Substance misuse, psychiatric disorder and parental relationships in patients attending a student health service

The mental health of students is a subject of growing concern. There are limited data on the prevalence of mental disorder in the student population and its relationship to previously noted high levels of drug and alcohol use is unknown. Although there is a considerable body of research into the links between experiences of parenting and the subsequent development of psychiatric morbidity, the nature and importance of such links in a student population has not been examined. The aims of this study were to establish the prevalence of substance misuse and psychiatric disorder in patients attending a student health service and to examine these in relation to perceived experiences of parenting. The study also aimed to assess the level of clinical detection of psychiatric disorders by general practitioners (GPs). Four hundred and thirty randomly selected attenders at a student health service completed a substance use and life style questionnaire, the General Health Questionnaire (GHQ) and the Parental Bonding Instrument. Psychiatric caseness, as defined by the GHQ, was compared with a retrospective review of comparable clinical case records. Fifty per cent of men and 32% of women exceeded sensible levels of alcohol consumption and 12% of men and 5% of women reported hazardous levels of alcohol intake. Cannabis was the most commonly used illicit substance, with 28% of men and 12% of women reporting regular use, while 64% of the subjects reported the use of any illicit drug. Sleep problems were common and the use of prescribed psychotropic drugs within the preceding year was reported by almost one-fifth of subjects. High levels of subjective stress, particularly financial, were associated with the use of illicit drugs (P < 0.01) and prescribed psychotropics (P < 0.0001). Sixty-five percent of women and 54% of men met the criteria for psychiatric caseness on the GHQ and this was associated with the use of illicit drugs (P < 0.01), prescribed psychotropics (P < 0.0001), sleep difficulties (P < 0.0001) and current stressors (P < 0.05). Defective parental bonding, particularly affectionless control (low care and overprotection), was associated with caseness on the GHQ (P < 0.0001), excessive alcohol consumption (P < 0.01) and sleep problems (P < 0.01). Psychological morbidity was recorded as present in 14% of consultations in the course of routine clinical practice. Psychological morbidity and substance misuse in students were significantly related to the styles of parenting experienced earlier in life. GPs working with students should be aware of the high prevalence of these problems in this population. Those responsible for higher education policy should take account of these findings and the fact that the presence of stressors such as financial worries was significantly associated with psychological distress, the prescription of psychotropic medication and the use of illicit drugs.