INTRODUCTION

Entering higher education is a transition that can cause stress, emotional imbalance, adaptation difficulties and a great impact on personal and academic life ¹. Factors inherent to the academic process are pointed out as possible causes of health problems. During college, some students become vulnerable to the appearance of affective disorders, such as depression and anxiety ². A systematic review with meta-analysis found that stress, low frequency of recreational activities, dissatisfaction with academic performance, and lack of emotional support in the academic environment are risk factors for mental health problems in undergraduate university students ³.

Recent research on the mental health of Chilean university students identified a significant proportion of students with mental health problems, estimating that 20-30% of this group is affected by anxiety, depression and stress. In addition, a notable gender disparity was reported, with a higher prevalence of depressive symptoms in women with 23.2%, compared to 13.4% in men ⁴. In this context, the mental health of college students has been a topic of interest in the literature ⁵. Studies reveal a high combined prevalence of depression and anxiety, among other mental health problems, in this population ⁶. Consequently, the use of psychotropic drugs among university students has increased, especially antidepressants, anxiolytics and psychostimulants, being also more frequent in women ^7-9.

A study conducted among university students found a high prevalence of mental health disorders, with 30.4% of participants reporting the use of psychotropic medications, mainly for the treatment of anxiety (30%) and depression (22.8%). The study revealed that the use of psychotropic medications increases as students progress through their academic programs, particularly in the later years when academic pressure intensifies. In contrast, regular participation in physical activities and adherence to adequate sleep patterns were identified as protective factors against mental health disorders, underscoring the need for greater attention to the mental well-being of this demographic ¹⁰.

To better understand psychotropic medication use among students, it is necessary to consider the pressure of the academic environment, which contributes to stress and mental health impairment. In addition, it is essential to understand how individual factors, such as family background and resilience, interact with these stressors. It is also pertinent to analyze the relationship between psychotropic use and self-care behavior. A multidimensional approach that considers social and academic factors may help to develop more effective interventions to promote mental health among students ^11,12.

However, solid research on this topic is scarce. Therefore, studies are needed to characterize the use of psychotropic drugs among university students and to correlate variables that help identify the groups most vulnerable to these drugs. In addition, some works have shown that the use of psychoactive drugs is higher in women, so it is important to evaluate the difference in the associated factors between male and female students ^13,14. Therefore, this study aims to evaluate the use of psychotropic drugs in students of a public university in Paraná, Brazil, and to identify associated sociodemographic, academic and health factors, stratified by sex.

MATERIALS AND METHODS

RESULTS

A total of 3238 students were included according to the selection procedure shown in Figure 1. The majority of students participating in the study were self-reported white and unmarried. Males showed higher percentages of self-reported good physical health status, sleep quality, and mental health compared to females (Table 1).

Figure 1 Flow chart of the GraduaUEL study sample, 2019. 

Use of at least one psychotropic medication was reported by 12.2% (n=396), 78.3% in women (n=310) and 21.7 in men (n=86). When stratified by sex, 14.0% (310/2221) of women and 8.5% (86/1017) of men used a psychotropic medication. A total of 518 psychotropic medications were identified (average 1.31 per user), with a higher prevalence of antidepressant use, and among antidepressants, selective serotonin reuptake inhibitors (SSRIs) were the most frequent (46.5%). According to generic name, the mostly used drugs were sertraline hydrochloride (15.4%), escitalopram oxalate (14.5%) and fluoxetine hydrochloride (9.7%) (Table 2).

In the adjusted analysis, for the group of women, we found a statistically significant association between the higher frequency of use of psychotropic medications, access to health insurance (PR=1.49; 95%CI: 1.25-1.78), diagnosis of depression (PR=4.60; 95%CI: 3.55-5.95), diagnosis of anxiety (PR=4.58; 95%CI: 3.23-6.49) and use of illicit drugs in the last three months (PR=1.25; 95%CI: 1.02-1.53). In contrast, psychotropic medication use was less frequent in those women who consumed alcohol on a weekly basis (PR=0.74; 95%CI: 0.60-0.90) (Table 3).

In the adjusted analysis for the group of men, we found that the use of psychotropic medications was more frequent among those with access to health insurance (PR=1.65; 95%CI: 1.15-2.36), dissatisfied or very dissatisfied with their academic performance (PR=1.77; 95%CI: 1.09-2.87), diagnosis of depression (PR=4.49; 95%CI: 2.81-7.16) and diagnosis of anxiety (PR=7.68; 95%CI: 4.25-13.89) (Table 3).

DISCUSSION

This study identified a 12.0% frequency of psychotropic drug use among students at a public university in Paraná, Brazil. Regarding women, consumption was higher among those who reported having used illicit drugs in the last three months. In men, drug use was higher among students who reported being dissatisfied with their academic performance. As for the overall sample, the highest frequency of psychotropic drug use was found in those who had access to health insurance, diagnosis of depression and diagnosis of anxiety.

The frequency of psychotropic drug use found in this study is similar to that described in psychology students in Brazil (15.1%) ²⁰⁾ and in students from different areas of a university in Portugal (12.7%) ²¹. A study conducted in students at the University of Lausanne, Switzerland, revealed that 12.1% of the participants reported having used psychotropic substances. In addition, women showed a higher propensity to use psychotropic drugs compared to men, which supports our findings ²². However, other works in Brazilian students from different health-related courses showed slightly higher prevalence rates (16.0%) ²³⁾ (19.0%) ²⁴, which is justified by the overload of academic and care activities ^2,3,9.

Our study found that women were more likely to use psychotropic medications, a result consistent with previous research showing higher rates of antidepressant use among women compared with men. This gender difference in antidepressant use is a common finding in many studies, with possible implications for public health and clinical practice ^10,22,25.

The use of psychotropic medications by women is a multifaceted phenomenon, influenced by a complex interaction of sociocultural, economic and health factors. In Uruguay, research has consistently shown that women are the main consumers of psychotropic medications, with a particular predilection for benzodiazepines and antidepressants. These medications are often used for extended periods of time, which may lead to a higher prevalence of psychotropic use among women. In addition, women are more likely to experience adverse side effects and to develop dependence on these medications, underscoring the need for a more nuanced understanding of the factors contributing to psychotropic use in this population ²⁶.

A study conducted in Brazilian medical students revealed that 30.4% used psychotropic drugs, with anxiety and depression being the main reasons for prescription. A significant correlation was reported between academic progress and prevalence of psychotropic use, with a higher incidence of diagnoses of mental disorders among women. The research highlights the need for institutional interventions to promote mental health among these students, emphasizing the importance of adequate sleep and regular physical activity as protective factors ¹⁰.

The higher frequency of psychotropic medication use in women compared to men is justified, since depression, anxiety and stress conditions are more common in women ^10,19,27-29. This research also highlights the higher frequency of medical diagnosis of depression and anxiety among female students, as well as the relationship of these diagnoses to psychotropic use. These medications are an important, although not the only, therapeutic strategy for the treatment of common mental disorders ^10,28.

In addition, women recognize depressive symptoms better, report physical and psychological symptoms more easily, and seek help for health problems more frequently than men (19.30). According to the National Health Survey (PNS) (2019), women showed a higher rate (82.3%) of medical consultations compared to men (69.4%), making them more likely to use medication ³¹.

Antidepressants were the most frequently used class of drugs among students, with SSRIs being the most frequent subgroup, similar to what has been described by other studies ³. Regarding the mostly used psychotropic drugs, our results showed a higher frequency of sertraline hydrochloride, escitalopram oxalate and fluoxetine hydrochloride, aligning with the findings of other national and international works in university students ^{3,21,23,32,33}. According to Martins de Oliveira et al. (2020) ³⁴, 60% of university students in Brazil have experienced or are experiencing anxiety during their undergraduate studies. In addition, 32% reported suffering from insomnia, 30% have used or are using some type of psychiatric medication, 20% experience persistent sadness, 10% suffer from fear or panic, 6% have had suicidal ideation, and 4% have had suicidal thoughts. These health conditions reinforce the rationale for the use of antidepressants, which, in addition to treating depression, have also been widely used for anxiety and sleep disorders.

As for other factors associated with the use of psychotropic drugs, we highlight access to private health insurance. This relation is consistent with the Belo Horizonte Health Survey, conducted in the Metropolitan Region of Belo Horizonte, in the state of Minas Gerais, Brazil ³⁵. Having private health insurance facilitates access to health services, particularly consultations with specialists, which contributes to greater use of medications, particularly psychotropic drugs, which cannot be purchased in pharmacies without a prescription ^21,35.

Regarding dissatisfaction with academic performance, our study showed that students using psychotropic medications had a high prevalence of previous diagnosis of depression. Depression is considered a disabling condition that can interfere negatively in many spheres of life, including students’ academic performance ³. Berchtold et al. found that students who used psychotropic medications had lower academic performance, poorer health status, and lower life satisfaction compared with those who did not use them. In addition, the study suggests that academic pressure is related to the use of these substances, as drug users reported greater academic difficulties.

Regarding the relation between the use of illicit drugs and psychotropic medications among women, we consider that the overload of activities, more common among women ³⁶, together with higher levels of stress, anxiety, depressive symptoms and the consequent use of medications for the central nervous system, favors the search for other forms of relief, such as the use of illicit drugs ³⁷.

The relationship between illicit substance use and depression and anxiety is complex. Research has shown that illicit substance use can be a contributing factor to depression and anxiety, particularly when combined with other factors such as academic stress and performance pressure ³⁸. In addition, the search for relief from symptoms of anxiety and depression may lead students to engage in substance use, including alcohol, tobacco, illicit drugs, and prescription medications ³⁹.

Recent studies also found a higher prevalence of depressive and anxiety disorders among women, leading to the use of psychotropic medications, in addition to dependence on illicit drugs ^40-42. Although drug use is more common among young men ^39,43,44, it is possible that the use of these substances is less related to mental health conditions and, therefore, to psychotropic use in this population.

In contrast, weekly alcohol consumption was related to a lower use of psychotropic medications. Alcohol consumption is part of daily entertainment, facilitating social interaction among students. This interaction favors social support among them, thus reducing the chances of developing depressive and anxiety symptoms ^45,46, and the consequent need for psychotropics. In contrast, a higher frequency and amount of alcohol consumption is associated with a higher risk of depression ^46,47. This association was not identified in our study, but may be related to the fact that the nondrinker group included former drinkers who stopped drinking because of health problems or the need for psychotropic medications, which could confound the association. A study in Sweden found that those who consumed alcohol lightly and moderately were less likely to develop depression, whereas those who did not consume or consumed heavily were more likely to be depressed ⁴⁶, which partially corroborates the findings of this research.

Our study has some limitations that should be highlighted. The data were collected online and, although widely disseminated, an electronic questionnaire does not allow a detailed explanation at the time of the survey. In this regard, the drug names may be subject to recall bias, despite the fact that this population is considered young and with a greater capacity to retain information. In addition, the response rate of this survey (25.8%) was lower than that reported by other studies with electronic questionnaires ⁴⁸. It is also important to note that, although the researchers conducted a thorough review of the completed questionnaires, excluding duplicates, triplicates, and responses from graduate students, among others, the risk persists that individuals not affiliated with the undergraduate programs of the surveyed university may have completed the questionnaire. Finally, social desirability bias may occur in the research due to the tendency of participants to provide socially acceptable answers, which could distort their true opinions and behavior ⁴⁹. As a strength, it should be noted that our study has a larger sample size than other surveys conducted among undergraduate students on medication use. In addition, it covers all areas and courses at UEL.

In conclusion, these results highlight the high frequency of psychotropic medication use among university students, especially among females, as well as among students with access to health insurance, with a diagnosis of depression and a diagnosis of anxiety, regardless of their sex. We also found that male students who reported dissatisfaction with their academic performance had a higher frequency of psychoactive medication use. Among the consumed medications, antidepressants, such as SSRIs, stood out, indicating the importance of investigating aspects related to mental health in this population. These findings demonstrate factors associated with the use of psychotropic medications in students, recognizing the university as an environment of increased susceptibility to mental health problems, which causes a greater need for central nervous system medications. We hope that this evidence can support actions at the local level, promoting not only campaigns for rational use of medications, but also measures to minimize and help students with the stress caused by academic life.