Associations Between Over-the-Counter Analgesics Usage and Symptoms of Anxiety and Depression in Adolescents: A Network Analysis

Abstract

Abstract Background The use of over-the-counter analgesics (OTCA) is common among adolescents, particularly females. Previous research has linked symptoms of anxiety and depression (AD) with OTCA usage, even after controlling for pain. AD encompasses a wide array of both psychological and physiological symptoms, and little is known about which of these symptoms are most strongly connected to OTCA usage. In the current study we assessed differences in associations between specific AD symptoms and OTCA usage in a large sample of adolescents. Furthermore, we examined whether the associations between AD symptoms and OTCA usage differed across genders. Method We included 626,581 participants from the Ungdata survey. AD symptoms were measured with an adapted version of Hopkins Symptom Checklist-10 and the Depression Mood Inventory, while a 5-point scale assessed OTCA usage. Non-regularized partial-correlation networks were constructed to explore conditional dependent relations between the use of OTCA and AD symptoms, including a separate network controlling for symptoms of pain. Gender-specific networks containing all symptoms were created. The networks were visualized and described statistically in terms of edge weights and bridge centrality (bridge expected influence). Results OTCA usage demonstrated associations with most AD symptoms, with the strongest links to “sleep problems”, “stiff or tense”, “everything is a struggle” and “suddenly scared”. When including pain symptoms as covariates, OTCA-AD edges weakened, but most edges persisted as significant. The strongest links were observed between OTCA usage and pain symptoms. Key bridging nodes between communities included “headache” and “stiff or tense”. OTCA usage demonstrated higher bridge expected influence in the female network than in the male. Further, “sleep problems” and “hopeless” showed stronger links to OTCA usage among females, whereas “stiff or tense” was more strongly related to OTCA usage among males. Conclusion Our study assessed the relationship between OTCA usage and specific symptoms of anxiety and depression in adolescents. Our results indicate that somatic expressions of AD, such as sleep disturbances and tension, displayed stronger associations with OTCA usage than more conventional AD symptoms. This pattern might be even more pronounced in males than females.