Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, ON, M5S 2S1, Canada.
Heidelberg Institute of Global Health, Universitätsklinikum Heidelberg, 69120, Heidelberg, Germany.
Eur Child Adolesc Psychiatry. 2021 Feb;30(2):293-301. doi: 10.1007/s00787-020-01518-3. Epub 2020 Mar 25.
Canada is in the midst of an ongoing, escalating opioid crisis, with significant impacts on adolescents and young adults. Accordingly, mental health impairment was examined as a risk factor for non-medical prescription opioid use (NMPOU) among high school students. In addition, the moderating effects of the school environment, in terms of the availability of mental health services and substance use policies, were characterized. Self-reported, cross-sectional data were obtained from the COMPASS study, including 61,239 students (grades 9-12) in 121 secondary schools across Canada. Current and lifetime NMPOU were ascertained. Categorical indicators of mental health impairment and school environment were derived. The main analytical strategy encompassed hierarchal multilevel logistic regression, including the addition of interaction terms to characterize the moderation effects. Current and lifetime NMPOU were reported by 5.8% and 7.2% of the students, respectively. After adjusting for confounders, students in the highest quintile of mental health impairment had odds ratios (OR) of 2.60 (95% confidence interval [CI] 2.29-2.95) and 2.96 (95% CI 2.64-3.33) for current and lifetime NMPOU, respectively when compared to students in the lowest quintile of mental health impairment. A significant interaction between mental health impairment and school environment indicated relatively lower risks of NMPOU in students from schools that provide more mental health services and have stricter substance use policies. Mental health impairment increased the risk of NMPOU, but the associations were moderated by the school environment. These findings underscore the importance of mental health services and substance use regulations in schools.
加拿大正处于持续升级的阿片类药物危机之中，青少年和年轻人受到的影响尤为严重。因此，本研究将心理健康障碍视为高中生非医疗处方类阿片类药物使用（NMPOU）的风险因素，并对学校环境（包括心理健康服务的提供情况和物质使用政策）的调节作用进行了研究。COMPASS 研究采用自我报告的横断面数据，纳入了加拿大 121 所中学的 61239 名 9-12 年级学生。本研究确定了当前和终身 NMPOU 的情况，并通过分类指标评估了心理健康障碍和学校环境。主要分析策略包括分层多水平逻辑回归，包括添加交互项来描述调节作用。分别有 5.8%和 7.2%的学生报告了当前和终身 NMPOU。在调整了混杂因素后，与心理健康障碍最低五分位的学生相比，心理健康障碍最高五分位的学生当前和终身 NMPOU 的比值比（OR）分别为 2.60（95%置信区间[CI] 2.29-2.95）和 2.96（95% CI 2.64-3.33）。心理健康障碍和学校环境之间存在显著的交互作用，表明在提供更多心理健康服务和更严格的物质使用政策的学校中，NMPOU 的风险相对较低。心理健康障碍增加了 NMPOU 的风险，但这种关联受到学校环境的调节。这些发现强调了学校心理健康服务和物质使用规定的重要性。
