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Introduction

Mental health diseases are a major global health concern, affecting millions of people from across diverse demographics (Vergès et al., 2021). The complex relationship between mental health and substance abuse has received a lot of attention in the medical and scholarly professions. This annotated bibliography report looks into this complicated confluence, concentrating on a critical assessment of four current research publications that investigate the phenomena of individuals with mental health illnesses using substances as a form of self-medication. Mental health illnesses, ranging from anxiety and depression to more serious conditions like schizophrenia, pose substantial challenges for affected individuals (Vergès et al., 2021). In their quest for relief from distressing symptoms, many individuals turn to substances such as alcohol, drugs, or prescription medications not prescribed to them (Broman et al., 2020). This method of self-medication can provide momentary comfort, but it frequently exacerbates underlying mental health issues, creating a vicious cycle of addiction and declining mental health (Turner et al., 2018). The main purpose of this annotated bibliography report is to the study designs, research objectives, findings, strengths, and limitations as well as prospective areas for improvement of the chosen research papers. This report provides valuable insights into recent research in this field better comprehend the complexities of this complicated topic and direct them toward more successful strategies for the benefit of individuals struggling with these dual challenges.

Main body

Research article 1: Self-Medication and Substance Use: A Test of the Hypothesis.

A quantitative research design has been employed in this research article, where the authors the authors Broman et al., (2020) utilized data specifically from National Longitudinal Study of Adolescent to Adult Health (ADD Health). Quantitative research is characterized by the collection and analysis of numerical data to uncover patterns, associations, and statistical relationships between variables (Molina-Mula J. 2022). In this study, the researchers Broman et al., (2020) rely on statistical analyses and quantitative measures to investigate the relationship between substance use and self-medication for emotional as well as physical problems. Numerical data are utilized to analyse the potential impact of various health conditions and factors on the substance use patterns among the study participants (Molina-Mula J. 2022). ADD Health, known for its large and nationally representative longitudinal data sample, provides a solid platform for this investigation (Broman et al., 2020). This extensive dataset spans an extended period, enabling researchers to investigate temporal connections and causal correlations between variables. The primary aim of this study is to determine whether people utilize substances as a kind of self-medication for treating mental health and physical concerns. It seeks to explore the self-medication hypothesis by investigating whether particular adolescent health characteristics influence substance use in young adulthood (Broman et al., 2020).

The study is conducted by depending upon the data collected from the database, ADD Health. The researchers employ multivariate analyses to investigate the relationships between health problems, self-rated health, learning and physical disabilities, suicide idea in adolescence, and subsequent substance use in young adulthood (Broman et al., 2020). They may evaluate the concurrent effects of multiple variables on the outcome of interest using these sophisticated statistical approaches, which gives them a deeper knowledge of these relationships (Molina-Mula, 2022). The study improves the generalizability of its findings by using a nationally representative longitudinal sample, making them pertinent and applicable to a wider population. The study's findings showed that, even after adjusting for prior substance use, a number of characteristics, such as health issues, self-rated health, physical and learning disabilities and suicidal ideation during adolescence, had a substantial impact on subsequent substance use in young adulthood (Broman et al., 2020). It can be said that most of the characteristics but not all show a positive contribution of these adolescent health conditions on substance abuse.

 One notable strength associated with this research article is the use of a large, nationally representative longitudinal sample from ADD Health, which enhances the external validity of the findings and allows for exploring temporal relationships (Broman et al., 2020). The employment of multivariate analyses permits the simultaneous examination of multiple factors, providing a comprehensive view of the complex relationship between health conditions and substance use (Molina-Mula J. 2022). However, one significant limitation is the dependence on self-reported data, which may introduce response bias and inaccuracies. Additionally, the study may not capture all potential confounding variables that could impact the relationship among health conditions as well as substance use (Broman et al., 2020). In order to improve the methodological quality of the study, future researchers can focus on incorporating more detailed and comprehensive measures of health conditions and substance use, including clinical assessments where possible (Molina-Mula, 2022). In addition, future researchers can also utilize a mixed-methods approach to triangulate findings from both quantitative and qualitative data sources (Vedel et al., 2019).

Research article 2: Self-medication with psychotropic drugs and mental health during residency. A survey of 2314 resident physicians

 The second research article also follows a quantitative research design. A cross-sectional approach is employed in this article, where relevant data is collected at a single point in time to estimate the prevalence of self-treatment with the psychotropic drugs among resident physicians (Molina-Mula, 2022). A self-administered questionnaire used in this study to gather quantitative data was distributed to all managers of French citizens' groups (Vergès et al. 2021). The primary objective of the study is to ascertain the prevalence of psychotropic drug self-treatment during residency across various medical and surgical specialties (Vergès et al., 2021). Additionally, the study examines the resident physicians' treatment pathways, mental health status, psychotropic drug usage habits, and depression screening.

A cross-sectional design was used to conduct the research study which is majorly focused on a questionnaire prepared through a literature review (Vergès et al., 2021). The questionnaire covers a variety of mental health topics, such as self-reported mental health illnesses, patterns of psychotropic drug use, depression screening, self-rated mental health status, and service pathways (Vergès et al., 2021). The self-administered questionnaire had been pretested as well as are given through French resident organizations, allowing for a voluntary response with no predefined thresholds. Evaluating the research findings, it is found that 30.5% of the 2,314 respondents reported using psychotropic drugs during their residency, with 21.7% for self-medication purposes and 8.0% for regular self-medication (Vergès et al., 2021). In addition, 72% of respondents claimed a mental condition, while just 22% sought professional help. The study's findings show a considerable increase in self-treatment with psychiatric medicines with residency seniority (Vergès et al., 2021). While the study provides useful information regarding the incidence of self-medication and mental health difficulties among residents, it does not fully explain why self-medication is so common or what factors contribute to residents' unwillingness to seek professional care (Vergès et al., 2021).

One of the major strengths is the large sample size. The study surveyed a substantial number of resident physicians, enhancing the study's statistical power and generalizability. Moreover, this research article used validated tools like the two-question screen test for depression, which added credibility to its results (Vergès et al., 2021). However, some limitations should be acknowledged. The study utilizes self-reported data, which could result in response bias and may not accurately represent all incidences of self-medication. To increase the methodological quality of future studies in this area, researchers should investigate integrating objective measurements of psychotropic drug usage and mental health issues (Molina-Mula, 2022). Implementing randomized sampling methods and longitudinal designs may also enhance the ability to establish causality and temporal relationships (Molina-Mula, 2022). Additionally, initiatives to reduce response bias, such as anonymous data collecting, could improve the reliability of the findings.

Research article 3: Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature

A qualitative study design has been adopted in this research article, especially a narrative evaluation of epidemiological literature (Turner et al., 2018). This type of qualitative research involves the synthesis and interpretation of current research findings in order to provide a comprehensive overview of a certain issue (Renjith et al., 2021). In this case, the authors conducted a review of epidemiological studies related to self-medication with alcohol and drugs for mood as well as anxiety disorders (Turner et al., 2018). Qualitative approaches, such as narrative reviews, enable the synthesis of multiple sources, resulting in a holistic viewpoint and a richer contextual understanding (Renjith et al., 2021). While investigating multifaceted phenomena in the field of mental health and substance use, this approach can be useful (Turner et al., 2018). This study's main goal is to provide a narrative summary of the epidemiological literature on the consumption of alcohol and drugs for self-medication in adults with mood and anxiety disorders (MD and AD). The research work helps to investigate the prevalence and predictors of self-medication, as well as the temporal link between MD/AD and later substance use disorders (SUD) (Turner et al., 2018).

Apart from this, an exhaustive search of two reputable academic databases, Scopus and PsycINFO is carried out in this research article authored by Turner et al., (2018). This comprehensive search approach enables the researchers to locate a large corpus of original research publications that are directly relevant to their research objectives (Renjith et al., 2021). The articles chosen for inclusion in the review must specifically investigate the prevalence and correlate self-medication with alcohol and drugs among people suffering from mental health distress like mood and anxiety disorders (MD/AD) (Turner et al., 2018). It also explores the temporal relationship between these disorders and subsequent substance use disorders (SUD). The review includes a total of 22 papers, demonstrating a carefully chosen selection that guarantees the inclusion of pertinent and instructive studies from the specified time (Turner et al., 2018). This meticulous approach to data collection and selection enhances the validity and credibility of the review's findings (Renjith et al., 2021).

The results of this research work reveal several important insights. The prevalence of self-medication with alcohol and/or drugs among individuals with MD/AD ranged from 21.9% to 24.1% (Turner et al., 2018). Certain characteristics associated with higher proportions of self-medication include gender, marital status, age and Caucasian ethnicity. Notably, the review includes longitudinal data to support the temporal onset of primary MD/AD and secondary SUD among self-medicators (Turner et al., 2018). Overall, by combining epidemiological data on the use of alcohol and medications for self-medication of mood and anxiety problems, the study successfully achieves its goal (Gianfrancesco & Goldstein, 2021).

This study's comprehensive analysis of existing epidemiological literature is a major strength, enabling a broad synthesis of information (Turner et al., 2018). However, as a narrative review, it does not employ primary data collection which may present constraints such as potential bias in article selection and the inability to conduct quantitative meta-analyses (Molina-Mula, 2022). With an aim to improve the methodological quality of future studies in this area, future researchers could consider conducting systematic reviews or meta-analyses to quantitatively synthesize findings from multiple studies (Johnson & Hennessy, 2019).

Research Article 4: Substance Use and Symptoms of Mental Health Disorders: a Prospective Cohort of Patients with Severe Substance Use Disorders in Norway

This research article is characterized by its quantitative study design, specifically a prospective cohort study (Aas et al., 2021). A prospective cohort design helps researchers to explore cause-and-effect interactions over time. (Capili, 2021) Additionally, it can be said that numerical data is collected and analyzed in quantitative research to draw statistical inferences and examine relationships between variables (Molina-Mula, 2022). The researchers examined the effects of substance use patterns as well as sociodemographic characteristics on mental health distress over time among people with severe substance use disorders (SUD) by using this specific design in this study (Aas et al., 2021). The study aims to examine how substance use behaviors and sociodemographic variables affected mental health distress over time among a cohort of people with severe SUD in Norway as judged by the ten-item Hopkins Symptom Checklist (SCL-10) (Aas et al., 2021). This aimed to enhance people’s understanding of the complex interplay between substance use as well as mental health symptoms among this population.

A clustered prospective cohort study with 707 patients who had severe SUD was used to conduct the research. Nine opioid-agonist therapy outpatient clinics as well as low-threshold municipality clinics in Norway provided data between 2017 and 2020 (Aas et al., 2021). In order to provide an overview of the participant characteristics, descriptive statistics which includes standard deviations and means were first calculated (Capili, 2021). The effect of substance use patterns and sociodemographic variables on the SCL-10 sum score was then examined. In addition, a linear mixed model analysis with beta coefficients and 95% confidence intervals was also used (Aas et al., 2021). The research findings revealed several important insights. The mean SCL-10 score at baseline was 2.2, with significant variation among participants. Individuals who reported regular use of benzodiazepines, cannabis, and opioids had higher symptoms of mental health issues, but those who used stimulants frequently had fewer symptoms (Aas et al., 2021). Furthermore, female participants with debt issues, and those in unstable living situations reported a greater burden of mental health symptoms (Aas et al., 2021). Despite individual differences, the study found no consistent time patterns showing significant changes in mental health symptoms over time for the full group (Capili, 2021).

The study demonstrates certain methodological advantages, such as its prospective cohort design that enables the evaluation of temporal correlations and offers insightful information about changes over time (Molina-Mula, 2022). In addition, the inclusion of a reasonably high sample size of 707 people improves statistical power and generalizability of findings (Aas et al., 2021). However, there are some significant drawbacks to consider. The use of self-reported data may bring response bias and mistakes, thereby impacting the validity of research’s findings (Aas et al., 2021). Moreover, the lack of continuous time trends in mental health symptoms suggests that observed variations may be more representative of self-medication habits than medication-related mental health changes (Capili, 2021). These limitations underline the importance of exercising caution when interpreting the findings.

To improve the study's methodological quality, researchers should investigate integrating objective measures of substance use and mental health symptoms to reduce dependency on self-reported data (Molina-Mula, 2022). Further, investigating potential causal linkages via interventions or experimental designs may provide more robust evidence. A longer follow-up period could provide a more detailed picture of changes throughout time (Molina-Mula, 2022). Finally, attempts to reduce potential response bias and data flaws, possibly through anonymous data collecting, might improve the study's validity.

Conclusion

The four research articles reviewed provide insight on the complicated and multidimensional association between mental health issues and substance use, providing useful insights that are highly pertinent to therapeutic practice. Despite their diverse methods, these studies collectively contribute to a more comprehensive knowledge of the intricate dynamics involved when individuals with mental health disorders resort to substance use as a means of self-medication. The first research study, which used a quantitative approach, emphasizes the significance of considering adolescent health factors while analyzing substance use patterns in young adulthood. The findings highlight the need of early intervention and assistance in addressing mental health difficulties among adolescents, potentially lowering the risk of substance abuse. The second article, a quantitative review, highlights the prevalence of self-medication among medical practitioners as well as the critical need for mental health support throughout residency. Clinicians can learn from this study by recognizing the challenges faced by medical trainees and implementing resources to promote mental well-being.

The third paper, a qualitative narrative evaluation research, underlines the significant burden of mental health symptoms among people suffering from severe substance use disorders. This study highlights the need to incorporate mental health assessments into clinical practice for medical professionals. Recognizing the high prevalence of co-occurring mental health problems enables healthcare providers to advocate for more personalized treatment programs and holistic care approaches. On the other hand, the fourth research study, a prospective cohort research, also emphasizes the complexities of the long-term link between substance use and mental health symptoms. Despite the lack of consistent patterns, this study cautions against assuming a medication-related decline in mental health and highlights the necessity for targeted therapies. it suggests that self-medication may play a more significant role than previously thought. Clinicians can utilize this knowledge to tailor their interventions, focusing on addressing the underlying causes of self-medication.

References

Aas, C. F., Vold, J. H., Gjestad, R., Skurtveit, S., Lim, A. G., Gjerde, K. V., ... & Fadnes, L. T. (2021). Substance use and symptoms of mental health disorders: a prospective cohort of patients with severe substance use disorders in Norway. Substance Abuse Treatment, Prevention, And Policy, 16, 1-10. https://doi.org/10.1186/s13011-021-00354-1

Broman, C. L., Wright, M. K., Broman, M. J., & Bista, S. (2019). Self-medication-and substance use: A test of the hypothesis. Journal of Child & Adolescent Substance Abuse, 28(6), 494-504. https://doi.org/10.1080/1067828X.2020.1789526

Capili, B. (2021). Overview: Cohort Study Designs. BMC Medical Research Methodology. 10.1097/01.NAJ.0000803196.49507.08

Gianfrancesco, M. A., & Goldstein, N. D. (2021). A narrative review on the validity of electronic health record-based research in epidemiology. BMC Medical Research Methodology, 21(1), 1-10.. https://doi.org/10.1186/s12874-021-01416-5

Johnson, B. T., & Hennessy, E. A. (2019). Systematic reviews and meta-analyses in the health sciences: Best practice methods for research syntheses. Social Science & Medicine, 233, 237-251. https://doi.org/10.1016/j.socscimed.2019.05.035

Molina-Mula J. (2022). Quantitative Research Methodology in the Health Sciences. Cambridge Scholars Publishing. https://www.cambridgescholars.com/resources/pdfs/978-1-5275-8198-2-sample.pdf

Renjith, V., Yesodharan, R., Noronha, J. A., Ladd, E., & George, A. (2021). Qualitative methods in health care research. International Journal Of Preventive Medicine, 12. 10.4103/ijpvm.IJPVM_321_19

Turner, S., Mota, N., Bolton, J., & Sareen, J. (2018). Self‐medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression And Anxiety, 35(9), 851-860. https://doi.org/10.1002/da.22771

Vedel, I., Kaur, N., Hong, Q. N., El Sherif, R., Khanassov, V., Godard-Sebillotte, C., ... & Pluye, P. (2019). Why and how to use mixed methods in primary health care research. Family Practice, 36(3), 365-368. 10.1093/fampra/cmy127

Vergès, Y., Driot, D., Deshayes, C., Delahaye, M., Oustric, S., & Dupouy, J. (2022). Self-medication with psychotropic drugs and mental health during residency. A survey of 2314 resident physicians. La Presse Médicale Open, 3, 100017. https://doi.org/10.1016/j.lpmope.2021.100017

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