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The gendered relationship between illicit substance use and self-harm in university students

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Abstract

Purpose

To estimate associations between multiple forms of substance use with self-harming thoughts and behaviours, and to test whether gender is an effect modifier of these associations, both independently and along with perceived risk of cannabis use.

Methods

Data were drawn from the 2018 Norwegian Students’ Health and Wellbeing Study (SHoT 2018). A national sample of n = 50,054 full-time Norwegian students (18–35 years) pursuing higher education completed a cross-sectional student health survey, including questions on past-year self-harm: non-suicidal thoughts of self-harm, non-suicidal self-harm, suicidal thoughts, and suicide attempt. Students reported their frequency of past-year alcohol use (range: never to ≥ 4 times/ week), illicit substance consumption, and perceived risk of cannabis use. The AUDIT and CAST screening tools measured problematic alcohol and cannabis consumption, respectively. We used logistic regression modelling adjusted for age, symptoms of depression and anxiety, and financial hardship (analytic sample range: n = 48,263 to n = 48,866).

Results

The most frequent alcohol consumption category (≥ 4 times/ week) was nearly always associated with more than a two-fold increased likelihood of self-harm. Less frequent alcohol consumption was associated with reduced odds of suicidal thoughts [monthly or less: OR = 0.87 (95% CI: 0.75–1.00), 2–4 times/month: OR = 0.79 (95% CI: 0.69–0.91), and 2–3 times/ week: OR = 0.83 (95% CI: 0.71–0.98)]. Problematic alcohol consumption was associated with most outcomes: odds ranging from 1.09 (95% CI: 1.01–1.18) for suicidal thoughts to 1.33 (95% CI: 1.00–1.77) for suicide attempt. There was evidence of multiple illicit substance by gender interactions: consumption of all but one illicit substance category (other drug use) was associated with all four forms of self-harm for women, but findings among men were less clear. Among men, only one illicit substance category (stimulant) was associated with most forms of self-harm. Women, but not men, who perceived cannabis use as a health risk were more likely to experience non-suicidal thoughts as cannabis consumption increased, and with harmful consumption patterns.

Conclusion

Frequent alcohol consumption is associated with increased risk of self-harm and suicidality for young women and men. Associations between illicit substance use and self-harm and suicidality appear stronger in women compared to men.

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Data availability

Details regarding data access are available from the Norwegian Institute of Public Health (https://www.fhi.no/en/more/access-to-data/).

Code availability

STATA code can be made available upon request.

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Acknowledgements

We wish to thank all students participating in the study, as well as the three largest student welfare organizations in Norway (SiO, Sammen, and SiT), who initiated and designed the SHoT study.

Funding

This work was partly supported by the Research Council of Norway through its Centres of Excellence funding scheme (project number 262700), the Canada Research Chairs program, and by the Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Awards (CGS-D) program. SHoT2018 has received funding from the Norwegian Ministry of Education and Research (2017) and the Norwegian Ministry of Health and Care Services (2016).

Author information

Authors and Affiliations

  1. School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cr, Room 308C, Ottawa, ON, K1G 5Z3, Canada

    Nicole G. Hammond & Ian Colman

  2. Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway

    Børge Sivertsen & Jens Christoffer Skogen

  3. Department of Research and Innovation, Helse-Fonna HF, Haugesund, Norway

    Børge Sivertsen

  4. Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway

    Børge Sivertsen

  5. Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway

    Jens Christoffer Skogen

  6. Faculty of Health Sciences, University of Stavanger, Stavanger, Norway

    Jens Christoffer Skogen

  7. Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway

    Simon Øverland

  8. Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway

    Ian Colman

Authors
  1. Nicole G. Hammond
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  2. Børge Sivertsen
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  3. Jens Christoffer Skogen
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  4. Simon Øverland
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  5. Ian Colman
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Contributions

All authors contributed to study conceptualization and design. Data analysis was performed by Dr. IC. The first draft of the manuscript was prepared by Ms. NGH. All authors provided feedback and approved the final manuscript.

Corresponding author

Correspondence to Ian Colman.

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Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Role of the funder

The Research Council of Norway, the Canada Research Chairs program, and the CGS-D program had no role in study design, data collection or analysis, nor did they influence the authors’ decision to prepare and publish this manuscript.

Ethics approval

The Regional Committee for Medical and Health Research Ethics in Western Norway approved SHoT2018 (no. 2017/1176).

Consent to participate

Participants provided informed consent (electronically).

Consent for publication

Not applicable.

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Hammond, N.G., Sivertsen, B., Skogen, J.C. et al. The gendered relationship between illicit substance use and self-harm in university students. Soc Psychiatry Psychiatr Epidemiol 57, 709–720 (2022). https://doi.org/10.1007/s00127-021-02209-3

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