Study links childhood trauma and simultaneous substance use to higher rates of depression in college students

A new study from the Texas A&M University School of Public Health at Texas A&M Health found that childhood trauma, such as abuse, neglect or household instability, and using multiple substances at the same time — particularly cannabis and stimulants — are strongly linked to experiencing depressive symptoms among college students.

“We found that these issues are not separate, but may be deeply connected,” said health behavior expert Benjamin N. Montemayor, who led the study. “Many of today’s students are navigating the double burden of past trauma and current mental health struggles, all while adjusting to the college experience.”

He added that college can be a critical period when the effects of childhood trauma begin to manifest as risky behaviors and mental health issues, as students gain independence and must decide whether to seek support and internalize or mask their feelings. The findings have important implications for how colleges and universities approach students’ mental health issues.

“For one thing, consuming multiple substances like alcohol, cannabis and nonprescription stimulants at the same time can increase health risks and make substance use disorders harder to treat,” he said. “At the same time, the mental health struggles of American college students have skyrocketed in recent years, with more than 60% meeting the criteria for at least one mental health condition.”

For the study, published in the International Journal of Mental Health and Addiction, 2,155 full-time college students who represented the nation’s broader student population in terms of age, sex and race/ethnicity and who had consumed alcohol within the past 12 months answered questions about their alcohol and cannabis use, nonmedical use of prescription stimulants such as Adderall, adverse childhood experiences and depressive symptoms.

The analysis showed that substance use is widespread among college students. Over a 30-day period, 73% of the sample reported drinking alcohol, 52% had used cannabis, and 10% reported the non-medical use of prescription stimulants. In addition, 24% reported simultaneous (at the same time) alcohol and cannabis use, while about 6% reported simultaneous alcohol and stimulant use.

Nearly 45% of participants fell into the moderate to severe range for depressive symptoms. On average, students reported about four types of adverse childhood experiences in their life — a level associated with increased risk for long-term health and social problems later in life. This average was notably higher than the national estimates for college students, which is typically under three.

“The higher trauma scores might be high because we specifically looked at students who already drink alcohol, and there is a well-established connection between childhood trauma and using alcohol and other substances as a way to cope,” Montemayor said.

The study identified four key findings:

• Students who had more adverse childhood experiences were significantly more likely to report higher levels of recent depressive symptoms.
• After accounting for important covariates, adverse childhood experiences, cannabis use and misusing prescription stimulants (like Adderall) were associated with higher depressive symptoms.
• Alcohol use alone was not significantly associated with depressive symptoms in this sample.
• Using alcohol and stimulants at the same time was linked to higher depressive symptoms after accounting for adverse childhood experience, whereas using alcohol and cannabis together did not appear to increase risk for depressive symptoms beyond cannabis use alone.

To learn more about this, the researchers examined students who reported simultaneous use of alcohol and cannabis or alcohol and stimulants within the past 30 days, but the results were inconclusive. Montemayor said this could be due to limitations in how depressive symptoms are measured, or because using multiple substances concurrently or simultaneously might mask the severity of those symptoms. He added that future studies should follow students over time to better understand what comes first — substance use or emotional distress — and to identify the risk profiles of students most affected.

“Overall, our findings tell us that to effectively support students, college health programs should move beyond treating issues in isolation and instead adopt integrated strategies that address mental health, substance use and early life trauma together,” Montemayor said.

He added that because certain substance combinations are more strongly linked to depression than others, college health programs may benefit from more targeted approaches, focusing on specific patterns of substance use and types of childhood adversity, rather than relying on compartmentalized programs or strategies that do not account for individual experiences.

Others involved in the study include were Texas A&M School of Public Health students Arham Hassan, Snehi Bajracharya, Aniqua Salwa and Anka A. Vujanovic.

By Ann Kellett, Texas A&M University School of Public Health