The role of poor mental health in substance use across socioeconomic strata of Armenian adolescents: a counterfactual mediation analysis

Objective To study the relationship between socioeconomic position (SEP) and adolescent substance use and explore the role of poor mental health in that relationship. Methods Adolescents aged 11-15 years participated in the Health Behavior in School-aged Children survey in Armenia. Robust Poisson regression and counterfactual mediation analysis were used. Results In a pooled analysis with 6512 adolescents, the adjusted prevalences of current smoking (prevalence ratio [PR] = 1.93, 95%CI = 1.29-2.88), weekly beer (PR = 1.46, 95%CI = 1.07-2.01), spirits (PR = 1.54, 95%CI = 1.01-2.37) or lifetime cannabis use (PR = 3.10, 95%CI = 0.91-10.59) were greater in low-SEP adolescents compared to the middle-SEP group. Poor mental health explained 25.6%-54.7% of that relationship. Similarly, high-SEP adolescents had increased risks of current smoking (PR = 1.54, 95%CI = 0.98-2.42), weekly beer (PR = 1.55, 95%CI = 1.11-2.18), spirit (PR = 1.58, 95%CI = 1.02-2.45), wine (PR = 1.33 95%CI = 1.01-1.75) intake, than middle-SEP adolescents. Conclusions Both low- and high-SEP adolescents in Armenia are at greater risk of substance use than the middle-income group. Poor mental health substantially contributes to substance use among low-SEP adolescents. Additional studies are needed to clarify the motives for substance use among high-SEP adolescents.