PERSPECTIVE OF SECONDARY SCHOOL STUDENTS ON CAUSES OF MENTAL

HEALTH ISSUES AND SUBSTANCE MISUSED IN NIGERIA

Abstract
This qualitative study explores the perspectives of secondary school students on the
causes of mental health issues and substance misuse in Nigeria, involving 12
respondents through semi-structured interviews. The study examines students'
understanding of factors contributing to these challenges, including societal,
familial, and personal influences. Findings reveal that students perceive peer
pressure, academic stress, family dynamics, and societal expectations as
significant contributors to both mental health issues and substance misuse.
Additionally, exposure to media and insufficient mental health education may
exacerbate these problems. Recommendations based on these findings include
implementing comprehensive mental health and substance misuse education in
schools to raise awareness and equip students with coping strategies. Schools
should foster supportive environments that encourage open dialogue about mental
health and substance misuse, reducing associated stigma. Collaboration with
mental health professionals to provide accessible resources and counseling
services in schools can also offer students the support they need. This study
emphasizes the importance of targeted interventions and preventive measures to
address the root causes of mental health issues and substance misuse among
secondary school students in Nigeria.
Keywords: Adolescents, Mental health issues, Substance misuse, mental health
education, preventive measures

Introduction
Mental health issues and substance misuse are growing concerns among secondary
school students in Nigeria. These challenges can have significant implications on
students' academic performance, personal development, and overall well-being.
Understanding the perspectives of secondary school students on the causes of these
issues is essential for designing effective interventions and preventive measures.
The objectives of this study are:
i. To explore secondary school students' perspectives on the causes of mental
health issues in Nigeria.
 ii. To investigate secondary school students' views on the causes of substance
misuse in Nigeria.
iii. To examine potential connections between students' experiences with mental
health issues and substance misuse.
iv. Examine the interventions secondary school students in Nigeria suggest to
address mental health issues and substance misuse among their peers
To achieve these objectives, the study addresses the following research questions:
1. What do secondary school students perceive as the primary causes of mental
health issues in Nigeria?
2. What factors do secondary school students identify as contributing to
substance misuse in Nigeria?
3. How do secondary school students perceive the relationship between mental
health issues and substance misuse?
4. What interventions do secondary school students in Nigeria suggest to
address mental health issues and substance misuse among their peers?

By addressing these questions, the study aims to provide insights into the
underlying factors contributing to these problems and offer recommendations for
schools and policymakers to address mental health and substance misuse among
secondary school students in Nigeria.

This special issue aims to compile current research specifically for young people in
relation to mental health concerns and substance misuse. This issue will highlight
the specific needs of young people who experience mental health concerns and
substance misuse, and create a space to advance research in the area. We are
interested in programs, practices, interventions which support young people to
address mental health concerns and substance misuse. Of particular interest for this
issue, the researcher will welcome contributions which center young people’s
perspectives and projects which support the participation of young people in
programs and research. We seek contributions from authors who are interested in
the narratives of young people and practitioners, and cutting-edge and novel
approaches which support young people to address mental health concerns and
substance misuse.
The majority of young people with drug and alcohol problems suffer from
concurrent mental health problems, referred to as co-occurring disorders or
comorbidity. Externalizing disorders such as Conduct Disorder (CD) and Attention
Deficit Hyperactivity Disorder (ADHD) appear to be the most common mental
health problems, but internalizing disorders such as depression, dysthymia and
anxiety also commonly occur. Boys are usually over-represented with respect to
externalizing disorders, while the opposite holds true for internalizing disorders,
even though some studies report equal gender distribution.
Most studies show that young people with co-occurring problems have more
extensive drug problems, higher levels of social problems and criminality, as well
as worse treatment outcomes and greater risk of relapse, compared with young
people with substance use problems alone. On the other hand, there are also studies
demonstrating that a relatively large proportion of adolescents with substance use
problems do not report any mental disorders or symptoms at initiation of treatment,
and studies showing minor differences between young people with and without
mental health problems with respect to treatment involvement, dropout rate and
treatment outcome.
Nigerian studies, have addressed the relationships between drug use and mental
health problems among young people. This despite a recent trend with an increased
prevalence of mental health problems among young people, and a development
with a growing number of young people being diagnosed with, and treated for drug
use problems.
In Nigeria, studies have been conducted – mainly based on adolescents in
inpatient or emergency care – show that the vast majority of young people have
mental health problems prior to onset of drug use, and that as many as 90%
demonstrate co-occurring disorders. There is little knowledge regarding mental
health problems among broader groups of young people who use drugs in Sweden.
There is also a lack of research on how different types of mental health problems
may be linked to drug use severity among young people – this applies to Swedish
research as well as to research on young people in general.
The aim of this research is to study self-reported occurrence of mental health
problems among young people receiving outpatient treatment for substance use
problems. We explore what types of mental health problems and social problems
are more or less predominant, and whether there are significant differences in
prevalence between boys and girls. In addition, we analyze how various mental
health problems with indicators of substance abuse severity such as early onset of
use, high frequency of use and multiple of drug used.
Frequency of mental health problems among young people in substance abuse
treatment
As stated earlier, co-occurring mental health problems are relatively common
among young people with drug and alcohol problems, even though such
occurrence may demonstrate large variations. For example, several research
reviews state that 50% to 90% of young people with drug and alcohol problems
also have extensive mental health problems.
Studies involving inpatient subjects generally demonstrate higher prevalence
of mental health problems compared with studies on young people treated in
outpatient or community-based programs. In one Nigeria, study on young people
enrolled at an emergency care center, 90% of girls and 81% of boys met the
criteria for at least one psychiatric disorder in addition to their substance use
problems. Another Nigeria study of young people receiving outpatient care for
drug problems showed that 64% met the criteria for a psychiatric diagnosis. An
Australian study with a broad selection of young people in different types of
treatment for substance use problems found that only one third had co-occurring
mental health problems.
The research review by Couwenbergh and colleagues concluded that
externalizing disorders such as CD and ADHD are the most frequently found co-
occurring psychiatric disorders among young people with substance use problems,
followed by internalizing disorders such as depression or dysthymia and anxiety.
However, the rate of various disorders varies greatly between different studies:
24% to 82% for CD, 3% to 48% for depression/dysthymia, 1% to 38% for anxiety
disorders, 3% to 38% for ADHD and 10% to 12% for post-traumatic stress
disorder (PTSD). Several studies suggests that it is common for young people with
drug and alcohol problems to have multiple co-occurring psychiatric diagnoses
when in treatment, and that the occurrence of problems varies with age, co-
occurring problems being more common among people in their late teens or early
adulthood.
prior research points to great variation in levels of co-occurring mental health
problems among young people in treatment for drug and alcohol problems, as well
as what types of mental disorders occur most frequently. The variation found in the
different studies may have several explanations. These include differences in
selection criteria, types of care, assessment methodology, diagnostic tools,
diagnostic systems and timeframes during which the conditions occur (e.g., the
past month, past year, any time in life), which collectively make comparisons
between different studies and contexts difficult.
Relationships between psychiatric disorders and severity of substance use
problems
Only a few studies have investigated associations between various psychiatric
disorders and indicators of severity of drug use problems among young people. A
study found that weakly or more frequent cannabis use in teenagers predicted an
approximately twofold increase in risk for later depression and anxiety. In contrast,
depression and anxiety in teenagers predicted neither later weekly nor daily
cannabis use. Daily use in young women was associated with an over fivefold
increase in the odds of reporting a state of depression and anxiety after adjustment
for undercurrents use of other substances.
Similarly, a study on undergraduate students in the US found frequent
marijuana use to be associated with depression and other substance use and
alcohol-related negative outcomes. Early onset of cannabis use has been associated
with higher rates of later substance use, juvenile offending, mental health
problems, and unemployment and school dropout. Results from a longitudinal
study from substance use treatment facilities in Nigeria showed a co-occurrence
between poly-drug use and mental distress. Mental distress increased both in
magnitude and over time with the number of drugs used. The authors conclude that
use of multiple drugs and mental distress appears strongly co-related over time.
There are various theories about the causal relationship between mental health
problems and drug problems. According to several researchers, psychiatric
problems usually precede drug and alcohol problems. This can for instance be
explained by the drugs serving as a self-medicating function by alleviating stress
and other unpleasant emotions. However, the link between mental health problems
and drug use cannot be explained solely on the basis of self-medication, since
young people primarily state other reasons for using drugs. The relationship
between the two conditions can also be reversed, where drug and alcohol use
increase the risk of mental health problems. Another possible explanation is that
underlying factors, such as difficult childhood circumstances or family problems
may be the cause of both. Mental health problems and substance abuse problems
may also be intertwined and develop simultaneously over time. Finally, substance
abuse and mental health problems may be mutually exclusive and coexist without
any link. It can be concluded that the association between drug and alcohol use
problems and mental disorders is strong but extremely complex.
Young people with substance use problems face a high risk of co-occurring
mental health problems, something that may involve a more difficult life situation,
social problems as well as worse treatment outcomes. The aim of this study is to
analyzed self-reported mental health problems among young people receiving
outpatient treatment for substance use problems in Sweden. We explore what types
of mental health problems are more or less predominant, and whether there are
significant differences between boys and girls. In addition, we analyzed how
various mental health problems covary with indicators of substance abuse severity.
Methods: The study is based on structured interviews with 1970 young people
enrolled at outpatient clinics in 11 Swedish cities. The data shall analyzed through
frequency- and averages-calculations, Chi-square tests and multivariate logistic
regression analyses. Results: Self-reported mental health problems were common
among the young people in the study. A relatively large percentage of the total
group (34-54%) reported problems such as concentration difficulties, sleeping
difficulties, anxiety and depression. At the same time, many of the young people
did not report any symptoms and only a small group, about 20%, reported
diagnosed mental health disorders. The results show substantial gender differences,
with girls reporting significantly higher levels of mental health problems.
Multivariate logistic regression analyses demonstrated significant associations
between severity of drug use problems and anxiety, concentration difficulties,
aggression, hallucinations and mental stress caused by experiences of trauma. The
study is based on structured interviews with young people receiving treatment for
drug and alcohol problems. Data were gathered from specialized outpatient clinics
for young people (13–21 years of age) with substance use problems in 11 Nigerian
cities. The participating cities are part of a researcher-practitioner collaboration
network focusing on knowledge development in outpatient treatment for the
present target group. The participating clinics represent Sweden’s three largest
cities and eight additional cities around the country. The basic characteristics of the
current sample are consistent with previous Nigerian studies on the target group in
outpatient treatment. The centers, usually referred to as UITH clinics, are carried
out as a collaboration between the social services and the healthcare system. All of
the clinics offer various types of treatment for substance use problems, as well as
counselling and support for young people and their families. Average length of
care is 4–6 months. Services offered by all clinics include psychosocial and
medical assessment with a focus on substance use problems, drug testing,
individual or family counselling, and manual-based treatment programme.
Personnel include social workers, nurses, psychologists and doctors.
Methods
The study is based on structured interviews with 2023 young people enrolled
at outpatient clinics in 6 UITH of each states. The data will be analyzed through
frequency- and averages-calculations, Chi-square tests and multivariate logistic
regression analyses. Initially, the study group was categorized by gender and the
variables included in the study regarding mental health problems were analyzed for
gender differences. The data was processed and analyzed by SPSS Statistics 24
software and Chi2 and t-tests were to be used for analyzing levels of significance.
To investigate the relationship between various mental health problems and drug
use, multivariate logistic regression analysis with three models shall be used to
carry out the data analysis. As dependent variables, we will used the following
dichotomized variables that indicate severity of drug use: high frequency of use,
i.e. two–three days a week or more for the primary drug (model 1), early onset of
substance use, i.e. age 12 or younger for alcohol intoxication and age 13 or
younger for drugs use (model 2), and presence of poly/multiple drugs used, i.e.
regular use of two or more drugs during the last three months (model 3). The
independent variables in all three analysis models include age and gender, as well
as self-reported mental health problems over the past 30 days: depression, anxiety,
concentration difficulties, aggressive behaviour, suicidal thoughts, hallucinations,
eating disorders, self-harming behaviour, and psychological stress from traumatic
events (e.g. witnessed or being subjected to violence or sexual abuse). The results
of these analyses are reported using odds ratios and significance levels. The
explained variance for each model is presented using Cox & Snell and Nagelkerke.
The majority of the young people live with their parents, are engaged in
studies, traineeship, or work. However, most have or have had extensive
difficulties in school that have impacted their attendance, satisfaction and
performance. The percentage of girls with school problems is significantly greater
than the percentages of boys. About one third of the young people have grown up
under difficult circumstances. Here too significant gender differences are found,
where girls, to a much greater degree than boys, have experienced financial
constraints, substance use problems, mental health problems and violence in their
childhood environment.
A significant higher proportion of boys have been arrested by police or
convicted of various crimes. Girls, however, report that they have been subjected
to physical, mental and sexual violence or assault to a greater degree. An estimated
two thirds of both boys and girls associate with friends who commit crimes or use
drugs. A number of gender differences were found regarding drug and alcohol use.
For both genders, cannabis is the drug that causes the greatest problem or is the
underlying reason for initiation of care, even though the percentage of boys that
report this is significantly larger than the percentage of girls. The opposite gender
pattern is seen with alcohol and other drugs.
Girls initiate their primary drug somewhat earlier than boys and they also use
that drug more often than boys. Gender differences are also reflected in alcohol
use, where girls to a significant higher extent report risky alcohol consumption
according to their AUDIT-C scores. Mental health problems such as suicidal
thoughts, suicide attempts, hallucinations, eating disorders and self-harming
behaviour are much less commonly reported (10% or less for the total group).
These problems are however two to three times more common among the girls.
Almost half of the girls and a quarter of the boys have experienced a serious
traumatic event or accident from which they have not yet psychologically
recovered.
One-fifth of the young people state that they have an ongoing contact with
psychiatry. About the same proportion state that they have received prescription
medication for a psychiatric disorder or functional impairment and that they have a
neuropsychiatric diagnosis. Girls report being in contact with psychiatric care or
taking medication to a significantly larger extent, while no significant gender
differences was found with respect to neuropsychiatric diagnosis. What specific
mental health problems are related to more severe substance use problems? The
study results suggest a strong link between concentration difficulties and severity
of drug use problems. High frequency of use, early onset of drug use, as well as
poly/multiple drug used, were associated with higher likelihood of reporting
concentration difficulties. Concentration difficulties may be a cause of early onset
of drug use for some adolescents and a consequence of extensive drug use for
others. According to our findings, anxiety problems appear to be clearly linked
with poly drug use and frequent drug use, but not to early onset of use. Anxiety
problems in adolescence have been shown to predict alcohol use problems in
young adulthood. Regarding cannabis, the opposite appears to be true: cannabis
use in adolescence can increase the risk of anxiety and depression later in life.
Aggressive behaviour, which may be linked to the condition often referred to as
conduct disorder, was mainly associated with early onset of drug use. An
association also suggested by several other studies. In our study, hallucinations and
psychological stress from traumatic events – which may be indications of more
severe mental health problems – are only linked to poly drug use. According to a
study by Harrison, Fulkerson & Beebe, young people with experiences of physical
and sexual abuse reported high rates of poly drug use, initiated substance use
earlier than their peers and gave more reasons for using, including use to cope with
painful emotions. PTSD (post-traumatic stress disorder), which can be a result of
traumatic experiences such as abuse, has also been shown to increase the risk of
developing substance use problems. Furthermore, results from a longitudinal
growth research study from substance use treatment facilities in Norway show that
use of multiple drugs and mental distress are strongly co-related over time.
Several mental health problems such as depression, suicidal thoughts, eating
disorders and self-harming behaviour did not show significant associations with
either high frequency of use, early onset of drug use, or poly drug use. This finding
suggests that young people with substance use problems may have co-occurring
mental health problems without any clear link between the two. However, these
mental health problems are more common in the study group compared with young
people in general. This may in part be explained by the fact that the young people
in the study, compared with young people in the general population at large, have
more difficult childhood circumstances and a greater social vulnerability.
Research Purposes:

1. The study aims to explore secondary school students' understanding of the causes of mental health
issues and substance misuse in Nigeria. This includes their perceptions of the relationship between
these challenges and their everyday experiences.

2. The study seeks to examine the societal, familial, and personal factors that students believe
contribute to mental health issues and substance misuse. This includes peer pressure, academic stress,
family dynamics, and societal expectations.

3. The study investigates the impact of media exposure and the role of mental health education on
students' perspectives of these challenges. Understanding these influences can help identify areas for
improvement in school curricula and community programs.

4. The study aims to use its findings to develop tailored recommendations for interventions in schools
and communities. These may include educational programs, support services, and policy changes that
address the root causes of mental health issues and substance misuse.

Research Questions:

1. How do secondary school students perceive the causes of mental health issues in Nigeria?

2. What societal, familial, and personal factors do secondary school students identify as contributing to
substance misuse?

3. How do media exposure and the level of mental health education influence students' perceptions of
mental health and substance misuse?

4. What interventions do secondary school students suggest for addressing the causes of mental health
issues and substance misuse in their schools and communities?

Meaning and consequences of substance misuse

Substance misuse refers to the inappropriate or excessive use of drugs, alcohol, or other substances in a
manner that leads to harmful consequences (Ifeadi & Agodi, 2024). It encompasses a range of behaviors,
including using substances beyond prescribed or recommended doses, using substances for non-medical
purposes, and using substances despite negative physical, mental, or social consequences (Csiernik,
2021).

Substance misuse can have significant negative effects on individuals, communities, and society as a
whole. It can lead to physical health problems such as addiction, overdose, and chronic diseases, as well
as mental health issues such as depression, anxiety, and psychosis. Additionally, substance misuse can
impair cognitive function, affect decision-making abilities, and increase the risk of accidents, injuries,
and risky behaviors.

Addressing substance misuse requires a comprehensive approach that includes prevention, education,
treatment, and support services. Prevention efforts aim to reduce the initiation of substance use and
promote healthy behaviors through education, community-based programs, and policy initiatives.
Treatment options may include counseling, therapy, medication-assisted treatment, and support groups
to help individuals overcome substance use disorders and achieve recovery. Support services provide
ongoing assistance and resources for individuals and families affected by substance misuse, including
access to healthcare, housing, employment, and social support networks.

Overall, addressing substance misuse requires a multi-faceted approach that involves collaboration
between individuals, communities, healthcare providers, policymakers, and other stakeholders to
promote healthy behaviors, reduce stigma, and support individuals in achieving and maintaining
recovery.

Ifeadi, C. N., & Agodi, F. (2024). MISUSE AND ABUSE OF PRESCRIPTION DRUGS: AN
OVERVIEW. Disseminating Scholarly Research Across The Globe, 27.

Csiernik, R. (2021). Substance use and misuse: Everything matters. Canadian Scholars.
 APPENDIX
Interview questions on Mental Health Issues and Substance misuse
1. How do you understand the term "mental health issues”?

2. What do you believe are the primary causes of such issues among secondary school
students in Nigeria?

3. Could you describe any societal, familial, or personal factors that you believe contribute
to substance misuse among secondary school students in Nigeria?

4. In your opinion, how does exposure to various forms of media influence the way students
perceive mental health and substance misuse?
5. How has your own exposure to media shaped your views on these topics?

6. Based on your experiences and observations, what interventions or strategies do you

think would be effective in addressing the root causes of mental health issues and
substance misuse among students in your school and community?

7. Have you noticed any particular patterns or trends in how mental health issues are
perceived and discussed among your peers? If so, could you elaborate on them?

8. What role do you think family dynamics play in influencing students' mental well-being
and their likelihood of engaging in substance misuse?

9. Do you believe there are any specific challenges or barriers that prevent students from
seeking help for mental health issues or substance misuse? If so, what are they, and how
do you think they could be addressed?

10. How do you think mental health education in schools can be improved to better equip
students with the knowledge and skills to address mental health challenges and substance
misuse?

11. Are there any specific resources or support services that you believe should be made
more readily available to students who are struggling with mental health issues or
substance misuse?
12. Could you share any personal experiences or anecdotes related to mental health issues or
substance misuse among your peers? How have these experiences shaped your own
understanding of these topics?

13. What role do you think teachers and school staff should play in supporting students'
mental health and addressing substance misuse within the school environment?

14. In your opinion, how can schools and communities work together to create a more
supportive and inclusive environment for students who are dealing with mental health
issues or substance misuse?