Gender differences in the association between substance use and elevated depressive symptoms in a general adolescent population


Christiane Poulin, Department of Community Health and  Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia, Canada, E-mail:


Aims  This study explores gender differences in the association between substance use and elevated depressive symptoms in the general adolescent population.

Design  Cross-sectional self-reported anonymous survey, the 2002/2003 Student Drug Use Survey in the Atlantic Provinces. The sample design was a single-stage cluster sample of randomly selected classes stratified by grade and region.

Setting  The four Atlantic provinces of Canada.

Participants  A total of 12 771 students in junior and senior high schools of the public school systems, representing a response rate of about 97%. The average age of participants was 15.2 years.

Measurements  The measure of elevated depressive symptoms was a 12-item version of the CES-D with three categories of depression risk validated in a companion study.

Findings  The prevalence of very elevated depressive symptoms was 8.6% in females and 2.6% in males. Alcohol use and cigarette smoking were found to be independent predictors of elevated depressive symptoms in females, but not males; cannabis use was found to be an independent predictor of elevated depressive symptoms in both males and females. Age was found to have a curvilinear relationship with elevated depressive symptoms in females but not in males. The adolescent's academic performance and province of residence were found to be independent risk factors of elevated depressive symptoms among both males and females. About 10.3% of adolescents considered to be potential candidates for needing help reported having received help because they felt depressed.

Conclusions  The association between depression risk and age, alcohol use, cigarette smoking and cannabis use in the general adolescent population is not straightforward and may differ according to gender. There is unmet need for help for depression among adolescents.