title: Educational inequalities in the co-occurrence of mental health and substance use problems, and its adult socio-economic consequences: a longitudinal study of young adults in a community sample.
abstract: OBJECTIVE
  To examine the relationship between the co-occurrence of mental health and substance use problems and socio-economic status (SES).
  
  
  METHODS
  A prospective longitudinal study of 808 males and females followed to age 30.
  
  
  METHODS
  Survey data were used to derive latent classes (profiles) of mental health (depression, anxiety) and substance use (alcohol, nicotine, and marijuana [cannabis]) problems at age 27. Analyses examined the associations of these profiles with earlier educational attainment (high school diploma) and indicators of SES at age 30.
  
  
  RESULTS
  Latent Class Analysis produced four profiles: a low disorder symptoms group, a licit substance use disorder symptoms group (alcohol and nicotine), a mental health disorder symptoms group, and a comorbid group. Earning a high school diploma by age 21 decreased the odds of belonging to the comorbid group or the licit substance use disorder symptoms group when compared to the low disorder symptoms group. These disorder profiles also were found to adversely impact subsequent adult SES. The adverse impact was more evident in income maintenance and wealth accumulation by age 30 than market or non-market labour force participation.
  
  
  CONCLUSIONS
  Earning a high school diploma lessens the risk of co-occurring mental health and substance use problems which contribute to economic instability in young adulthood. Findings underscore the importance of public health programmes to reduce the incidence of mental health and substance use problems and their associated high costs to individuals and to society.
authors.affiliation: Social Development Research Group, School of Social Work, University of Washington, USA. jel5@uw.edu
authors.forename: J O
authors.initials: JO
authors.lastname: Lee
authors.forename: T I
authors.initials: TI
authors.lastname: Herrenkohl
authors.forename: R
authors.initials: R
authors.lastname: Kosterman
authors.forename: C M
authors.initials: CM
authors.lastname: Small
authors.forename: J D
authors.initials: JD
authors.lastname: Hawkins
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012923:Social Class; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult
keywords: Comorbidity; Health inequalities; Mental health; Socio-economic status; Substance use disorder