Catalina Espitia-Cepeda1†
Bárbara González-Amado2†
Salvador Simó-Algado1†
Víctor José Villanueva-Blasco2*†- 1Institute for Research and Innovation in Life and Health Sciences in Central Catalonia, Universitat de Vic—Universitat Central de Catalunya (UVic-UCC), Barcelona, Spain
- 2Faculty of Health Sciences, Valencian International University, Valencia, Spain
Background: This systematic review aims to analyze the relationship between prescribed and non-prescribed use of psychotropic drugs and the presence of symptoms of depression, anxiety, stress, suicidal ideation, and suicide in the university population without a clinical disorder diagnosis, considering different types of psychotropic drugs (sedatives, tranquilizers, opioids, sleep aids).
Methods: Following PRISMA 2020 guidelines, a systematic search was carried out in PubMed/MEDLINE, the Web of Science, Scopus, CINAHL and PsyInfo. Registered in PROSPERO (CRD42023446068). Thirty-four quasi-experimental studies meeting ≥60% MMAT quality were included (assessed using the MMAT) were included. Data extraction considered demographic variables, mental health outcomes, types of psychotropic drugs, and prescription status.
Results: The findings reveal a significant association between both prescribed and non-prescribed psychotropic drug use and symptoms of psychological distress. Non-prescribed use was more strongly linked to anxiety, stress, and depression, whereas prescribed use was more closely related to suicidal ideation and suicide. Antidepressants, anxiolytics, and opioids were most frequently involved. Women and, in several studies, LGBTQ+ students displayed higher prevalence of psychotropic use in relation to distress.
Conclusion: The results emphasize the need for a preventive, contextual, and integral approach to address psychotropic drug use in university settings. Healthy Campus initiatives should reinforce awareness campaigns, promote psychosocial well-being, ensure early detection of psychological distress, and reflect critically on academic structures that may exacerbate emotional difficulties. Further research is needed from an intersectional and multilevel perspective to inform targeted interventions and institutional policy.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023446068, identifier (CRD42023446068).
Introduction
The consumption of psychotropic drugs with and without a medical prescription is considered a growing public health problem [Bouvier et al., 2019; Hulme et al., 2018; National Institute on Drug Abuse, 2018; Rougemont-Bücking et al., 2018; Schepis et al., 2018; Substance Abuse and Mental Health Services Administration (SAMHSA), 2021].
Psychotropic drugs have inhibitory effects on the central nervous system (CNS), leading people to use them with or without a prescription to alleviate various types of physical and psychological discomfort (National Institute on Drug Abuse, 2018). The consumption of psychotropic drugs has been associated with the presence of chronic pain (Garland et al., 2020; Groenewald et al., 2019; Rogers et al., 2021), psychological distress (Ponnet et al., 2015), stress (Jensen et al., 2016), post-traumatic stress disorder (Aarstad-Martin and Boyraz, 2017), anxiety (Bouvier et al., 2019; Montiel et al., 2020; Wheeler et al., 2019), depression (Bouvier et al., 2019; Bryan et al., 2021; Kedia et al., 2020; Montiel et al., 2020; Pontes et al., 2021; Villanueva-Blasco et al., 2022b; Wheeler et al., 2019), suicidal ideation and suicide (Montiel et al., 2020; Pontes et al., 2021; Villanueva-Blasco et al., 2022b), or sleep disorders (Alasmari et al., 2022).
In recent decades, various systematic reviews and meta-analyses have been conducted on the consumption of psychotropic drugs among the general population, adolescents, young adults, and university students, with different objectives. Some have focused on specific types of psychotropic drugs, such as stimulants (i.e., Bavarian et al., 2015; Benson et al., 2015), opioids (i.e., Bonar et al., 2020; Bouvier et al., 2019; Weyandt et al., 2022), or benzodiazepines (i.e., Votaw et al., 2019). Others have analyzed aspects such as the prevalence of psychotropic drug consumption (i.e., Jia et al., 2018), changes in consumption over a lifetime (i.e., Schepis et al., 2020), the main reasons for consumption (i.e., Bennett and Holloway, 2017; Drazdowski, 2016), risk and protective factors related to consumption (i.e., Lyons et al., 2019; Nargiso et al., 2015), and the origin and diversion of psychotropic drugs for non-medical use (i.e., Hulme et al., 2018). However, most of the studies included in these systematic reviews did not differentiate between prescribed (misuse pattern) and non-prescribed psychotropic drugs.
Nowadays, non-prescribed psychotropic drugs are the second most illicitly consumed psychoactive substance after marijuana (Rougemont-Bücking et al., 2018), particularly those classified as opioids, stimulants, and sedatives (Hulme et al., 2018). The use of non-prescribed psychotropic drugs can lead to various health consequences such as overdose (World Health Organization, 2023), addiction, and increased demand for addiction treatment (Yamamoto et al., 2021), polydrug use (Aarstad-Martin and Boyraz, 2017; Bakhshaie et al., 2019; Gallucci and Martin, 2015; Molloy et al., 2019; Papazisis et al., 2018), and death [Center for Disease Control and Prevention (CDCP) and National Center for Health Statistics (NCHS), 2017].
The consumption of psychotropic drugs, both prescribed and non-prescribed, can emerge as a coping strategy in response to certain psychosocial stressors (Villanueva-Blasco et al., 2022a). This relationship between psychotropic drug use and stress factors can be explained through the Transactional Model of Stress (Lazarus and Folkman, 1986). This model proposes three coping styles: (a) task-focused, seeking logical ways to solve the problem; (b) emotion-focused, aimed at assigning a new meaning to the stressor to mitigate emotional distress; and (c) avoidance-oriented, where the individual seeks distractions to avoid facing the problem. This last coping style is significantly associated with maladaptive behaviors such as drug use and the risk of addiction (Glodosky and Cuttler, 2020; Lee-Winn et al., 2018).
Several studies agree in identifying the university population as a particularly vulnerable group to experiencing stress (Glodosky and Cuttler, 2020; Zenebe and Necho, 2019). This stress can be linked to various aspects of university life and may lead to the use of psychotropic drugs as a coping strategy. The use of non-prescribed psychotropic drugs has been associated with the motivation to improve academic performance or as a cognitive enhancement method (Cook et al., 2021; Gallucci et al., 2014; Gallucci and Martin, 2015; Molloy et al., 2019; Ponnet et al., 2015; Yomogida et al., 2018; Zahavi et al., 2023), social pressure (Ponnet et al., 2015), or job uncertainty (Colell et al., 2016). Another reason for the increased use of psychotropic drugs among university students is easy accessibility (Hulme et al., 2018). Anxiety and difficulty sleeping are some of the reasons for consuming anxiolytics (Ghandour et al., 2012). While stimulants are mainly used to increase concentration, alertness, and to study. Opioids are used to relieve physical pain, sleep, and reduce anxiety (Ghandour et al., 2012).
Beyond the university population diagnosed with a clinical disorder who receive pharmacological treatment, the consumption of psychotropic drugs in the university population appears as a coping strategy for psychosocial and academic stressors. Far from pathologizing university life, the aim of this systematic review was to answer the following research questions: What is the relationship between the use of psychotropic drugs, both prescribed and non-prescribed, and the presence of symptoms of depression, anxiety, stress, suicidal ideation, and suicidal behavior among university students? Which types of psychotropic drugs are most frequently associated with indicators of psychological distress in this population? Based on these research questions, the primary objective was to analyze the relationship between the use of psychotropic drugs (prescribed and non-prescribed) and symptoms of depression, anxiety, stress, suicidal ideation, and suicidal behavior among university students. As a secondary objective, the study aimed to identify the types of psychotropic drugs most frequently associated with various indicators of psychological distress in this population. This relationship is examined by considering different categories of psychotropic substances (sedatives, tranquilizers, opioids, and sleep-inducing medications), regardless of whether they were used with or without medical prescription.
Method
Data sources and search strategy
A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines (Page et al., 2021). The search was performed in the Web of Science (WoS), APA PsycInfo, CINAHL, PubMed/MEDLINE, and Scopus databases from January of 2023 to March 2025. The research protocol was registered in PROSPERO (registration code: CRD42023446068).
Various keywords were identified based on a review of previous literature and the authors’ knowledge in the field of study. Additionally, the DeCS Thesaurus was used to identify and select specific terms for the initially selected keywords. Subsequently, through an iterative process, new keywords were selected based on the results reported in the initial searches. Finally, the keywords were combined using the following search strategy: (((((((((((“College student*”) OR (“University student*”)) OR (“young adult*”)) OR (College*)) OR (“Student*”)) OR (“Emerging adulthood*”)) OR (Undergraduate*)) AND ((((“risk factor*”) OR (“relation*”)) OR (“associa*”))) AND ((((((“Anxiety*”) OR (“Stress*”)) OR (“Suicide*”)) OR (“Suicidal ideation*”)) OR (“depression*”)) OR (“Psychological distress*”))) AND (((((((((((((((((“Psychotropic drug*”) OR (“Psychotropic medication misuse”)) OR (“non-medical use of prescription drugs”)) OR (“non-medical prescription drug use”)) OR (“Prescription drug misuse”)) OR (“Hypnotic*”)) OR (“Sedativ*”)) OR (“Analgesic*”)) OR (“Opioid*”)) OR (“Substance misuse”)) OR (“Stimulant*”)) OR (“non-medical prescription opioid*”)) OR (“non-medical prescription drug*”)) OR (“opioid analgesics*”)) OR (“nonmedical use of prescription drugs”)) OR (“nonmedical prescription drug”)))).
Eligibility criteria
The studies included in this review met the following inclusion criteria: (a) Studies with an university population sample (undergraduate and postgraduate) or that, even incorporating other types of populations, included differentiated results for the university population; (b) Studies that included quantitative data on variables of consumption with and without medical prescription of: sedatives, tranquillizers, opioids, sleeping pills; (c) Studies that analyzed the relationship between consumption and mental health variables, including depression, anxiety, stress, suicidal ideation and suicide; (d) Studies published in English and Spanish; (e) No date limit; and, (f) Minimum methodological quality of 60% (MMAT—Mixed Methods Appraisal Tool).
In addition, the following exclusion criteria were considered: (a) Studies conducted in animals; (b) University population diagnosed with mental disorders or previous addiction; (c) Studies addressing behavioral addictions; and (e) Literature reviews, systematic reviews, meta-analyses, books, book chapters, conference communications and doctoral theses.
Selection process
Three authors (first author, second author, and fourth author) independently identified the sought studies in three steps following the literature (Gunnell et al., 2020). First, the titles of articles obtained from the initial searches were examined and selected based on the eligibility criteria mentioned earlier. Next, a review of titles and abstracts was conducted to select articles that aligned with the review objectives. Third, full-text articles were thoroughly analyzed and selected for eligibility. Lastly, the bibliographic references of all selected articles were manually reviewed to identify relevant articles missed in the initial search strategy (ancestry approach).
The search strategy yielded a total of 18,643 records and 8 articles listed in the references of others articles, with 34 articles remaining after the entire selection process that were included in the systematic review. The selection process is summarized in Figure 1.
Figure 1. Flowchart. The flowchart was created using the PRISMA tool (Page et al., 2021).
Data extraction
Two authors (first author, and fourth author) independently and systematically extracted data from the final list of included studies. The following categories of manuscripts were identified and considered: (a) Authorship, year and country, (b) Study type, (c) Characteristics of the target population: sex and age, (d) Sample size, (e) Study objectives, (f) Mental health variables, (g) Mental health assessment (h) Psychotropic drug variables, (i) Psychotropic drug assessment, and (j) Main study outcomes. Discrepancies between the authors were resolved through consensus decision-making.
Assessment of methodological quality
The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT) (Hong et al., 2018). The MMAT is a critical appraisal tool designed for systematic reviews that include quasi-experimental empirical studies (Table 1). For this study, only studies providing quantitative data were included. The assessment of methodological quality for each study is presented in Table 1. A decision was made to select studies with a minimum of 60% methodological quality.
Table 1. Assessment of methodological quality for quasi-experimental studies.
Results
Characteristics and results of selected studies
Table 2 presents information from the 34 articles identified with a methodological quality of 60% or higher. In terms of study design, all were quasi-experimental. Most of the studies were conducted in the USA (n = 25), with others in France (n = 1), Brazil (n = 1), Canada (n = 1), Germany (n = 1), Puerto Rico (n = 1), Saudi Arabia (n = 1), Switzerland (n = 1), China (n = 1) and Serbia (n = 1). The age of participants ranged from 17 to 58 years, considering samples not only from undergraduate students but also from master’s and doctoral programs. The sample sizes across all studies were generally large, ranging from 41 to 22,783 participants.
Table 2. Coding table of primary studies: articles included in the systematic review.
Depression and psychotropic drug consumption
Several studies have confirmed that the presence of depressive symptoms in university students is related to the consumption of psychotropic drugs, both with medical prescription (Balayssac et al., 2018) and without prescription or with misuse (Balayssac et al., 2018; Benson and Flory, 2017; Ford and Schroeder, 2008; Freibott et al., 2024; Gaume et al., 2024; Hua et al., 2023; Walters et al., 2018; King et al., 2020; Kouros and Papp, 2024; McCauley et al., 2011; Meshesha et al., 2017; Peralta et al., 2016; Tam et al., 2020; Teter et al., 2010; Čanković et al., 2023; Weyandt et al., 2009). Some of these results suggest a significant and direct relationship (Ford and Schroeder, 2008; Freibott et al., 2024; Gaume et al., 2024; Hua et al., 2023; Walters et al., 2018; Kouros and Papp, 2024; Meshesha et al., 2017; McCauley et al., 2011; Tam et al., 2020; Čanković et al., 2023; Weyandt et al., 2009). On the other hand, some studies report no association between depressive symptoms and psychotropic drug consumption (Sousa et al., 2020), or an inverse relationship in the case of misuse of psychotropic drugs, finding that higher depressive symptoms are associated with a lower likelihood of misusing prescribed medications (Cabriales et al., 2013; Verdi et al., 2014).
In terms of the type of psychotropic drug, the relationship between depressive symptoms and consumption is confirmed for opioids (Freibott et al., 2024; Hua et al., 2023; Meshesha et al., 2017; Weyandt et al., 2021; Zullig and Divin, 2012), stimulants (Benson and Flory, 2017; Ford and Schroeder, 2008; King et al., 2020; Teter et al., 2010; Weyandt et al., 2009; Zullig and Divin, 2012), sedatives (Gaume et al., 2024; Hua et al., 2023; Walters et al., 2018; Tam et al., 2020; Čanković et al., 2023; Zullig and Divin, 2012), and antidepressants (Zullig and Divin, 2012).
Anxiety and psychotropic drug consumption
There is evidence of a relationship between anxiety symptoms and the consumption of psychotropic drugs without medical prescription or with misuse (Balayssac et al., 2018; Cabriales et al., 2013; Freibott et al. (2024); Gaume et al., 2024; Hua et al., 2023; Jeffers et al., 2015; Tam et al., 2020; Verdi et al., 2014; Weyandt et al., 2021), particularly with stimulants (Dussault and Weyandt, 2013; King et al., 2020; Verdi et al., 2014; Weyandt et al., 2009), opioids (Freibott et al., 2024; Hua et al., 2023) ad sedatives (Gaume et al., 2024; Hua et al., 2023). Regarding the relationship with anxiety, a significant and direct association has also been identified (Balayssac et al., 2018; Tam et al., 2020). On the other hand, Walters et al. (2018) report no association between anxiety symptoms and psychotropic drug consumption.
Stress and psychotropic drug consumption
There is evidence to suggest that stress is associated with the consumption of psychotropic drugs in general (Balayssac et al., 2018; Boulton and O'Connell, 2017), as well as with non-prescription stimulants (Antshel et al., 2021; Schepis et al., 2021). Several studies have indicated a correlation between stress and the use of psychotropic drugs (Bahlaq et al., 2023; Betancourt et al., 2013; Schepis et al., 2021; Verdi et al., 2014). On the other hand, the study by Grant et al. (2018) directly associated non-prescription stimulant use with post-traumatic stress. Also, the study of Sattler (2019), reported that higher levels of stress were associated with a likely use of stimulants (named like Cognitive Enhancement drug use). Finally, the study of Bahlaq et al. (2023) reports a relationship between stimulants misuse and stress symptoms.
Suicidal behavior and use of psychotropic drugs
In general, studies find a relationship between the use of prescribed anxiolytics and opioids (Davis et al., 2020; Zullig and Divin, 2012), sedatives (Zullig and Divin, 2012), and antidepressants (Zullig and Divin, 2012) with suicidal ideation, attempts, and behavior.
On the other hand, in the study of Vidourek et al. (2010) concludes that students who had never used psychopharmaceuticals without a prescription were more likely to have lifetime suicidal ideation and to contemplate attempting suicide in the past 12 months.
Discussion
The findings confirm consistent associations between psychotropic drug use and depressive, anxiety, and stress symptoms in university populations. Crucially, non-prescribed use is more strongly linked to anxiety, stress, and depression, whereas prescribed use is more closely associated with suicidal ideation and behavior (particularly involving antidepressants, anxiolytics, and opioids). This dual pattern, evident across the included studies, should frame risk interpretation and guide differential prevention strategies by type of use.
Most of the identified evidence is consistent regarding the relationship between psychotropic medication and depression (Balayssac et al., 2018; Benson and Flory, 2017), anxiety (Balayssac et al., 2018; Tam et al., 2020), and stress (Balayssac et al., 2018; Betancourt et al., 2013; Boulton and O'Connell, 2017) within the university context. However, the primary finding of this systematic review indicates that symptoms related to depression, anxiety, and stress are more strongly associated with non-prescription psychotropic medication use (Antshel et al., 2021; Balayssac et al., 2018; Bahlaq et al., 2023; Cabriales et al., 2013; Dussault and Weyandt, 2013; Freibott et al., 2024; Ford and Schroeder, 2008; Gaume et al., 2024; Grant et al., 2018; Hua et al., 2023; Jeffers et al., 2015; King et al., 2020; McCauley et al., 2011; Meshesha et al., 2017; Peralta et al., 2016; Sattler, 2019; Schepis et al., 2021; Tam et al., 2020; Teter et al., 2010; Verdi et al., 2014; Weyandt et al., 2009, 2021). In this regard, Balayssac et al. (2018) report that students who self-medicate exhibit higher rates of anxiety and depression than their counterparts who consume some form of psychotropic medication, as directed by a medical professional.
In contrast, suicidal ideation and completed suicide were more strongly associated with prescribed psychotropic medication use, particularly antidepressants, anxiolytics, and opioids (Davis et al., 2020; Zullig and Divin, 2012). However, the study of Vidourek et al. (2010) proposed that there was a major odd of suicidal ideation in students that have ever consumed NMPD and that in a prevalence of last year, the same students were more likely to contemplated the idea of suicide.
In relation to the consumption of non-prescription psychotropic medications, the most compelling evidence suggests that these drugs are readily accessible among university students (Hulme et al., 2018; Verdi et al., 2014). In this context, it is evident that measures to enhance awareness among family and friends are essential, as they represent the primary facilitators of non-prescription psychotropic medications (Ford et al., 2020; Hulme et al., 2018; Schepis and Krishnan-Sarin, 2009; Schepis et al., 2019). Furthermore, the consumption of non-prescription psychotropic medications is associated with a number of adverse health outcomes, including overdoses, addiction, and increased demand for addiction treatment. Additionally, there is a correlation between the use of these medications and polydrug use, as well as fatalities [Center for Disease Control and Prevention (CDCP) and National Center for Health Statistics (NCHS), 2017].
In relation to suicidal behavior, multiple studies (Andersen et al., 2023; Choi et al., 2020; Dogan et al., 2016) clearly highlight the role of psychotropic medications. Symptoms of depression have an indirect effect through stress on suicidal ideation (Restrepo et al., 2018), suggesting that academic stressors in students with depression may increase the risk of suicidal behavior. Additionally, several studies have examined the potential adverse effect of psychotropic medication use on suicidal behavior. Khan et al. (2022) emphasized the relationship between the use of Zolpidem and an increased risk of suicide, finding a dose-dependent association.
As previously mentioned, the role of stress in relation to psychotropic drug use among university students may extend beyond a mere association between the two. Various studies have linked stress and high academic demands with psychotropic drug use (Betancourt et al., 2013; Schepis et al., 2021), motivated by the desire to enhance academic performance, increase concentration and alertness, and facilitate studying (Betancourt et al., 2013; Cook et al., 2021; Gallucci et al., 2014, Gallucci and Martin, 2015; Ghandour et al., 2012; Molloy et al., 2019; Ponnet et al., 2015; Schepis et al., 2021; Yomogida et al., 2018; Zahavi et al., 2023). In fact, the primary motivation for the use of psychotropic drugs without a prescription was academic (Schepis et al., 2021). This means that the structure of the university academic system, the demands placed on students, and their lack of active coping resources place them at greater risk of using psychotropic drugs without a prescription. As Schepis et al. (2021) argue, education extends beyond academic knowledge, with universities serving as a socialization context for promoting holistic and healthy education.
Sex and LGBTQ+ disparities
Several studies show a higher likelihood of psychotropic drug use associated with psychological distress symptoms among women (e.g., higher odds of use linked to depression and/or suicidality; effects particularly pronounced for analgesics) (Zullig and Divin, 2012).
In national female samples, major depressive episodes and posttraumatic stress disorder were associated with nonmedical use of psychotropic drugs (McCauley et al., 2011). Among LGBTQ+ students, there were indications of a higher prevalence of non-prescribed use to relieve anxiety compared with the heterosexual population (Tam et al., 2020). Conversely, some studies suggest that men with anxiety symptoms may exhibit higher consumption, although without statistically significant differences compared with women in certain samples (Benotsch et al., 2014).
Taken together, the evidence points to meaningful disparities by sex and sexual orientation that should be considered when designing preventive and institutional interventions.
Proposals from healthy university campuses
Based on the findings of the present systematic review, Healthy University Campuses provide an ideal framework for implementing measures from an integral, preventive, and structural perspective to address the use of psychotropic drugs, both prescribed and non-prescribed, linked to psychological distress among university students. It is proposed that Healthy Campus initiatives strengthen actions aimed at informing and raising awareness about the risks associated with the misuse and non-medical use of psychotropic drugs, as well as promoting a more comprehensive institutional response to student psychological distress. In this regard, it is essential to implement ongoing informational campaigns that highlight the risks of non-prescribed psychotropic drug use and its association with symptoms of anxiety, depression, stress, and suicidal ideation. These campaigns should be complemented by the inclusion of educational content on safe medication use and healthy coping strategies in the students’ cross-curricular training programs.
Additionally, it is necessary to offer early detection services, brief interventions, and referral pathways within the university setting. To achieve this, it is recommended to establish accessible psychological support services on campus that enable early identification of emotional distress, problematic drug use, or suicidal ideation. These services should include brief, non-stigmatizing interventions and ensure timely and effective referral to primary care or external mental health services when appropriate.
Moreover, fostering students’ psychosocial well-being through the active promotion of healthy lifestyles is essential. This involves creating university environments that prioritize a balance between academic performance and key aspects such as rest, physical activity, healthy eating, and the development of meaningful social relationships. These actions should be embedded within an institutional policy that promotes well-being in a transversal and sustained manner.
Finally, there is a need to critically reflect on the current academic model. Universities must examine the structural and cultural factors that act as chronic stressors, such as competitiveness, performance pressure, and academic overload. Within this context, it is suggested that institutions explore reforms that encourage an academic culture based on meaningful learning and cooperation, as part of a broader strategy to prevent emotional distress among students. In this sense, Tam et al. (2020) emphasize the importance of analyzing the relationship between mental health and psychotropic drug use from a psychosocial and environmental perspective.
Limitations
One of the main limitations of the present systematic review is that does not consider sex as a mediating variable. Although several studies suggest subgroup differences (e.g., higher likelihood of psychotropic drug use among women (especially analgesics) and a possible higher rate of non-prescribed use to manage anxiety among LGBTQ+ students), the heterogeneity of definitions and measures, sample sizes, and the low power of subgroup analyses, together with findings that are not always consistent (e.g., higher consumption among men with anxiety without clear statistical differences), limit the strength of the inferences; therefore, the results should be interpreted as exploratory. Future studies should delve into the sex as a mediating variable between nonmedical psychotropic consumption and depression, stress, anxiety, suicidal ideation and suicide.
On the other hand, the research conducted is largely focused geographically on the United States, which hinders the generalization of the results to other countries. Similarly, various university models, as well as different economic, social, demographic, and environmental factors in each country, may influence the relationship between mental health and psychotropic drug consumption. Therefore, future studies should delve into these issues further.
In addition, the analysis of the present study has led to the emergence of several questions that future research can address and that Healthy Campuses should reflect upon. What is the role of coping styles in the use of non-prescribed psychotropic drugs in the context of psychological distress among university students? Should university students be provided with training in adaptive coping skills and strategies during their early years? It is also necessary to consider whether Healthy Campuses provide sufficient guidance and mental health support resources for the university community. What measures should be implemented to address contextual and academic determinants from an environmental perspective?
Conclusion
The results of this systematic review demonstrate a significant relationship between the use of psychotropic drugs, both prescribed and non-prescribed, and the presence of symptoms of depression, anxiety, stress, suicidal ideation, and suicidal behavior among university students. Specifically, non-medical use of psychotropic drugs is primarily associated with symptoms of psychological distress such as anxiety, stress, and depression, while prescribed use is more closely linked to suicidal ideation and completed suicide.
Moreover, disparities are observed by sex and within the LGBTQ+ population. Women show a higher likelihood of use linked to depression and suicidal behavior, and there are signs of greater non-prescribed use among LGBTQ+ students for coping with anxiety. These findings reinforce the need for intersectional approaches in both research and practice.
These findings underscore the need to adopt an integral, contextual, and preventive approach to address psychotropic drug use within the university setting. The Healthy University Campus framework offers a strategic opportunity to develop policies and programs that not only inform about the risks of non-medical use, but also promote psychosocial well-being, early detection of emotional distress, and the transformation of structural factors that contribute to such issues.
Finally, the importance of continuing to investigate this phenomenon from an intersectional and multilevel perspective is highlighted, taking into account individual, social, academic, and cultural variables. Only through a coordinated, evidence-based institutional response will it be possible to reduce problematic psychotropic drug use in universities and ensure an environment that fosters students’ mental health.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Author contributions
CE-C: Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing – original draft, Writing – review & editing. BG-A: Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Resources, Supervision, Validation, Visualization, Writing – review & editing. SS-A: Conceptualization, Funding acquisition, Project administration, Validation, Visualization, Writing – review & editing. VV-B: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.
Funding
The author(s) declare that financial support was received for the research and/or publication of this article. The publications and other results are supported by the AGAUR-FINO Predoctoral Program (2024 FI-1 00052) Joan Oró grants from the Secretariat of Universities and Research of the Department of Research and Universities of the Generalitat of Catalonia and the European Social Plus Fund. The work was supported by the Valencian International University [PII2024_141].
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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The author(s) declare that no Gen AI was used in the creation of this manuscript.
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References
Aarstad-Martin, S., and Boyraz, G. (2017). Posttraumatic stress, risky drinking, and prescription drug misuse in trauma-exposed college students. J. Loss Trauma 22, 599–612. doi: 10.1080/15325024.2017.1360590
Alasmari, M. M., Alkanani, R. S., Alshareef, A. S., Alsulmi, S. S., Althegfi, R. I., Bokhari, T. A., et al. (2022). Medical students' attitudes toward sleeping pill usage: A cross-sectional study. Front. Psych. 13:1007141. doi: 10.3389/fpsyt.2022.1007141
Andersen, C. U., Ahmed, H., Rædkjær, M., Hasselstrøm, J. B., and Larsen, M. K. (2023). Deaths caused by medication in persons not using illicit narcotic drugs: an autopsy study from Western Denmark. Basic Clin. Pharmacol. Toxicol. 132, 111–119. doi: 10.1111/bcpt.13808
Antshel, K. M., Parascandola, T., Taylor, L. E., and Faraone, S. V. (2021). Achievement goal orientation and stimulant misuse in college students. J. Am. Coll. Heal. 69, 125–133. doi: 10.1080/07448481.2019.1656635
Bahlaq, M. A., Ramadan, I. K., Abalkhail, B., Mirza, A. A., Ahmed, M. K., Alraddadi, K. S., et al. (2023). Burnout, stress, and stimulant abuse among medical and dental students in the Western region of Saudi Arabia: an analytical study. Saudi J. Med. Med. Sci. 11, 44–53. doi: 10.4103/sjmms.sjmms_98_22
Bakhshaie, J., Rogers, A. H., Kauffman, B. Y., Tran, N., Buckner, J. D., Ditre, J. W., et al. (2019). Emotion dysregulation as an explanatory factor in the relation between negative affectivity and non-medical use of opioid in a diverse young adult sample. Addict. Behav. 95, 103–109. doi: 10.1016/j.addbeh.2019.02.025
Balayssac, D., Pereira, B., Darfeuille, M., Cuq, P., Vernhet, L., Collin, A., et al. (2018). Use of psychotropic medications and illegal drugs, and related consequences among French pharmacy students – SCEP study: A nationwide cross-sectional study. Front. Pharmacol. 9:725. doi: 10.3389/fphar.2018.00725
Bavarian, N., Flay, B. R., Ketcham, P. L., and Smit, E. (2015). The illicit use of prescription stimulants on college campuses: A theory-guided systematic review. Health education & behavior: the official publication of the Society for Public. Health Educ. Behav. 42, 719–729. doi: 10.1177/1090198115580576
Bennett, T., and Holloway, K. (2017). Motives for illicit prescription drug use among university students: A systematic review and meta-analysis. Int. J. Drug Policy 44, 12–22. doi: 10.1016/j.drugpo.2017.02.012
Benotsch, E. G., Koester, S., Martin, A. M., Cejka, A., Luckman, D., and Jeffers, A. J. (2014). Intentional misuse of over-the-counter medications, mental health, and polysubstance use in young adults. J. Community Health 39, 688–695. doi: 10.1007/s10900-013-9811-9
Benson, K., and Flory, K. (2017). Symptoms of depression and ADHD in relation to stimulant medication misuse among college students. Subst. Use Misuse 52, 1937–1945. doi: 10.1080/10826084.2017.1318146
Benson, K., Flory, K., Humphreys, K. L., and Lee, S. S. (2015). Misuse of stimulant medication among college students: A comprehensive review and meta-analysis. Clin. Child. Fam. Psychol. Rev. 18, 50–76. doi: 10.1007/s10567-014-0177-z
Betancourt, J., Ríos, J. L., Pagán, I., Fabián, C., González, A. M., Cruz, S. Y., et al. (2013). Non-medical use of prescription drugs and its association with socio-demographic characteristics, dietary pattern, and perceived academic load and stress in college students in Puerto Rico. P. R. Health Sci. J. 32, 89–94. Available at: https://prhsj.rcm.upr.edu/index.php/prhsj/article/view/811
Bonar, E. E., Coughlin, L., Roche, J. S., Philyaw-Kotov, M. L., Bixler, E. A., Sinelnikov, S., et al. (2020). Prescription opioid misuse among adolescents and emerging adults in the United States: A scoping review. Prev. Med. 132:105972. doi: 10.1016/j.ypmed.2019.105972
Boulton, M., and O'Connell, K. A. (2017). Nursing students' perceived faculty support, stress, and substance misuse. J. Nurs. Educ. 56, 404–411. doi: 10.3928/01484834-20170619-04
Bouvier, B. A., Kinnard, E. N., Yedinak, J. L., Li, Y., Elston, B., Green, T. C., et al. (2019). Prevalence and correlates of depressive symptomology among young adults who use prescription opioids non-medically. J. Psychoactive Drugs 51, 441–452. doi: 10.1080/02791072.2019.1654151
Bryan, M. A., Charron, E., Adeoye-Olatunde, O., Brown, J., Ghitza, U., Winhusen, T. J., et al. (2021). Concomitant cannabis misuse and associations with depression, pain and substance misuse among patients prescribed opioids. Pharmacy (Basel, Switzerland) 9:134. doi: 10.3390/pharmacy9030134
Cabriales, J. A., Cooper, T. V., and Taylor, T. (2013). Prescription drug misuse, illicit drug use, and their potential risk and protective correlates in a Hispanic college student sample. Exp. Clin. Psychopharmacol. 21, 235–244. doi: 10.1037/a0031973
Čanković, S., Mijatović, J. V., Harhaji, S., Šušnjević, S., Ukropina, S., Kvrgić, S., et al. (2023). Prevalence and factors associated with depressive symptoms among medical students in their first and final year of study. Vojnosanit. Pregl. 80, 41–49. doi: 10.2298/VSP220209046C
Center for Disease Control and Prevention (CDCP) and National Center for Health Statistics (NCHS) (2017) Health, United States, 2016: with chartbook on long-term trends in health. Health, United States, 2016, 314–317. Available online at: https://www.cdc.gov/nchs/data/hus/hus16.pdf
Choi, Y. H., Choi, Y. H., Lee, D. H., Lim, J. Y., Kim, K., and Lee, J. H. (2020). Characteristics of adolescent patients admitted to the emergency department due to attempted suicide by poisoning; a brief report. Adv. J. Emerg. Med. 4. doi: 10.22114/ajem.v0i0.268
Colell, E., Sanchez-Niubo, A., Ferrer, M., and Domingo-Salvany, A. (2016). Gender differences in the use of alcohol and prescription drugs in relation to job insecurity. Testing a model of mediating factors. Int. J. Drug Policy 37, 21–30. doi: 10.1016/j.drugpo.2016.07.002
Cook, C., Kurtz-Costes, B., and Burnett, M. (2021). Nonprescription stimulant use at a public university: students’ motives, experiences, and guilt. J. Drug Issues 51, 376–390. doi: 10.1177/0022042620988107
Davis, R. E., Doyle, N. A., and Nahar, V. K. (2020). Association between prescription opioid misuse and dimensions of suicidality among college students. Psychiatry Res. 287:112469. doi: 10.1016/j.psychres.2019.07.002
Dogan, H., Adıgüzel, L., Uysal, E., Sarıkaya, S., Ozucelik, D. N., Okuturlar, Y., et al. (2016). Differences between adolescent and adult cases of suicidal drug intoxication. Bakırköy Tıp Derg. 12, 20–23. doi: 10.5350/BTDMJB201612104
Drazdowski, T. K. (2016). A systematic review of the motivations for the non-medical use of prescription drugs in young adults. Drug Alcohol Depend. 162, 3–25. doi: 10.1016/j.drugalcdep.2016.01.011
Dussault, C. L., and Weyandt, L. L. (2013). An examination of prescription stimulant misuse and psychological variables among sorority and fraternity college populations. J. Atten. Disord. 17, 87–97. doi: 10.1177/1087054711428740
Ford, J. A., Pomykacz, C., Szalewski, A., Esteban McCabe, S., and Schepis, T. S. (2020). Friends and relatives as sources of prescription opioids for misuse among young adults: the significance of physician source and race/ethnic differences. Subst. Abus. 41, 93–100. doi: 10.1080/08897077.2019.1635955
Ford, J. A., and Schroeder, R. D. (2008). Academic strain and non-medical use of prescription stimulants among college students. Deviant Behav. 30, 26–53. doi: 10.1080/01639620802049900
Freibott, C. E., Auty, S. G., Stein, M. D., and Lipson, S. K. (2024). Opioid misuse and mental health in college student populations: A national assessment. J. Affect. Disord. 363, 72–78. doi: 10.1016/j.jad.2024.07.078
Gallucci, A. R., and Martin, R. J. (2015). Misuse of prescription stimulant medication in a sample of college students: examining differences between varsity athletes and non-athletes. Addict. Behav. 51, 44–50. doi: 10.1016/j.addbeh.2015.07.004
Gallucci, A. R., Usdan, S. L., Martin, R. J., and Bolland, K. A. (2014). Pill popping problems: the non-medical use of stimulant medications in an undergraduate sample. Drugs Educ. Prev. Policy. 21, 181–188. doi: 10.3109/09687637.2013.848840
Garland, E. L., Trøstheim, M., Eikemo, M., Ernst, G., and Leknes, S. (2020). Anhedonia in chronic pain and prescription opioid misuse. Psychol. Med. 50, 1977–1988. doi: 10.1017/S0033291719002010
Gaume, J., Carrard, V., Berney, S., Bourquin, C., and Berney, A. (2024). Substance use and its association with mental health among Swiss medical students: A cross-sectional study. Int. J. Soc. Psychiatry 70, 808–817. doi: 10.1177/00207640241232321
Ghandour, L. A., El Sayed, D. S., and Martins, S. S. (2012). Prevalence and patterns of commonly abused psychoactive prescription drugs in a sample of university students from Lebanon: an opportunity for cross-cultural comparisons. Drug and alcohol dependence, 121, 110–117. doi: 10.1016/j.drugalcdep.2011.08.021
Glodosky, N. C., and Cuttler, C. (2020). Motives matter: cannabis use motives moderate the associations between stress and negative affect. Addict. Behav. 102:106188. doi: 10.1016/j.addbeh.2019.106188
Grant, J. E., Redden, S. A., Lust, K., and Chamberlain, S. R. (2018). Nonmedical use of stimulants is associated with riskier sexual practices and other forms of impulsivity. J. Addict. Med. 12, 474–480. doi: 10.1097/ADM.0000000000000448
Groenewald, C. B., Law, E. F., Fisher, E., Beals-Erickson, S. E., and Palermo, T. M. (2019). Associations between adolescent chronic pain and prescription opioid misuse in adulthood. J. Pain 20, 28–37. doi: 10.1016/j.jpain.2018.07.007
Gunnell, K., Poitras, V. J., and Tod, D. (2020). Questions and answers about conducting systematic reviews in sport and exercise psychology. International Review of Sport and Exercise Psychology 13, 297–318.
Hong, Q. N., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., et al. (2018). The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for Information, 34, 285–291. doi: 10.3233/EFI-180221
Hua, Y., Shi, G., Zheng, X., Huang, C., Xu, Y., Huang, G., et al. (2023). Sex differences in the associations of non-medical use of prescription drugs with depressive and anxiety symptoms among undergraduates in China. J. Affect. Disord. 332, 254–261. doi: 10.1016/j.jad.2023.04.002
Hulme, S., Bright, D., and Nielsen, S. (2018). The source and diversion of pharmaceutical drugs for non-medical use: A systematic review and meta-analysis. Drug Alcohol Depend. 186, 242–256. doi: 10.1016/j.drugalcdep.2018.02.010
Jeffers, A. J., Benotsch, E. G., Green, B. A., Bannerman, D., Darby, M., Kelley, T., et al. (2015). Health anxiety and the non-medical use of prescription drugs in young adults: a cross-sectional study. Addict. Behav. 50, 74–77. doi: 10.1016/j.addbeh.2015.06.012
Jensen, C., Forlini, C., Partridge, B., and Hall, W. (2016). Australian university students' coping strategies and use of pharmaceutical stimulants as cognitive enhancers. Front. Psychol. 7:277. doi: 10.3389/fpsyg.2016.00277
Jia, Z., Jin, Y., Zhang, L., Wang, Z., and Lu, Z. (2018). Prevalence of drug use among students in mainland China: A systematic review and meta-analysis for 2003-2013. Drug Alcohol Depend. 186, 201–206. doi: 10.1016/j.drugalcdep.2017.12.047
Khan, H., Garg, A., Yasmeen Agarwal, N. B., Yadav, D. K., Khan, M. A., and Hussain, S. (2022). Zolpidem use and risk of suicide: A systematic review and meta-analysis. Psychiatry Research, 316:114777. doi: 10.1016/j.psychres.2022.114777
Kedia, S., Ahuja, N., Wyant, D. K., Dillon, P. J., Akkus, C., and Relyea, G. (2020). Compositional and contextual factors associated with drug overdose deaths in the United States. J. Addict. Dis. 38, 143–152. doi: 10.1080/10550887.2020.1729079
King, E. R., Willcott Benoit, W., Repa, L. M., and Garland, S. N. (2020). Prevalence and factors associated with non-medical prescription stimulant use to promote wakefulness in young adults. J. Am. Coll. Heal. 70, 174–181. doi: 10.1080/07448481.2020.1730851
Kouros, C. D., and Papp, L. M. (2024). College students' prescription drug misuse over time and links with their mental health and well-being. Addict. Behav. 149:107895. doi: 10.1016/j.addbeh.2023.107895
Lazarus, R. S., and Folkman, S. (1986). Estrés y procesos cognitivos (M. Zaplana, Trad.). Martínez Roca.
Lee-Winn, A. E., Mendelson, T., and Johnson, R. M. (2018). Associations between coping and marijuana use in a nationally representative sample of adolescents in the United States. Addict. Behav. 80, 130–134. doi: 10.1016/j.addbeh.2018.01.025
Lyons, R. M., Yule, A. M., Schiff, D., Bagley, S. M., and Wilens, T. E. (2019). Risk factors for drug overdose in young people: A systematic review of the literature. J. Child Adolesc. Psychopharmacol. 29, 487–497. doi: 10.1089/cap.2019.0013
McCauley, J. L., Amstadter, A. B., Macdonald, A., Danielson, C. K., Ruggiero, K. J., Resnick, H. S., et al. (2011). Non-medical use of prescription drugs in a national sample of college women. Addict. Behav. 36, 690–695. doi: 10.1016/j.addbeh.2011.01.020
Meshesha, L. Z., Pickover, A. M., Teeters, J. B., and Murphy, J. G. (2017). A longitudinal behavioral economic analysis of non-medical prescription opioid use among college students. Psychol. Rec. 67, 241–251. doi: 10.1007/s40732-017-0235-2
Molloy, B. K., Stock, M. L., Dodge, T., and Aspelund, J. G. (2019). Predicting future academic willingness, intentions, and nonmedical prescription stimulant (NPS) use with the theory of reasoned action and prototype/willingness model. Subst. Use Misuse 54, 2251–2263. doi: 10.1080/10826084.2019.1645175
Montiel, F. A., McNab, P. R., Gilreath, T., Salmeron, B., and Williams, F. (2020). A comprehensive multivariate model of biopsychosocial factors associated with opioid misuse and use disorder in a 2017–2018 United States national survey. BMC Public Health 20, 1–16. doi: 10.1186/s12889-020-09856-2
Nargiso, J. E., Ballard, E. L., and Skeer, M. R. (2015). A systematic review of risk and protective factors associated with nonmedical use of prescription drugs among youth in the United States: a social ecological perspective. J. Stud. Alcohol Drugs 76, 5–20. doi: 10.15288/jsad.2015.76.5
National Institute on Drug Abuse (2018). El consumo de drogas entre los adultos mayores. Available online at: https://www.drugabuse.gov/es/publications/el-consumo-de-drogas-entre-los-adultos-mayores
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical research ed.), 372, n71. doi: 10.1136/bmj.n71
Papazisis, G., Tsakiridis, I., and Siafis, S. (2018). Nonmedical use of prescription drugs among medical students and the relationship with illicit drug, tobacco, and alcohol use. Subst. Abuse 12:117822181880229. doi: 10.1177/1178221818802298
Papp, L. M., Kouros, C. D., Armstrong, L., and Curtin, J. J. (2023). College students' momentary stress and prescription drug misuse in daily life: testing direct links and the moderating roles of global stress and coping. Stress Health 39, 361–371. doi: 10.1002/smi.3191
Pate, M. C., and Bolin, R. M. (2019). Examining the relationship between strain and the use of nonmedical prescription drugs among college students. J. Drug Issues 49, 163–182. doi: 10.1177/0022042618812398
Peralta, R. L., Stewart, B. C., Steele, J. L., and Wagner, F. A. (2016). Nonmedical use of prescription drugs in emerging adulthood: differentiating sex from gender. Addict. Res. Theory 24, 389–397. doi: 10.3109/16066359.2016.1140745
Ponnet, K., Wouters, E., Walrave, M., Heirman, W., and Van Hal, G. (2015). Predicting students' intention to use stimulants for academic performance enhancement. Subst. Use Misuse 50, 275–282. doi: 10.3109/10826084.2014.952446
Pontes, N. M. H., Ayres, C., Wunnenberg, M., and Pontes, M. C. F. (2021). Gender differences in the relationship between prescription opioid misuse and depressive symptoms and suicidality among US high school students. Nurs. Outlook 69, 641–651. doi: 10.1016/j.outlook.2021.01.006
Restrepo, J. E., Amador Sánchez, O., Calderón Vallejo, G., Castañeda Quirama, T., Osorio Sánchez, Y., and Diez Cardona, P. (2018). Depresión y su relación con el consumo de sustancias psicoactivas, el estrés académico y la ideación suicida en estudiantes universitarios colombianos. Health and Addictions/Salud y Drogas, 18, 227–239. doi: 10.21134/haaj.v18i2.349
Rogers, A. H., Orr, M. F., Shepherd, J. M., Bakhshaie, J., Ditre, J. W., Buckner, J. D., et al. (2021). Anxiety, depression, and opioid misuse among adults with chronic pain: the role of emotion dysregulation. J. Behav. Med. 44, 66–73. doi: 10.1007/s10865-020-00169-8
Rougemont-Bücking, A., Grazioli, V., Marmet, S., Daeppen, J. B., Lemoine, M., Gmel, G., et al. (2018). Non-medical use of prescription drugs by young men: impact of potentially traumatic events and of social-environmental stressors. Eur. J. Psychotraumatol. 9:1468706. doi: 10.1080/20008198.2018.1468706
Sattler, S. (2019). Nonmedical use of prescription drugs for cognitive enhancement as response to chronic stress especially when social support is lacking. Stress Health 35, 127–137. doi: 10.1002/smi.2846
Schepis, T. S., Buckner, J. D., Klare, D. L., Wade, L. R., and Benedetto, N. (2021). Predicting college student prescription stimulant misuse: an analysis from ecological momentary assessment. Exp. Clin. Psychopharmacol. 29, 580–586. doi: 10.1037/pha0000386
Schepis, T. S., Klare, D. L., Ford, J. A., and McCabe, S. E. (2020). Prescription drug misuse: taking a lifespan perspective. Subst. Abuse. Res. Treat. 14:1178221820909352. doi: 10.1177/1178221820909352
Schepis, T. S., and Krishnan-Sarin, S. (2009). Sources of prescriptions for misuse by adolescents: differences in sex, ethnicity, and severity of misuse in a population-based study. J. Am. Acad. Child Adolesc. Psychiatry 48, 828–836. doi: 10.1097/CHI.0b013e3181a8130d
Schepis, T. S., Teter, C. J., Simoni-Wastila, L., and McCabe, S. E. (2018). Prescription tranquilizer/sedative misuse prevalence and correlates across age cohorts in the US. Addict. Behav. 87, 24–32. doi: 10.1016/j.addbeh.2018.06.013
Schepis, T. S., Wilens, T. E., and McCabe, S. E. (2019). Prescription drug misuse: sources of controlled medications in adolescents. J. Am. Acad. Child Adolesc. Psychiatry 58, 670–680.e4. doi: 10.1016/j.jaac.2018.09.4
Sousa, B. O. P., ALT, S., Souza, J., SAD, S., MAD, S., and Pillon, S. C. (2020). Nursing students: medication use, psychoactive substances and health conditions. Rev. Bras. Enferm. 73. doi: 10.1590/0034-7167-2019-0003
Substance Abuse and Mental Health Services Administration (SAMHSA) (2021). Prescription stimulant misuse and prevention among youth and young adults. Rockville, MD: National Mental Health and Substance Use Policy Laboratory.
Tam, C. C., Benotsch, E. G., and Weinstein, T. L. (2020). Resilience and psychiatric symptoms as mediators between perceived stress and non-medical use of prescription drugs among college students. Am. J. Drug Alcohol Abuse 46, 120–130. doi: 10.1080/00952990.2019.1653315
Teter, C. J., Falone, A. E., Cranford, J. A., Boyd, C. J., and McCabe, S. E. (2010). Nonmedical use of prescription stimulants and depressed mood among college students: frequency and routes of administration. J. Subst. Abus. Treat. 38, 292–298. doi: 10.1016/j.jsat.2010.01.005
Verdi, G., Weyandt, L. L., and Zavras, B. M. (2014). Non-medical prescription stimulant use in graduate students: relationship with academic self-efficacy and psychological variables. J. Atten. Disord. 20, 741–753. doi: 10.1177/1087054714529816
Vidourek, R. A., King, K. A., and Knopf, E. (2010). Non-medical prescription drug use among university students. Am. J. Health Educ. 41, 345–352. doi: 10.1080/19325037.2010.10599163
Villanueva-Blasco, V. J., Mateu-Mollá, J., Villanueva-Silvestre, V., and Vázquez-Martínez, A. (2022a). Relationship between depression and risky alcohol consumption in women: the mediating role of coping styles and age. Int. J. Ment. Health Addict. 12, 1–18. doi: 10.1007/s11469-022-00931-w
Villanueva-Blasco, V. J., Villanueva-Silvestre, V., Vázquez-Martínez, A., de Vicente, L. P., and Pérez-Gálvez, B. (2022b). Depression, suicidal ideation, and consumption of psychotropic drugs during lockdown by COVID-19 according to gender and age. Int. J. Ment. Heal. Addict. 1–17, 1–17. doi: 10.1007/s11469-022-00962-3
Votaw, V. R., Geyer, R., Rieselbach, M. M., and McHugh, R. K. (2019). The epidemiology of benzodiazepine misuse: A systematic review. Drug Alcohol Depend. 200, 95–114. doi: 10.1016/j.drugalcdep.2019.02.033
Walters, K. S., Bulmer, S. M., Troiano, P. F., Obiaka, U., and Bonhomme, R. (2018). Substance Use, Anxiety, and Depressive Symptoms Among College Students. Journal of Child and Adolescent Substance Abuse, 27, 103–111. doi: 10.1080/1067828X.2017.1420507
Weyandt, L. L., Gudmundsdottir, B. G., Holding, E. Z., Marraccini, M. E., Keith, M., May, S. E., et al. (2022). Prescription opioid misuse among university students: A systematic review. J. Am. Coll. Heal. 70, 1119–1137. doi: 10.1080/07448481.2020.1786095
Weyandt, L. L., Gudmundsdottir, B. G., Shepard, E., Brick, L., Buchanan, A., Clarkin, C., et al. (2021). Nonmedical prescription opioid use among a sample of college students: prevalence and predictors. Pharmacy (Basel, Switzerland) 9:106. doi: 10.3390/pharmacy9020106
Weyandt, L. L., Janusis, G., Wilson, K. G., Verdi, G., Paquin, G., Lopes, J., et al. (2009). Nonmedical prescription stimulant use among a sample of college students: relationship with psychological variables. J. Atten. Disord. 13, 284–296. doi: 10.1177/1087054709342212
Wheeler, P. B., Stevens-Watkins, D., Moody, M., Dogan, J., and Lewis, D. (2019). Culturally relevant risk and protective factors for nonmedical use of prescription opioids among incarcerated African American men. Addict. Behav. 93, 46–51. doi: 10.1016/j.addbeh.2019.01.014
World Health Organization. (2023). Sobresosis de opioides. Available online at: https://www.who.int/es/news-room/fact-sheets/detail/opioid-overdose
Yamamoto, M., Inada, K., Enomoto, M., Habukawa, M., Hirose, T., Inoue, Y., et al. (2021). Current state of hypnotic use disorders: results of a survey using the Japanese version of benzodiazepine dependence self-report questionnaire. Neuropsychopharmacol. Rep. 41, 14–25. doi: 10.1002/npr2.12149
Yomogida, K., Mendez, J., Figueroa, W., and Bavarian, N. (2018). Correlates of recreation- versus academic-motivated misuse of prescription stimulants. J. Drug Issues 48, 472–484. doi: 10.1177/0022042618774825
Zahavi, E., Lev-Shalem, L., Yehoshua, I., and Adler, L. (2023). Methylphenidate use and misuse among medical residents in Israel: a cross-sectional study. Hum. Resour. Health 21:5. doi: 10.1186/s12960-023-00792-x
Zenebe, Y., and Necho, M. (2019). Socio-demographic and substance-related factors associated with mental distress among Wollo university students: institution-based cross-sectional study. Ann. General Psychiatry 18:28. doi: 10.1186/s12991-019-0252-4
Keywords: systematic review, non-medical prescription, psychotropic drugs, stress, anxiety, depression, suicidal ideation, PRISMA
Citation: Espitia-Cepeda C, González-Amado B, Simó-Algado S and Villanueva-Blasco VJ (2025) Systematic review of the use of prescription and non-prescription psychotropic drugs and their relation with mental health in university population. Front. Psychol. 16:1661844. doi: 10.3389/fpsyg.2025.1661844
Edited by:
Carlos Roncero, University of Salamanca, SpainReviewed by:
Sarah Fernandes Teixeira, Centro Universitário do Espírito Santo, BrazilAlessandra Oliveira Silva, Universidade de São Paulo—Campus de Ribeirao Preto, Brazil
Copyright © 2025 Espitia-Cepeda, González-Amado, Simó-Algado and Villanueva-Blasco. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Víctor José Villanueva-Blasco, dmp2aWxsYW51ZXZhQHVuaXZlcnNpZGFkdml1LmNvbQ==
†ORCID: Catalina Espitia-Cepeda, orcid.org/0009-0001-3350-231X
Bárbara González-Amado, orcid.org/0000-0001-9262-1469
Salvador Simó-Algado, orcid.org/0000-0002-0072-6296
Víctor José Villanueva-Blasco, orcid.org/0000-0001-6081-1583