|Year : 2022 | Volume
| Issue : 3 | Page : 277-284
Drug abuse among Nigerian high-school adolescents: Exploring the relationship with problematic internet use, suicidality, anxiety, depression, and self-esteem
Tolulope Opakunle1, Olubukola Opakunle2, Damilola Toki3, Olutayo Aloba4, Chioma Nwozo1
1 Department of Mental Health, State Specialist Hospital, Osogbo, Nigeria
2 Department of Community Medicine, Osun State University, Osogbo, Nigeria
3 Health & Rehabilitation Sciences Graduate Program, Faculty of Health Sciences, Western University, London Ontario, Canada
4 Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
|Date of Submission||19-Dec-2021|
|Date of Decision||08-Mar-2022|
|Date of Acceptance||14-Mar-2002|
|Date of Web Publication||2-Jun-2022|
Department of Mental Health, State Specialist Hospital, Osogbo, Osun State
Source of Support: None, Conflict of Interest: None
Background: Drug abuse is a global public health problem that is associated with increased psychiatric morbidity and mortality. Objectives: This study assessed the prevalence of drug abuse and its relationship with problematic Internet use (PIU), suicidality, anxiety, depression, and self-esteem among high school adolescents. Materials and Methods: This is a cross-sectional descriptive study involving 1304 Nigerian high school adolescents recruited through the multistage stratified sampling method. The participants completed a study-specific sociodemographic questionnaire, a 10-item Drug Abuse Screening Test (DAST), Problematic Internet Use Questionnaire-Short Form-6 (PIU-SF-6), the Mini International Neuropsychiatric Interview Suicidality module, the Hospital Anxiety and Depression Scale, and Rosenberg Self-Esteem Scale (RSES). Results: The prevalence rate of drug abuse was 49.8%. Adolescents who abused drugs had higher mean scores on PIU, suicidality, depression, and anxiety scales and lower scores on the self-esteem scale. All these variables cumulatively accounted for approximately 22% of the total variance in the DAST score. Conclusions: Drug abuse is still prevalent among Nigerian adolescents, with a significant association with PIU, suicidality, depression, anxiety, and low self-esteem. All these variables may provide the template for psychological and social interventions that are specifically targeted to the management of drug abuse among Nigerian adolescents.
Keywords: Adolescents, depression, drug abuse, internet addiction, suicide
|How to cite this article:|
Opakunle T, Opakunle O, Toki D, Aloba O, Nwozo C. Drug abuse among Nigerian high-school adolescents: Exploring the relationship with problematic internet use, suicidality, anxiety, depression, and self-esteem. Int J Med Health Dev 2022;27:277-84
|How to cite this URL:|
Opakunle T, Opakunle O, Toki D, Aloba O, Nwozo C. Drug abuse among Nigerian high-school adolescents: Exploring the relationship with problematic internet use, suicidality, anxiety, depression, and self-esteem. Int J Med Health Dev [serial online] 2022 [cited 2022 Aug 12];27:277-84. Available from: https://www.ijmhdev.com/text.asp?2022/27/3/277/346428
| Introduction|| |
Drug abuse is a global public health problem, with disturbing figures among adolescents.,, Studies from developed and developing countries indicate that more than half of the students enrolled in high school engage in drug abuse, regarded as harmful or hazardous use of psychoactive substances, including alcohol and other illicit drugs.,,, Some of the identified drivers for drug abuse among adolescents include peer pressure, experimentation, and easy access to substances, alongside the desire to reduce stress and cope with life pressures.,
The differences observed in the prevalence rates of adolescent drug abuse across countries may be attributed to the differences in sample characteristics and the variations in sociocultural factors. Globally, it is estimated that 9% of the adolescent population aged 12 years and older are classified as drug dependent. In Europe, up to 58% of adolescents engage in substance abuse, whereas in Asia, about 40% of adolescents are reported to abuse various psychoactive substances., Findings from a systematic review and a meta-analytic report of 27 studies across sub-Saharan Africa indicate that the overall prevalence of drug abuse among adolescents is 41.6%. In Nigeria, available statistics indicate a relatively high prevalence rate of adolescent drug abuse, ranging from 32.9% to 69.3%.,,,
The abuse of drugs among adolescents is associated with risky sexual behaviors, poor academic performance, criminal behaviors, and an increased risk of developing a mental disorder., Other psychosocial factors associated with adolescent drug abuse in developed countries include problematic Internet use (PIU), suicidality, low self-esteem, depression, and anxiety.,,,, PIU is the inability of an individual to exert self-control in terms of involvement in activities on the Internet, thereby resulting in marked impairments in psychosocial functioning., Literature shows that PIU does not exist independently but often coexists with other psychopathological conditions such as drug abuse, particularly among adolescents.
Drug abuse increases the odds of suicidal behaviors among adolescents., It is one of the high-ranking risk factors associated with adolescent suicidal behaviors and associated mortality., This is in concert with the existing body of evidence that showed a linkage between high scores on depressive symptom evaluating instruments and adolescents who engage in drug abuse. It has been suggested that depressive symptoms worsen with increasing drug abuse among adolescents. Higher levels of anxiety symptoms have also been reported among adolescents who abuse drugs. Furthermore, substance abuse, particularly alcohol, is associated with a reduced sense of self-worth (i.e., self-esteem) among adolescents. One plausible reason for this association is that adolescents with low self-esteem engage in drug abuse as a means of coping with their sense of poor self-worth.
There is a dearth of studies regarding the psychological factors associated with drug abuse among Nigerian adolescents. An extensive electronic literature search revealed that most of the Nigerian studies of drug abuse among adolescents were focused primarily on epidemiological descriptions of prevalence rates and the types of the substance of abuse., In addition, other gaps emerging from existing literature on drug abuse among Nigerian adolescents include relatively small sample sizes,, the related social settings, the parental /guardian factors, and awareness about the risk of substance use. To the knowledge of the authors of this current study, no study in Nigeria has examined among adolescents the relationship of drug abuse with psychological or mental health-related variables such as PIU, suicidality, anxiety, and depression.
Therefore, the aim of this study, apart from evaluating the current prevalence rate of drug abuse among Nigerian adolescents, is to assess the strength and directions of the relationship of PIU, suicidality, anxiety, depression, and self-esteem with drug abuse. Ultimately, this study will not only contribute to the current data regarding the prevalence of drug use among the Nigerian adolescent population but also enable the identification of the psychological factors that can prospectively play a role in the development of psychological interventions for the management of drug abuse among Nigerian adolescents.
| Materials and Methods|| |
This study was conducted in Osogbo, the capital city of Osun State, in Southwestern Nigeria. The city has a total of 15 public senior secondary schools. Using a balloting approach, we randomly selected six of the senior high schools. After the selection of the senior secondary schools, we subsequently adopted a multistage stratified sampling recruitment method to obtain our sample. In the first stage, three classrooms from the three arms of the senior secondary classes (I, II, and III; the equivalent of Grade 10 to 12) were randomly selected from each high school (yielding nine classrooms from each school and a total of 54 classrooms from the six schools). Second, using a balloting method, we selected 25 students per classroom, producing a total of 1350 senior high school adolescents. What we did in the balloting method used to select the senior secondary schools and the number of students to be recruited per classroom was to write out the names of the 15 public senior high schools and the names of the students in the selected classrooms individually on different pieces of paper that were folded (in order not to make the names of the schools and students visible). This was done separately for the schools and the students. It is from this pool of folded papers that the six schools and the 25 students per classroom were selected.
We prepared a study-specific sociodemographic questionnaire to collect respondents’ sociodemographic variables such as age, gender, and family settings.
The Drug Abuse Screening Test (DAST) is a 10-item self-reported brief measure that provides information on the abuse of nonmedical and nonprescribed drugs. The DAST-10 has been used to assess the abuse of these drugs among outpatients in other African countries. The 10-item DAST is an abridged version of the 28-item instrument. The higher the cumulative score on the DAST, the greater the likelihood that the respondent is abusing one or more drugs. A score of 0 implies no drug abuse, a total score of 1–2 means a low level of drug abuse, 3–5 signifies a moderate level of drug abuse, 6–8 indicates a substantial level of drug abuse, and 9 to 10 indicates a severe level of drug abuse. Therefore, in this study, any respondent with a minimum score of 1 was recorded to be engaged in drug abuse. The DAST-10 cumulative score is further classified into the categories of actions that should be taken; a score of 0 indicates no action needed, 1–5 suggests monitoring and further investigations, and a total score of 6–10 reflects the need for intensive assessment.
The difficulties related to Internet use were evaluated with the Problematic Internet Use Questionnaire-Short Form-6 (PIU-SF-6). This shortened version was extracted from the original 18-item version. The three dimensions (Obsessions, Neglect, and Control) in the original version, which has six items per dimension, were retained in the short-form version, which has two items per dimension. Each item on the three dimensions of the PIUQ-SF-6 is scored on a 5-point Likert scale, ranging from “never”rated 1 to “always/almost always”rated 5. The aggregate score on the whole instrument ranged from 6 to 30. Higher scores reflect more severe PIU. A cutoff score of 15 was used to determine those with problematic Internet use. The PIU-SF-6 has been validated among Nigerian adolescents.
The Mini-International Neuropsychiatric Interview (MINI) is designed as a brief structured interview for the major Axis I psychiatric diagnoses in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the tenth edition of the International Classification of Diseases (ICD-10). The MINI Suicidality module was used to objectively assess suicidality among the respondents. There are nine questions in this module labeled C1 to C9. Questions C1 to C8 assess suicidality-related events in the previous one month, whereas question C9 assesses lifetime suicide attempts. MINI has been used in diverse clinical and nonclinical populations in Nigeria.,
The Hospital Anxiety and Depression Scale (HADS) is a 14-item scale with two subscales (each consists of seven items). It quantitatively assesses anxiety and depressive symptoms. Each item is rated on a 4-point Likert scale (0–3). The cumulative score on each subscale ranges from 0 to 21. Its psychometric properties have been reported to be adequate in different populations in Nigeria.
The Rosenberg Self-Esteem Scale (RSES) is a self-worth evaluating 10-item questionnaire. Each item is scored on a four-point Likert scale ranging from strongly agree to strongly disagree. Items 2, 5, 6, 8, and 9 on the scale are reverse scored. Higher scores reflect a greater sense of self-worth. Satisfactory reliability and validity have been demonstrated among Nigerian adolescents.
The approval for the study protocol was obtained from the Specialist Hospital Health Research Ethics Committee of the Hospitals’ Management Board, Osogbo in Osun State. The education authorities in charge of the schools where the study was conducted also gave ethical approval for the study. The high school students excluded were those older than 19 years, those with a current or previous history of a psychiatric disorder, those who refused to assent, and those whose parents or guardians refused consent. All the senior high school students gave their assent. The adolescents went home with a study-specific parental/guardians consent form that explained the objectives of the study. Their parents or guardians were requested to append their signatures on the form as an indication of their consent. Out of the 1350 adolescents recruited for the study, 46 parents/guardians refused to give their consent for the recruitment of their children into the study. Hence, study measures from 1304 respondents were available for analysis (response rate of approximately 97%).
Statistical analyses were performed with the Statistical Package for Social Sciences (SPSS) software, 21st version. Descriptive statistics such as the mean (standard deviation) and frequency (percentages) were utilized in depicting the students’ sociodemographic variables and scores on the DAST-10 and the other study measures. The dependent variable was drug abuse as measured with the DAST-10, whereas the other study measures were the exploratory variables. The directions and strengths of the relationship between DAST-10 score and the other measures were evaluated by applying correlational analyses. The t-test was utilized to compare the mean scores of respondents who abused drugs and did not abuse drugs. A multivariate linear analysis was conducted to identify selected sociodemographic and exploratory variables that significantly predicted the DAST-10 scores among the respondents. The level of statistical significance was set at a p-value less than 0.05, and all tests were two-tailed.
| Results|| |
Sociodemographic and study measure characteristics of the respondents
As shown in [Table 1], the mean age of the respondents was 15.77 (SD 1.36) years. Females constituted 51% (665) of the respondents. The majority (89.8%) of them had their parents living together. The prevalence of drug abuse was 49.8% (i.e., those who scored 1 and above on the DAST-10). The mean scores of the DAST-10, PIU-SF-6, MINI Suicidality module, RSES, and HADS-Depression and HADS-Anxiety subscales were 1.59 (SD 2.17), 15.44 (SD 5.42), 4.52 (SD 8.97), 17.01 (SD 2.17), 7.22 (SD 3.49), and 8.52 (SD 3.80), respectively.
|Table 1: Sociodemographic and study measure characteristics of the respondents (n = 1304)|
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Correlational analysis between DAST-10 and other study measures
[Table 2] shows that there were statistically significant positive correlations (Pearson’s) between DAST-10 and PIU-SF-6 (rp = 0.111, P < 0.001), MINI Suicidality (rp = 0.363, P < 0.001), HADS-Depression (rp = 0.231, P < 0.001), as well as HADS-Anxiety (rp = 0.363, P < 0.001). In addition, DAST-10 had a statistically significant negative correlation with RSES (rp = -0.143, P < 0.001) and age (rp = -0.057, P < 0.001). The Cronbach’s alpha values of the DAST-10, PIU-SF-6, MINI Suicidality module, RSES, HADS-Anxiety, and HADS-Depression were 0.79, 0.77, 0.72, 0.70, 0.69, and 0.71, respectively.
|Table 2: Correlational analysis between DAST-10 and other study measures (n = 1304)|
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Comparison of the mean DAST-10 score with other study measures mean scores between the respondents with and without drug abuse
As demonstrated in [Table 3], the respondents who abused drugs compared with those who did not (DAST-10 score of one and above compared with a score of zero) had higher mean scores regarding PIU, suicidality, depression, and anxiety symptoms and lower self-esteem scores [Table 3].
|Table 3: Comparison of the mean DAST-10 score with other study measures mean scores between the respondents with and without drug abuse|
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Multiple linear regression showing factors associated with the DAST-10 scores among adolescents
[Table 4] (regression analysis) shows that all the psychological variables in our study collectively explained 22% of the variance in the dependent variable (DAST-10).
|Table 4: Multiple linear regression showing factors associated with the DAST-10 scores among adolescents (n = 1304)|
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| Discussion|| |
This is a cross-sectional study that examined the correlates of drug abuse, in addition to the assessment of the current prevalence of drug abuse among Nigerian senior high school adolescents. The prevalence of drug abuse was 49.8%. This finding is similar to what was reported in an Ethiopian adolescent study (47.9%). Our observation is slightly higher than the findings of a systematic review of 27 studies across sub-Saharan Africa, which reported a prevalence rate of 41.6%. However, the observed prevalence in our study is much lower than the rate of 66%, which was previously reported four years earlier in the same region where this study was conducted. The reason for the reduced prevalence in our study may be a beneficial offshoot of the regular enlightenment on the hazards of drug abuse that the adolescents in this region of the country have been exposed to through the various media since the study by Ogunsola and Fatusi in 2016. Another plausible reason for the lowered prevalence rate may be the free mental health services provided by the State Government. The disparity noted between our study and the earlier one could also be due to methodological differences. It has been suggested that the contrasts in the prevalence of substance abuse in different communities may be due to different sample characteristics, cultural backgrounds, and socioeconomic environments.
Substance use is associated with serious mental health problems among adolescents. In our study, substance abuse was positively correlated with PIU, suicidality, depression, and anxiety symptoms. It has been reported that drug abuse independently increases suicidal behaviors and PIU among adolescents., This could be due to fact that drug abuse erodes judgment, impairs impulse control, and interrupts neurotransmitter pathways, thereby leading to behaviors of disinhibition. In addition, there is an exacerbation in the severity of depressive and anxiety symptoms as substance use increases.,
Self-esteem is the perception of one’s worthiness. Low self-esteem makes adolescents view themselves as inadequate, worthless, unlovable, and incompetent. We noted that drug abuse negatively correlated with self-esteem (i.e., those who abuse drugs have lower self-esteem). This is consistent with a Pakistani study that reported an association between drug abuse and low self-esteem in a sample of older adolescents. It has been postulated that adolescents with low self-esteem engage in substance use as a way of coping with negative feelings regarding themselves.,
In multiple linear regression analysis, drug abuse was significantly associated with age, PIU, suicidality, depression, anxiety, and low self-esteem. All the psychological variables along with the age of the respondents in our study collectively explained 22% of the variance in the dependent variable (DAST-10). Studies from developed countries have reported that PIU among adolescents is a major contributor to the variances regarding psychoactive substance abuse among the adolescent population., Some authors have suggested that substance abuse and PIU have similar behavioral characteristics., The results of our regression analysis seem to show that there is a need for more studies to investigate other variables that may potentially contribute to drug abuse among Nigerian adolescents.
This study is not without some limitations. First, the adolescents were recruited from senior high schools in the southwestern region of Nigeria; hence, our findings may not be generalized to adolescents in the other parts of the country. Second, the direction of causality between drug abuse and the other study measures cannot be established due to the cross-sectional nature of the study. In addition, some of our respondents may have been subjected to both recall and reporting bias due to the self-reported nature of some of the study measures. Despite these limitations, the strength of our study is that we recruited a fairly large sample size. Also, this is the first study in Nigeria to examine the relationships between a modestly significant number of psychological variables and psychoactive substance use among the adolescent population.
| Conclusions|| |
This study has shown that there is still a relatively high rate of drug abuse among high school adolescents in Nigeria. Drug abuse is significantly associated with PIU, suicidality, depression, anxiety, and low self-esteem. Consequently, the study findings contribute to the body of evidence, calling for an intensification of efforts by key stakeholders, government, and nongovernment organizations to reduce the prevalence and burden of drug abuse among high school adolescents through innovative interventions. There is an urgent need for the formulation and implementation of mental health policies that will strengthen school-based mental health services directed towards the identification and provision of support services to adolescents who abuse various psychoactive substances. Services provided under school-based mental health services may include screening for the related psychological variables identified in this study among the adolescents.
- Need for the provision of mental health services, specifically for addressing the needs of senior high school adolescents. These services may play an important role in screening for drug use and the design of public health interventions geared toward the prevention of drug use.
- Mainstreaming psychoeducation into the curricula and daily routines observed in schools, as a strategy to mitigate some of the risk factors for substance abuse.
The authors are grateful to the staff and students in the high schools where this study was conducted. They are also grateful to the parents and guardians of the students who gave their consent.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Golpe S, Gómez P, Braña T, Varela J, Rial A The relationship between consumption of alcohol and other drugs and problematic internet use among adolescents. Adicciones 2017;29:268-77.
Wu LT, Woody GE, Yang C, Pan JJ, Blazer DG Racial/ethnic variations in substance-related disorders among adolescents in the united states. Arch Gen Psychiatry 2011;68:1176-85.
Ogunsola OO, Fatusi AO Risk and protective factors for adolescent substance use: A comparative study of secondary school students in rural and urban areas of Osun State, Nigeria. Int J Adol Med Health2016;29:3-14.
Kabwama SN, Matovu J, Ssenkusu JM, Ssekamatte T, Wanyenze R Alcohol use and associated factors among adolescent boys and young men in Kampala. Uganda. Subst Abuse Treat Prev Policy 2021;16:49-58.
Morrison MA Addiction in adolescents. West J Med 1990;152:543-6.
Bassi A, Idoko L, Ogundeko T, Ramyil M, Abisoye-Ogunniyan A, Ogbole E, et al
. Substance Abuse and its Prevalence Among Secondary School Adolescents in Kagoro, Kaduna State, Nigeria. World J Res Rev2017;5:11-6.
Bakhshani NM, Dahmardei M, Shahraki SF, Hosseinbor M, Ansari MA Substance abuse among high school students in Zahedan. 2014;314-21.
Gurung A, Shrestha N, Silwal M, Gurung R, Ojha S Prevalence of Substance Use and Associated Factors Among High School Adolescents in Rithepani, Lekhnath-2, kaski, Nepal. J Gandaki Med College-Nepal 2017;10:43-8.
Muck R, Zempolich KA, Titus JC, Fishman M, Godley MD, Schwebel R An overview of the effectiveness of adolescent substance abuse treatment models. Youth Soc 2001;33:143-68.
Grunbaum JA, Lowry R, Kann L, Pateman B Prevalence of health risk behaviors among asian american/pacific islander high school students. J Adolesc Health 2000;27:322-30.
Olawole-Isaac A, Ogundipe O, Amoo EO, Adeloye D Substance use among adolescents in sub-Saharan Africa: A systematic review and meta-analysis. South African J Child Health 2018;12:s79-s84.
Anyanwu OU, Ibekwe RC, Ojinnaka NC Pattern of substance abuse among adolescent secondary school students in Abakaliki. Cogent Med 2016;3:1272160.
Idowu A, Aremu AO, Olumide A, Ogunlaja AO Substance abuse among students in selected secondary schools of an urban community of oyo-state, south west Nigeria: Implication for policy action. Afr Health Sci 2018;18:776-85.
Oshodi OY, Aina OF, Onajole AT Substance use among secondary school students in an urban setting in nigeria: Prevalence and associated factors. Afr J Psychiatry (Johannesbg) 2010;13:52-7.
Volkow ND, Li TK Drugs and alcohol: Treating and preventing abuse, addiction and their medical consequences. Pharmacol Ther 2005;108:3-17.
Bond L, Toumbourou JW, Thomas L, Catalano RF, Patton G Individual, family, school, and community risk and protective factors for depressive symptoms in adolescents: A comparison of risk profiles for substance use and depressive symptoms. Prev Sci 2005;6:73-88.
Yoo HJ, Cho SC, Ha J, Yune SK, Kim SJ, Hwang J, et al
. Attention deficit hyperactivity symptoms and internet addiction. Psychiatry Clin Neurosci 2004;58:487-94.
Bohnert KM, Ilgen MA, Louzon S, McCarthy JF, Katz IR Substance use disorders and the risk of suicide mortality among men and women in the Us veterans health administration. Addiction 2017;112:1193-201.
Wu CS, Wong HT, Shek CH, Loke AY Multi-dimensional self-esteem and substance use among chinese adolescents. Subst Abuse Treat Prev Policy 2014;9:42.
Hernandez L, Cancilliere MK, Graves H, Chun TH, Lewander W, Spirito A Substance use and depressive symptoms among adolescents treated in a pediatric emergency department. J Child Adolesc Subst Abuse 2016;25:124-33.
Ohannessian CM Anxiety and substance use during adolescence. Substance Abuse 2014;35:418-25.
Vadher SB, Panchal BN, Vala AU, Ratnani IJ, Vasava KJ, Desai RS, et al
. Predictors of problematic internet use in school going adolescents of bhavnagar, india. Int J Soc Psychiatry 2019;65:151-7.
Christakis DA, Moreno MA Trapped in the net: Will internet addiction become a 21st
-century epidemic? Arch Pediatr Adolesc Med 2009;163:959-60.
Somani S, Meghani S Substance abuse among youth: A harsh reality. Emerg Med (Los Angel) 2016;6:2.
Swahn MH, Ali B, Bossarte RM, Van Dulmen M, Crosby A, Jones AC, et al
. Self-harm and suicide attempts among high-risk, urban youth in the U.S.: Shared and unique risk and protective factors. Int J Environ Res Public Health 2012;9:178-91.
Pompili M, Serafini G, Innamorati M, Biondi M, Siracusano A, Di Giannantonio M, et al
. Substance abuse and suicide risk among adolescents. Eur Arch Psychiatr Clin Neurosci 2012;262:469-85.
Espada JP, Sussman S, Medina TBH, Alfonso JP Relation between substance use and depression among Spanish adolescents. Int J Psychol Psychol Ther 2011;11:79-90.
Jessor R, Van Den Bos J, Vanderryn J, Costa FM, Turbin MS Protective factors in adolescent problem behavior: Moderator effects and developmental change. Develop Psychol 1995;31:923.
Manyike PC, Chinawa JM, Chinawa AT, Obu HA, Nwokocha ARC, Odetunde OI Correlates for psycho-active substance use among boarding secondary school adolescents in Enugu, south east, Nigeria. Bmc Pediatr 2016;16:78.
Okwaraji F Substance abuse among secondary school adolescents in Enugu. Int J Med Health Develop 2006;11:130-5.
Odukoya OO, Sobande OO, Adeniran A, Adesokan A Parental monitoring and substance use among youths: A survey of high school adolescents in Lagos state, Nigeria. Niger J Clin Pract 2018;21:1468-75.
Adenaike A, Surakat A, Adegboyega S, Senuga M Menace of drug abuse on youth development and academic performance: Evidence from Nigeria. J Soc Behav Sci 2014;3:81-101.
Skinner HA The drug abuse screening test. Addict Behav 1982;7:363-71.
El-Sherbiny A Drug abuse among patients of Tanta university hospital outpatient clinic, Gharbia governorate, Egypt. Tanta Med J 2015;43:82.
Demetrovics Z, Király O, Koronczai B, Griffiths MD, Nagygyörgy K, Elekes Z, et al
. Psychometric properties of the problematic internet use questionnaire short-form (Piuq-Sf-6) in a nationally representative sample of adolescents. Plos One 2016;11:e0159409.
Demetrovics Z, Szeredi B, Rózsa S The three-factor model of internet addiction: The development of the problematic internet use questionnaire. Behav Res Methods 2008;40:563-74.
Opakunle T, Aloba O, Opakunle O, Eegunranti B Problematic Internet Use Questionnaire-Short Form-6 (PIUQ-SF-6): Dimensionality, validity, reliability, measurement invariance and mean differences across genders and age categories among Nigerian adolescents. Int J Mental Health2020;49:229-46.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al
. The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for Dsm-Iv and Icd-10. J Clin Psychiatry 1998;59:22-33;quiz 34-57.
Opakunle T, Akinsulore A, Aloba OO, Fatoye FO Obsessive-compulsive symptoms in schizophrenia: Prevalence and associated factors in a Nigerian population. Int J Psychiatry Clin Pract 2017;21:195-200.
Adewuya AO, Ola BA, Afolabi OO Validity of the patient health questionnaire (Phq-9) as a screening tool for depression amongst Nigerian university students. J Affect Disord 2006;96:89-93.
Zigmond AS, Snaith RP The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-70.
Abiodun OA A validity study of the hospital anxiety and depression scale in general hospital units and a community sample in Nigeria. Br J Psychiatry 1994;165:669-72.
Rosenberg M Society and the adolescent self-image. Princeton, NJ: Princeton University Press; 2015.
Oyefeso AO, Zacheaus A Self-esteem as determined by gender differences among Yoruba adolescents to Ibadan, Nigeria: A research note. J Child Psychol Psychiatr 1990;31:461-3.
Birhanu AM, Bisetegn TA, Woldeyohannes SM High prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia: Multi-domain factor analysis. BMC Public Health 2014;14:1186.
Opakunle T, Aloba O, Opakunle O Suicidality among Nigerian postpartum women: Prevalence and correlates. Trop J Obstetr Gynaecol 2019;36:391-7.
Keyes KM, Martins SS, Hasin DS Past 12-month and lifetime comorbidity and poly-drug use of ecstasy users among young adults in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Drug Alcohol Depend 2008;97:139-49.
Moradi SF, Ghanbari HB, Aghamohammadian SH The effectiveness of reality therapy group training on the enhancement of the self-esteem of a group of students of Ferdowsi University of Mashhad. Stud Educ Psychol 2011;2:227-38.
Chinawa JM, Obu HA, Manyike PC, Obi IE, Israel OO, Chinawa AT Self esteem among adolescents in Nigerian secondary schools: A neglected issue. Br J Med Med Res 2015;5:98-106.
Akhter A Relationship between substance use and self-esteem. Int J Sci Eng Res2013;4;2:65-79.
Liu TC, Desai RA, Krishnan-Sarin S, Cavallo DA, Potenza MN Problematic internet use and health in adolescents: Data from a high school survey in connecticut. J Clin Psychiatry 2011;72:836-45.
Dalbudak E, Evren C, Aldemir S, Evren B The severity of internet addiction risk and its relationship with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students. Psychiatry Res 2014;219:577-82.
[Table 1], [Table 2], [Table 3], [Table 4]