2011),
o cannabis abuse and anxie y (Low e al., 2008). Como bidi y
be ween cannabis use and obsessi e-compulsi e diso de s in
young adul s (Sp adin e al., 2017) has also been epo ed. Finally,
while abundan esea ch has linked cannabis use in adolescen s
wi h an inc eased isk o psychosis la e on (Ma coni e al., 2016),
his associa ion in adolescen s migh disappea when accoun ing
o con ounding a iables (Fonseca-Ped e o e al., 2020).
Fu he mo e, esea ch wi h adul popula ions has consis en ly
shown ha sex di e ences exis in he p e alence and ea u es o
he como bidi y be ween MHD and SUD (e.g., F em e al., 2017;
Khan e al., 2013). Howe e , no many s udies ha e e alua ed sex
di e ences in he associa ion be ween men al heal h and subs ance
use p oblems in adolescen s, and inconsis en esul s ha e been
epo ed. Da a has shown ha gi ls wi h SUD o en p esen wi h
highe a es o como bidi y (Robe e al., 2007), and gi ls in SUD
ea men p esen wi h highe le els o men al heal h p oblems.
O he s udies ailed o i nd signi i can sex di e ences in he
associa ions be ween men al heal h symp oms and alcohol and
o he d ugs use (He ads ei e al., 2018).
E idence-based in e en ions aking in o accoun bo h SUD and
MHD in adolescen s a e cu en ly unde de eloped (B ewe e al.,
2017). In o de o design ailo ed ea men s a egies, cla i ying
his speci i c associa ion be ween SUD and MHD seems c ucial.
Mo eo e , mo e esea ch is needed o be able o iden i y speci i c
ea men app oaches ha add ess sex di e ences in como bidi y,
pa icula ly among adolescen s (Di e al., 2017). The pu pose o
his s udy is wo- old: 1) o e alua e sex di e ences in alcohol
and cannabis use pa e ns and men al heal h symp oms, and 2)
o e alua e he p edic i e ole o MHD wi h ega ds o alcohol
and cannabis use diso de s. Wi h his aim, seconda y analyses
ha e been ca ied ou wi h da a om a esea ch s udy conduc ed
be ween 2010 and 2012 (Fe nández-A amendi e al., 2013).
Me hod
Pa icipan s
The ini ial sample was made up o 863 adolescen s om nine
high schools o e ing academic and echnical cou ses om he
P incipali y o As u ias (Spain). The exclusion c i e ia o his s udy
we e: 1) No p o iding a alid ques ionnai e acco ding o he c i e ia
es ablished by he In equency Scale, as indica ed below and 2)
being 18 yea s o age o olde . A o al o 772 pa icipan s p o ided
a alid ques ionnai e (89.5%) and 684 we e 18 yea s o younge
(79.26% o he ini ial sample). These 684 pa icipan s (53.7% gi ls;
mean age = 16.62 yea s; SD = 0.852) made up he i nal sample. The
desc ip i e cha ac e is ics o pa icipan s a e shown in Table 1.
Ins umen s
Sociodemog aphic in o ma ion. Pa icipan s we e eques ed o
p o ide in o ma ion on hei age and sex.
F equency and pa e ns o alcohol and cannabis use in he las
mon h we e e alua ed h ough he i ems o he Eu opean School
Su ey P ojec on Alcohol and O he D ugs S uden Ques ionnai e
(Eu opean Moni o ing Cen e o D ugs and D ug Addic ion
[EMCDDA], 2007). These ques ions measu ed he equency
o subs ance use using a Like scale (1-7) co esponding o 7
al e na i es (namely: ne e /1-2 imes/3-5/6-9/10-19/20-39/mo e
han 40 imes).
Alcohol- ela ed p oblems. To de ec he p esence o alcohol-
ela ed p oblems, he Spanish e sion (López-Núñez e al., 2012)
o he Ru ge s Alcohol P oblem Index (RAPI; Whi e & Labou ie,
1989), alida ed in his s udy, was used. Only hose adolescen s
epo ing any alcohol use we e p esen ed he RAPI. This e sion has
shown excellen eliabili y (C onbach’s α = .91) wi h adolescen s
(López-Núñez e al., 2012). The sel - epo includes 23 ques ions
wi h Like - ype esponses (whe e 0 = ne e ; 1 = 1 o 2 imes; 2 =
3 o 5 imes; 3 = mo e han 5 imes) on he equency o alcohol-
ela ed e en s ha occu ed in he p e ious yea . A cu -o le el
o 7 poin s in he RAPI showed a high eliabili y (C onbach’s
Alpha = .87) and a sensi i i y and speci i ci y o 81.9% and 71.3%
espec i ely o alcohol dependence.
Cannabis- ela ed p oblems. To e alua e p oblems associa ed
o cannabis use, he Spanish e sion (Fe nández-A amendi e al.,
2012) o he Cannabis P oblems Ques ionnai e o Adolescen s –
Sho Fo m (CPQ-A-S; P oud oo e al., 2010), alida ed as pa
o his s udy, was used. Only adolescen s epo ing any cannabis
use we e p esen ed he CPQ-A-S. This ques ionnai e includes
12 dicho omous i ems on he p esence o di e en p oblems
commonly associa ed o cannabis use. Reliabili y o CPQ-A-S is
mode a e (C onbach’s Alpha = .70). A sco e o 3 poin s p esen s
a sensi i i y and speci i ci y o 83% and 77.5% espec i ely o
cannabis dependence (Fe nández-A amendi e al., 2012).
P esence o a DSM-IV-TR diagnosis o abuse o dependence
o alcohol and cannabis was e alua ed by means o sel - epo ed
dicho omous ques ions on he co esponding c i e ia. Acco ding o
DSM-IV-TR (Ame ican Psychological Associa ion [APA], 2000)
p esence o one o mo e symp oms o abuse was conside ed a
diagnosis o alcohol/cannabis abuse, and p esence o h ee o mo e
c i e ia o dependence, was conside ed a diagnosis o alcohol/
cannabis dependence (clus e ed wi hin a yea ). Fo analy ic
pu poses, diagnoses we e me ged in o alcohol use diso de (AUD)
in case alcohol abuse o alcohol dependence was de ec ed; and
cannabis use diso de (CUD) in case cannabis abuse o cannabis
dependence was de ec ed.
Psychopa hological p oblems we e assessed by means o he
B ie Symp om In en o y (BSI) by De oga is and Melisa a os
(1983). This ins umen yields sco es on nine dimensions and
one global index: soma iza ion, obsessi e-compulsi e (OCD),
in e pe sonal sensi i i y (IS), dep ession, anxie y, hos ili y, phobic
anxie y, pa anoid idea ion, psycho icism, and Global Se e i y Index
(GSI). Reliabili y o each dimension o he BSI anges be ween .72
and .95 (Pe eda e al., 2007). Following he adminis a ion manual
o he BSI (De oga is & Melisa a os, 1983), posi i e diagnoses o
each dimension we e calcula ed ollowing no ma i e sco es.
An in equency scale was included in he assessmen ba e y in
o de o de ec ques ionnai es ha had been i lled up in a andom
Se gio Fe nández-A amendi, Víc o Ma ínez-Lo edo, and Ca la López-Núñez
38
o e a ic manne . The ins umen was he O iedo In equency
Scale (INF-OV; Fonseca-Ped e o e al., 2009) which e alua es he
pa icipan s’ ag eemen o disag eemen wi h 12 i ems such as he
ollowing: ‘Ha e you e e seen a i lm on ele ision?’. Following
he ules es ablished by he au ho s, ques ionnai es wi h mo e han
h ee w ong answe s we e excluded om s a is ical analyses.
P ocedu e
All he da a was collec ed h ough sel -adminis e ed
ques ionnai es ha we e included as pa o a compu e ized su ey
ha pe mi s he design and applica ion o an adap i e es wi h
all he ins umen s. The so wa e was se up o ale esponden s
i hey ga e an incong uen answe and o wa n hem i hey le
any blank i em. All s uden s in cou ses aimed a adolescen s wi h
ages anging om 14 o 18 yea s ( om he hi d yea o seconda y
educa ion up o echnical aining and baccalau ea e cou ses), om
nine andomly selec ed high schools in he egion, pa icipa ed
in he s udy. The s udy was app o ed by he E hics Commi ee
o he Minis y o Science and Inno a ion, and he Depa men
o Educa ion o he egional go e nmen . Indi idual and amily
consen was ob ained h ough he schools ollowing hei egula
p o ocols. All pa icipan s i lled up he ques ionnai es in hei own
class ooms, wi h no eaching s a p esen . T ained esea che s
supe ised he applica ion o he su ey, gua an eeing ha s uden s
espec ed he p i acy o hei classma es
Da a analysis
Fi s o all, desc ip i e analyses o demog aphic a iables,
subs ance use, subs ance use p oblems and men al heal h symp oms
we e calcula ed, o he ull sample and by sex. Analysis o a iance
(ANOVA) and chi-squa e s a is ic wi h Ya es co ec ion o
con inui y we e ca ied ou o e alua e sex di e ences in con inuous
a iables e alua ing subs ance use, subs ance use p oblems and
men al heal h symp oms. Secondly, chi-squa e s a is ics wi h Ya es
co ec ion o con inui y, and he Fishe exac es we e ca ied ou
o e alua e sex di e ences in he p e alence o MHD, acco ding
o h esholds es ablished by he BSI, among pa icipan s wi h AUD
and CUD. E ec sizes we e calcula ed using Phi coe i cien (Φ)
and e a-squa ed o all he a o emen ioned chi-squa e and ANOVA
calcula ions, espec i ely. Con i dence le el was se a 95%. Thi dly,
wo logis ic eg essions we e ca ied ou o e alua e he p edic i e
ole o a posi i e diagnosis in each men al heal h dimension wi h
ega ds o he p esence o AUD o CUD. Wi h his pu pose, i s ly,
chi squa e odd a ios o each men al heal h diagnosis and AUD/
CUD we e calcula ed. Those a iables epo ing signi i can odd
a ios we e included in he model. Secondly, possible in e ac ions
be ween men al heal h diagnoses and sex, and be ween e e y wo
men al heal h diagnoses we e calcula ed wi h he B eslow-Day es .
Signi i can in e ac ions we e also included in he models. Finally,
wo independen logis ic eg ession models (one o AUD, and one
o CUD) we e ca ied ou wi h backwa ds s epwise elimina ion
condi ional model. Con i dence le el was 95%. The s a is ical
package SPSS Ve sion 26.0 was used o all analyses.
Resul s
Desc ip i e esul s (Table 1) indica e ha equen (mon hly)
use o alcohol is conside ably p e alen in his sample (77.5%),
and ha 29.8% o adolescen s epo ha ing in oxica ed wi h
alcohol a leas once in his pe iod; wi h no signi i can sex
Table 1
Desc ip i e analyses and gende di e ences in subs ance use p e alence, subs ance use p oblems and men al heal h sco es
To al
(n = 684)
[M (SD)]
Boys
(n = 367)
[M (SD)]
Gi ls
(n = 317)
[M (SD)] S a is ic (p- alue) E ec size
Age 16.62 (0.85) 16.76 (0.87) 16.45 (0.80) 23.60 (≤.001)1.033
Alcohol las mon h (%) 77.5% 79.0% 75.7% 0.886 (.346)2-.040
D unk las mon h (%) 29.8% 32.7% 26.5% 2.834 (.092)2-.068
Cannabis las mon h (%) 17.7% 22.3% 12.3% 11.097 (.003)2-.131
RAPI (among d inke s) 6.12 (7.55) 6.66 (7.92) 5.49 (7.05) 4.121 (.043)1.006
CPQ-A-S (among use s) .57 (1.45) .74 (1.69) .36 (1.08) 4.604 (.033)1.017
AUD (%) 27.2% 33.0% 20.5% 12.727 (≤.001)2-.140
CUD (%)
Soma iza ion
OC
IS
Dep ession
Anxie y
Hos ili y
Phobic Anxie y
Pa anoid idea ion
Psycho icism
9.6%
0.99 (0.85)
0.89 (0.86)
0.79 (0.84)
1.08 (0.75)
1.06 (0.84)
0.96 (0.92)
0.92 (0.86)
0.96 (0.89)
0.93 (0.82)
14.4%
0.92 (0.89)
0.82 (0.85)
0.77 (0.85)
1.02 (0.78)
1.04 (0.86)
0.91 (0.95)
0.89 (0.88)
0.83 (0.88)
0.90 (0.83)
4.1%
1.06 (0.79)
0.96 (0.86)
0.81 (0.83)
1.14 (0.71)
1.09 (0.82)
1.01 (0.87)
0.95 (0.84)
1.11 (0.88)
0.98 (0.81)
19.691 (≤.001)2
5.004.(026)1
4.590 (.033)1
.363 (.547)1
3.983 (.046)1
.724 (.395)1
1.970 (.161)1
.804 (.370)1
16.894 (≤.001)1
1.665 (.197)1
-.175
.007
.007
.001
.006
.001
.003
.001
.024
.002
GSI 0.42 (0.46) 0.38 (0.45) 0.46 (0.46) 4.877 (.028)1.007
No es: RAPI: Ru ge s Alcohol P oblem Index; CPQ-A-S: he Cannabis P oblems Ques ionnai e o Adolescen s – Sho Fo m; AUD: Alcohol Use Diso de ; CUD: Cannabis Use Diso de ; OCD:
Obsessi e-Compulsi e Diso de ; IS: In e pe sonal Sensi i i y; GSI: Global Se e i y Index
1ANOVA; 2Chi-squa e
Sex Di e ences in Como bidi y Be ween Subs ance Use and Men al Heal h in Adolescen s: Two Sides o he Same Coin
39
di e ences. Howe e , among d inke s, boys p esen ed wi h a
signi i can ly highe se e i y o alcohol- ela ed p oblems acco ding
o he RAPI. As o cannabis, signi i can ly mo e boys (22.3%)
han gi ls (12.3%) had used i in he las mon h. Among cannabis
use s, boys p esen ed also wi h signi i can ly mo e cannabis- ela ed
p oblems. The p e alence o AUD and CUD was also signi i can ly
highe among boys. Rega ding men al heal h, gi ls p esen ed wi h
signi i can ly mo e symp oms o soma iza ion, pa anoid idea ion,
OC and dep ession. Resul s o he GSI also show signi i can ly
highe sco es among gi ls. Fo all men al heal h dimensions, he
e ec sizes we e small, excep o pa anoid idea ion, which was
be ween medium and la ge.
As epo ed in Table 2, among adolescen s wi h AUD,
a signi i can ly highe numbe o gi ls esul ed posi i e o
soma iza ion, pa anoid idea ion and hos ili y. Among adolescen s
wi h CUD, gi ls we e mo e likely o be posi i e o OCD, hos ili y
and in e pe sonal sensi i i y. Also, gi ls wi h CUD p esen ed wi h
a highe p e alence o posi i e cases han boys acco ding o he
GSI.
Finally, wo logis ic eg ession models we e calcula ed.
Rega ding he AUD model, p elimina y analyses indica ed ha
anxie y, obsessi e-compulsi e, hos ili y, dep ession, phobic anxie y
and he in e ac ion be ween dep ession and pa anoid idea ion we e
signi i can p edic o s o AUD (p < .05), and consequen ly we e
included in he model. As o he CUD model, p elimina y analyses
indica ed ha anxie y, psycho icism, pa anoid idea ion, obsessi e-
compulsi e, hos ili y, dep ession, in e pe sonal sensi i i y, phobic
anxie y and he in e ac ion be ween obsessi e-compulsi e and sex,
hos ili y and sex, in e pe sonal sensi i i y and sex, and hos ili y
and obsessi e-compulsi e we e signi i can p edic o s (p < .05).
Consequen ly, hey we e all included in he CUD model.
Resul s om logis ic eg ession model o AUD (Negelke ke R2
= .044) indica e ha a posi i e diagnosis o obsessi e-compulsi e
diso de and phobic anxie y we e signi i can p edic o s o AUD.
As o he CUD model (Negelke ke R2 = .078), dep ession and
he in e ac ion be ween hos ili y and obsessi e-compulsi e we e
signi i can p edic o s o CUD.
Discussion
To ou knowledge, no p e ious s udy has e alua ed sex
di e ences in como bidi y o SUD and MHD among Spanish
adolescen s. Ou esul s indica e ha boys p esen wi h signi i can ly
mo e subs ance use p oblems and diso de s, whe eas gi ls epo ed
signi i can ly mo e men al heal h p oblems. Como bidi y be ween
MHD and SUD was also signi i can ly highe among gi ls.
In ou s udy, no signi i can sex di e ences we e ound in he
equency o alcohol d inking o in oxica ion, in line wi h p e ious
esea ch wi h Spanish adolescen s (P ie o-U súa e al., 2020). Only
a signi i can ly highe numbe o boys epo ed using cannabis in he
las mon h compa ed o gi ls. These ends a e in line wi h cu en
na ional da a (Plan Nacional Sob e D ogas, 2019). Howe e , he
p e alence o AUD and CUD was signi i can ly highe in boys
han in gi ls, in line wi h p e ious s udies (Duncan e al., 2015;
Golds ein e al., 2012). Mo eo e , and among use s, alcohol and
cannabis- ela ed p oblems we e signi i can ly highe in boys ha
in gi ls. P e ious s udies ha e indica ed ha men a e mo e likely
o be haza dous d inke s (E ol & Ka pyak, 2015), and ha ea ly
Table 2
P e alence (%) o posi i e cases by sex in he B ie Symp om In en o y dimensions among adolescen s wi h AUD and CUD
Alcohol Use Diso de (AUD) Cannabis Use Diso de (CUD)
Boys (%)
n = 121 Gi ls (%)
n = 65 χ2
p E ec size Boys
(%)
n = 53
Gi ls (%)
n = 13 χ2p E ec size
Anxie y 28.1 34.4 0.499 .480 .065 30.2 50.0** * .310 .162
Soma iza ion 21.5 43.1 8.547 .003 .227 24.5 53.8 * .050 .254
Psycho icism 19.0 24.6 0.500 .480 .066 26.4 46.2 * .190 .171
Pa anoid 5.8 16.9 4.795 .029 .163 9.4 30.8 * .067 .247
OCD 19.0 29.2 1.977 .160 .117 24.5 69.2 * .006 .377
Hos ili y 10.7 33.8 13.300 ≤.001 .282 13.2 61.5 * .001 .459
Dep ession 20.7 20.0 0.000 1.000 -.008 30.2 38.5 * .741 .071
In e pe sonal Sensi i i y 5.0 10.8 * .226 .109 7.5 46.2 * .003 .428
Phobic Anxie y 30.6 43.1 2.382 .123 .125 35.8 61.5 1.886 .170 .208
GSI 4.1 7.7 0.470 .323 .075 5.7 38.5 * .006 .400
No e: OCD: Obsessi e-Compulsi e Diso de ; GSI: Global Se e i y Index
*Fishe exac es
** n = 12 due o missing alues
Table 3
Logis ic eg ession model showing men al heal h dimensions signi i can ly
p edic ing he p esence o Alcohol Use Diso de s among adolescen s
B D p OR CI 95%
Dep ession .968 1 .004 2.631 1.374 5.040
Hos ili y * OCD 1.179 1 .004 3.252 1.450 7.292
Table 4
Logis ic eg ession model showing men al heal h dimensions signi i can ly
p edic ing he p esence o Cannabis Use Diso de s among adolescen s
B D p OR CI 95%
OCD .671 1 .007 1.957 1.202 3.186
Phobic Anxie y .517 1 .013 1.677 1.116 2.520
Se gio Fe nández-A amendi, Víc o Ma ínez-Lo edo, and Ca la López-Núñez
40
d inking is mo e associa ed wi h p oblem d inking in males (Tedo
e al., 2018), o whom d inking is mo e closely associa ed wi h
nega i e consequences such as agg ession (Gussle -Bu kha d
& Giancola, 2005). On he o he hand, women ha e shown o
be less likely o engage in p oblem d inking (E ol & Ka pyak,
2015). Simila esul s ha e been epo ed on cannabis use, since
gi ls p esen wi h mo e p o ec i e ac o s han men ha p e en
hem om escala ing hei cannabis use (Bu e s, 2004). Finally,
and ega ding men al heal h, wo ld epo s om he Wo ld Heal h
O ganiza ion (WHO, n.d.) concludes ha a es o dep ession,
anxie y and soma ic complain s a e highe among women. Ou
esul s show a simila end since gi ls epo ed signi i can ly highe
sco es in soma iza ion, obsessi e-compulsi e symp oma ology
and dep ession, and also in pa anoid idea ion and o e all global
se e i y.
Among adolescen s wi h AUD, gi ls p esen ed wi h highe a es
o como bidi y han boys in all a eas, in line wi h p e ious s udies
(Golds ein e al., 2012; Robe e al., 2007). Howe e , acco ding
o ou esul s, only he p e alence o soma iza ion, hos ili y and
pa anoid idea ion was signi i can ly highe among gi ls wi h
AUD han among boys wi h AUD. Highe a es o soma iza ion
among young emale hea y d inke s ha e al eady been epo ed
(Laukkanen e al., 2001; Milani e al., 2004). Also, d inking among
women has been linked o masculini y and agg ession (Pa ó-
He nández e al., 2019), which could be ul ima ely ela ed o he
high le els o hos ili y ound in ou s udy. Mo eo e , gi ls ha e
shown highe sensi i i y (E ol & Ka pyak, 2015; Sal a o e e al.,
2017) and ulne abili y o alcohol e ec s and hei in e pe sonal
consequences (Chandley e al., 2014; P esley & Pimen el, 2006).
D inking among women goes agains adi ional gende no ms
(Fe nández-Rod íguez e al., 2019), making i is less socially
accep able o hem (Ha ison & Esqueda, 2000). Consequen ly,
alcohol use among women is associa ed wi h inc eased social
and pe sonal s igma (da Sil ei a e al., 2018) and migh be linked
o addi ional men al heal h p oblems. As o pa anoid idea ion,
p e ious s udies ha e also epo ed high le els o pa anoid
idea ion among women wi h SUD (Newland e al., 2015), which
he au ho s link o possible symp oms o anxie y and un ea ed
wi hd awal symp oms. Howe e , u he s udies a e equi ed ha
con i m his hypo hesis.
As o CUD, a es o como bidi y a e also highe among gi ls in
all a eas. Howe e , only he p e alence o obsessi e-compulsi e
diso de , hos ili y, in e pe sonal sensi i i y and global se e i y
esul ed signi i can ly highe among gi ls. E ec sizes indica e
a mode a e e ec , which migh e l ec a conside able clinical
ele ance o hese sex di e ences, wi h a mo e se e e p o i le
o men al heal h p oblems among gi ls ha among boys wi h
CUD. Ou esul s a e in line wi h p e ious esea ch indica ing
ha cannabis use is mo e s ongly linked o agg essi eness and
conduc p oblems in gi ls han in boys (Pede sen e al., 2001).
Again, cannabis use has been commonly associa ed wi h male
ypicali y and adi ional male gende no ms, whe eas i goes
agains adi ional emale oles (Hemsing & G ea es, 2020).
Mo eo e , hese au ho s conclude ha cannabis use is associa ed
wi h agg essi e masculini y among gi ls. These esul s migh
explain he highe le els o hos ili y and in e pe sonal sensi i i y
ound in ou sample o gi ls wi h CUD. Finally, he associa ion
be ween OCD and CUD had al eady been epo ed (Sp adin e al.,
2017), and CUD migh eme ge as a consequence o an excessi e
use o cannabis as a coping mechanism agains in uding hough s.
In ou s udy, he high a es o como bidi y be ween OCD and CUD
among gi ls sugges s ha young emale adolescen s migh be mo e
ulne able o his associa ion. Howe e , hese hypo heses s ill
equi e u he esea ch.
Finally, and acco ding o logis ic eg ession models, dep ession
and he in e ac ion be ween obsessi e-compulsi e diso de and
hos ili y inc eased h ee- old he likelihood o p esen ing an
AUD. These esul s would con i m p e ious associa ions epo ed
be ween high- isk d inking pa e ns, alcohol abuse and dep ession
(Chhoa e al., 2019; Low e al., 2008; Ri che e al., 2016). P e ious
s udies ha e also epo ed a signi i can associa ion be ween
ex e nalizing p oblems and d inking (Colde e al., 2013; Colde
e al., 2017; S andheim e al., 2011). In e es ingly, acco ding
o ou esul s, ex e nalizing p oblems ep esen ed by hos ili y
(which includes i i abili y, u ges o b eak hings, a gumen s and
ou bu s o empe ) would be a isk ac o only when in e ac ing
wi h in e nalizing p oblems such as in usi e hough s o OCD. I
could be ha alcohol use can become p oblema ic when d inking
is used o deal wi h in usi e hough s in an impulsi e manne
among hese adolescen s. This is o g ea clinical ele ance gi en
ha como bidi y be ween AUD and OCD has shown speci i c
associa ed isks such as suicidal hough s (Gen il e al., 2009).
Rega ding CUD, logis ic eg ession indica es ha obsessi e-
compulsi e diso de and phobic anxie y inc eased nea ly wo- old
he likelihood o p esen ing a CUD. These esul s co obo a e he
esul s by Sp adlin e al. (2017), who i nd a speci i c associa ion
be ween OCD and cannabis misuse. Addi ionally, ou esul s a e in
line wi h he esul s om he me a-analyses by Kedzio and Laebe
(2014), linking anxie y and cannabis use diso de . Howe e , in ou
s udy, his associa ion was speci i c only o phobic anxie y, which
includes ea o c owds, public spaces and anspo s. I has been
epo ed ha cannabis use s ha e di i cul ies and p esen wi h
e asi e s yles when coping wi h anxie y (Wilcockson & Sanal,
2016), and ha social anxie y and a oidance a e closely ela ed
wi h coping mo i es o cannabis use (Buckne & Z olensky,
2014), which is in u n linked o cannabis dependence (Johnson e
al., 2010). Fu he s udies should co obo a e hese associa ions.
Su p isingly, and despi e he sex di e ences ound in he bi a ia e
analyses, no signi i can in e ac ions be ween sex and men al
heal h p oblems ha e esul ed signi i can in he logis ic eg ession
models. This sugges s ha addi ional a iables, no included he e,
migh be media ing he sex di e ences de ec ed in he associa ion
be ween MHD and SUD.
The p esen s udy has se e al limi a ions. Fi s ly, his is a
seconda y analysis o a p e ious esea ch, and epidemiological da a
migh no be up o da e wi h mos cu en ends. Also, no da a could
be collec ed ega ding addi ional sociodemog aphic a iables ha
could in l uence he e alua ed ela ionships. Howe e , and gi en he
conside able necessi y o e alua ing como bidi y be ween subs ance
use and men al heal h, pa icula ly among Spanish adolescen s,
as well as o imp o ing ou knowledge on sex di e ences in his
ega d, he p esen esul s a e o g ea in e es . Secondly, only
alcohol and cannabis use pa e ns, p oblems and diso de s ha e
been ho oughly e alua ed in ou s udy. Fu he esea ch should
add ess como bidi y o addi ional subs ances and SUD, such as
obacco, he second mos used subs ance by his popula ion. The
use o hese subs ances could ha e addi ional impac s on he esul s
o he ela ionships analyzed in his s udy. Besides, ou s udy did
no analyze he e ec o possible como bidi ies in men al heal h
dimensions, nei he como bidi ies in subs ance use diso de s.

Sex Di e ences in Como bidi y Be ween Subs ance Use and Men al Heal h in Adolescen s: Two Sides o he Same Coin
41
Fu he s udies a e necessa y ha add ess hese issues. Thi dly,
sc eening es s ha e been used o e alua e MHD. Al hough his
has allowed us o ca y ou a comp ehensi e e alua ion o mul iple
MHD, conclusions on he a es o como bidi y o he epo ed
diagnoses ha e o be in e p e ed wi h cau ion. Finally, he c oss-
sec ional na u e o ou s udy p e en s us om discussing possible
causali y in he epo ed associa ions.
Despi e boys p esen ing mo e alcohol and cannabis- ela ed
p oblems, as well as highe p e alence o AUD and CUD, gi ls
epo ed signi i can ly mo e men al heal h p oblems and highe
como bidi y be ween MHD and SUD. In pa icula , dep ession
and he in e ac ion be ween hos ili y and obsessi e-compulsi e
symp oms indica ed a highe isk o AUD, whe eas obsessi e-
compulsi e symp oms and phobic anxie y inc eased he isk o
p esen ing CUD. Fu he s udies should con inue e alua ing he
associa ions be ween SUD and MHD and symp oms in adolescen s,
ocusing on sex di e ences.
Ou s udy s esses he impo ance o add essing men al heal h
p oblems among adolescen s p esen ing wi h subs ance use
p oblems and diso de s, in o de o p o ide a comp ehensi e
psychological assis ance. Pa icula ly, special a en ion needs o
be placed on adolescen gi ls, who p esen wi h signi i can ly mo e
como bid men al heal h p oblems. Finally, ou esul s indica e ha
p o iding app op ia e men al heal h ca e se ices and p e en ion
p og ams o adolescen s could con ibu e o educe subs ance use
p oblems in his popula ion.
Acknowledgemen
This s udy was unded by he Spanish Minis y o Inno a ion
and Science (Re : MICINN-08-PSI2008-00309). The au ho s
would like o hank he Educa ion Depa men o he P incipali y
o As u ias, as well as he pa icipa ing ins i u ions, hei s a and
hei s uden s.
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