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SMAD. Revista eletrônica saúde mental álcool e drogas

versão On-line ISSN 1806-6976

SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. (Ed. port.) vol.10 no.2 Ribeirão Preto ago. 2014 

DOI: 10.11606/issn.1806-6976.v10i2p93-100


Common mental disorders, alcohol consumption and tobacco use, among nursing students at a public university in the western Brazilian Amazon



Bruno Pereira da SilvaI; Clarissa Mendonça Corradi-WebsterII; Edilaine Cristina da Silva Gherardi-DonatoIII; Miyeko HayashidaIV; Marluce Miguel de SiqueiraV

IMSc, Assistant Professor, Centro Multidisciplinar, Universidade Federal do Acre, Campus Floresta, Cruzeiro do Sul, AC, Brazil
IIPhD, Professor, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
IIIPhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
IVRN, PhD, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
VPhD, Associate Professor, Universidade Federal do Espírito Santo, Vitória, ES, Brazil





The objective of this study is to identify the prevalence of two common mental disorders, alcohol consumption and tobacco use, among nursing students of a public university in the western Brazilian Amazon. This is an exploratory and descriptive study, using AUDIT instruments, SRQ-20 and smoking questionnaire. Of the total number of students 93.4% said they consume a low-risk amount of alcohol, but 26% said they binge drank at least once a month. As for tobacco, 78.6% claimed to have used it because of curiosity and the desire to experiment and 46.1% said they "felt nervous, tense or worried" and had a "depressive/anxious mood." In comparing these results it allows for a more consistent planning of prevention programs that addresses the needs of this community.

Descriptors: Alcoholism; Smoking; Diagnosis, Dual (Psychiatry); Students, Nursing.




The literature suggests that the symptoms of anxiety and depression(1-2) and the abuse of psychoactive substances has been growing among young people(1-4).  The university population is an important group to be studied epidemiologically because they are usually people in the transition from adolescence to adulthood, having to deal with the different tasks of this stage of development, tasks that generate emotional distress. Among these tasks, we highlight: the development of new relationships and social repertoires, emotional and physical distance from their immediate family, the construction of autonomy and values, and the development of new social roles (3).

Furthermore, Higher Education Institutions (HEIs) are increasingly competitive. This competition begins with the selection process of the entrance exam, which is often full of applicants for admission into a good university. Once at university, there are the academic demands of each course, as well as expectations to enter the job market (5).

Amongst university students in the area of health care, this situation is worsened by the close emotional contact with different people and the pain they experience. Students are usually people who have made the choice to help other human beings to be born, to experience (to overcome the problems and limitations) and to die with dignity (6-7).

Previous studies have addressed the topic of mental health among college students. In a study developed with health care students at a public university in the state of São Paulo, it showed a prevalence of 23% of problematic alcohol use (PAU), 30.6% had common mental disorders (CMD) and 7.3% had a co-occurrence of PAU and CMD(4). In another study, conducted with students of two undergraduate nursing courses, it was found that the prevalence rate of symptoms indicative of depression among the respondents was 14% (n = 114)(2). Lastly, significant results were found in a study that examined depressive symptoms among medical students at a public university, it showed a prevalence of 40.5% (n = 84). Of these, 1.2% had severe depressive symptoms, 4.8% moderate and 34.5%, mild levels (1).

Given the relevance of this topic and the impact that the improper use of psychoactive substances may have on young people preparing for adult life and the job market, some studies have specifically addressed this issue. Several approach students in the health care area, especially Medical Students (8-9), Nursing(10-11) and to a lesser extent, Pharmacy(12) and Dentistry(13). Corroborating this argument about the importance of this subject, in 2010, the National Secretary of Policies over Drugs, published the first National Survey on Alcohol, Tobacco and Other Drug Use among universities of the 27 Brazilian capitals(5).  They surveyed 12,856 students of 100 institutions, 51 of them public and 49 private and showed the profile of abused psychoactive substances (APSs) of Brazilian universities. The results showed the use of low risk alcohol, moderated and high by college students was 78.2%, 19.2% and 2.6%, respectively. Binge drinking represented 37.7% and 25.3% of alcohol consumption in the past 12 months and 30 days respectively. Tobacco was the second most used APS, with 46.7% for use in their lifetime, 27.8% within the past year and 21.6% within a month. In the northern part of the country, the consumption of low-risk alcohol, moderate and high by college students was 79.2%, 18.9% and 1.9%, respectively, and 39.4% and 31.4% of them binge drank. For tobacco, use in their lifetime and in the past year was 17.9%, and for the past month was 14.1%. These studies play an important role in Brazilian society, since they reinforce the need for a thematic approach in universities, concerning the mental health of young graduate students, especially those in health care(2).

However, existing studies, mostly, bring samples pertaining to HEI of a few regions of the country, especially the Southeast, with emphasis on the State of São Paulo. This limits the comparison of results as well as the construction of a reliable national reality(5). The reality of PAU, tobacco consumption and the prevalence of CMDs, and the effects of the use of these APSs association with psychiatric disorders among students of the northern part of the country have barely been studied (8).

In order to do this it is necessary to analyze the factors associated with CMD, alcohol consumption and tobacco use among college students. Such analysis is extremely important to prevent the worsening of symptoms and the development of a psychopathological clinical picture, along with developing strategies to reduce the harm related to substance use.

Thus, this study aims to identify the prevalence of common mental disorders, alcohol consumption, and tobacco use among nursing college undergraduates at the Federal University of Acre, Floresta Campus (FUAFC). This study may contribute to the understanding and planning of preventive health measures appropriate in academia.



A quantitative, exploratory and descriptive study was conducted. The study setting was the Multidisciplinary Center, at the Federal University of Acre, Floresta Campus. Data collection was conducted in May 2012, with the authorization of professors and the institution.

Participants were 76 college students from the 1st, 3rd, 5th, and 7th periods of the nursing undergraduate course of that institution. Thus, the inclusion criteria were: being a student of the nursing course, being enrolled in the first semester of 2012 and agreeing to participate in the study.

Data collection was performed by using three self-administered instruments, of these, two were from the public domain. The first instrument was the Alcohol Use Disorders Identification Test (AUDIT)(14), validated in Brazil, and used to track patterns of alcohol consumption. The questions were about the pattern of alcohol consumption, the signs and symptoms of addiction and the problems arising from the use of this substance. The second instrument was a self-administered questionnaire with closed questions, developed and validated by researchers(11) of the State University of Rio de Janeiro (SURJ), to investigate tobacco use among college students in nursing. This questionnaire investigates sociodemographic variables and issues related to tobacco consumption. The third instrument was the Self-Reporting Questionnaire (SRQ-20), a tool used for the screening of minor psychiatric disorders, not psychotic disorders, and/or common mental disorders (CMD); featuring 20 questions, with yes or no type answers. Positive responses indicate a greater intensity of CMD or emotional distress and scores greater than six indicate a positive clinical case for CMD(15).

The instruments were applied in the classroom with the permission of the professor who taught the class, and with previous authorization of the nursing course coordinator. The average time to answer the questionnaire was 40 minutes.

Data was entered and organized in a Microsoft Excel spreadsheet program. We used descriptive statistics with use of absolute frequency and percentages for the analysis of data processed in the Statistical Package for the Social Sciences - SPSS 17.

The study was submitted and approved by the Research Ethics Committee (REC) of FUAFC. The participants were informed of the research objectives and their rights in participation, respecting Resolution no. 466/2012 of the National Health Council(16). Participants were also required to sign an Informed Consent.



The study population consisted of 120 students of the nursing undergraduate course, of those, 76 students were present in the classroom at the time of application of the instruments, covering all classes of the nursing institution. Thus, 76 subjects signed the Informed Consent, agreeing to participate in the study. Losses were by absence; there were no refusals. The majority were women (73.37%, n = 56), up to 25 years of age (76.1%, n = 57), and single (77.6%, n = 59).

The application of AUDIT was used to identify problematic alcohol use with a cutoff point of seven. The analysis of the AUDIT total score, of the 76 university students sample, found that 5 students (6.6%) had a positive AUDIT score (greater than or equal to 8), identifying problematic alcohol use, 35 students (46.1%) presented a negative AUDIT score (lower than or equal to 7) identifying low-risk use of alcohol, and 36 students (47.3%) who reported not having consumed alcohol in the last 12 months.

In other words, amid nursing students 93.4% showed a pattern of drinking (Table 1) in risk zone I of the AUDIT (scores greater than or equal to 0 and less than or equal to 7 points), featuring low-risk alcohol consumption and students who reported not having consumed alcohol in the last 12 months. In zone II of the AUDIT (scores greater than or equal to 8 and less than or equal to 15 points), it was identified that 6.6% showed a pattern of drinking characteristic of risky alcohol use.



In the present study, there were no students identified with the characteristic of harmful alcohol use or probable alcohol dependence syndrome, zone III and IV of the AUDIT (scores greater than or equal to 16 and less than or equal to 20 points, and greater than 20 points, respectively).

The pattern of binge drinking (questions 2 and 3 of AUDIT), showed that 4 students (5.4%) mentioned drinking two or three glasses of alcohol on a typical day and 3 students (4.1%), drank six or seven glasses. Of the students drinking five or more glasses of alcohol in one occasion, 19 of these (26.0%) drank less than once a month, 6 (8.2%) drank once a month, and 2 (2.7%) once a week.

The experience of students who used tobacco is presented in Table 2. It was observed that 28 (37.3%) of the respondents had smoked at least once in their lifetime, and of those only one continued to use tobacco.



Table 3 shows the reasons for the students tobacco use. It is observed that 78.6% used because of curiosity and the desire to experiment, 21.4% were under the influence of extra-familial group and 10.7% did not care about damage to their health.



The results of the SRQ-20 was distributed into a regrouping of symptoms(16). Table 4 shows the distribution of the sample answers by regrouped items of the SRQ-20.



Note that in the group of symptoms "depressive/anxious mood", 46.1% "feels nervous, tense or worried," 31.6% "startles easily" and 28.9% "has had a sad sense lately." In the group of "somatic symptoms", 31.6% had frequent headaches and 25% "had unpleasant sensations in the stomach." In the group of symptoms "vital energy decrease," 32.9% reported having "difficulty making decisions" and 26.3% said they were "easily tired." In the last group, "depressive thoughts," 9.2% said they "have lost interest in things."

With the application of the chi-square test aimed at investigating the association between common mental disorders, alcohol consumption, and tobacco use; associations between CMD and alcohol consumption were found (χ22 = 0.24; p = 0.530) and between CMD and tobacco use (χ2 = 1.33; p = 0.204).



In a study(17) with students in the nursing course of a private higher education institution, the sociodemographic profile shows that most of the college is female, single and between the ages of 20-25 years. This profile is similar to the present study and other findings in the literature(10-11).

According to the study investigating the co-occurrence of alcohol abuse and common mental disorders in graduate students in health care, performed by Yosetake(4), 76.5% of the students showed a pattern of drinking in the risk zone I of the AUDIT (low-risk drinking), 20.5% in zone II (risky drinking), 2.6% in zone III (abusive drinking) and 0.4% in Zone IV (likely dependence). It is worth noting that the study in question has also worked with a predominantly female sample, but with a greater number of men than of this research, which could explain the higher scores found by the author.

In relation to alcohol consumption, researchers(18)  found that 83.4% of students from two nursing schools have used it in the last year. Of all students, 73.4% had AUDIT scores ≤8. These figures are close to those found in this study.

Regarding the prevalence of binge drinking, one study revealed that 33.4% of students who drank did so at least once a month(4).  In the present study, although 94.6% of students admitted to low-risk drinking, 26% said they binge drank at least once a month. Considering that consumption of high doses of alcohol on a single occasion can put young people at risk, it is important to develop reduction strategies for this population(3).  This data also indicates that, when used in the clinic, the AUDIT should be considered not only in relation to their total score, but also the questions must be reviewed individually.

Concerning the tobacco experimentation, the national literature found that 23% of nursing students at the Northern University Center of the Holy Spirit (NUCHS)(10), tried the substance at least once in their lifetime and 77% abstained. Among those who had experienced tobacco use only 13% remained consuming.

The results of a study(17) performed with nursing students from a private college Guarapari, ES, showed that when asked about the main reasons for tobacco use, 33.3% of subjects responded that it was curiosity and the desire to try smoking; 19% responded that they were under the influence of extra-familial group. In another study with students from the same area, the NUCHS, the reasons that led college students to smoking was that 75% were curious and had the desire to try smoking, and 25% were influenced by an extra-familial group(10). In this study, we found that these issues were also the most prevalent.

According to the literature(10,17), the motivations for tobacco consumption by college students is related to social environment factors such as: family, the media, friends, as well as personal characteristics like the sense of needing to belong, curiosity, pleasure and idleness; these findings have been corroborated by this study.

The results from a study of health students from the interior of São Paulo, regarding the prevalence of minor psychiatric symptoms, tracked by SRQ-20, are similar to this study(4). In both studies, the minor psychiatric symptoms were grouped into the following: "depressive/anxious mood," "vital energy decrease," "somatic symptoms," and "depressive thoughts." In the group of "depressive/anxious mood" it was observed that 56.5% reported feeling nervous, tense or worried, and 39.2% said they get tired easily. In the group called "vital energy decrease," 28.9% said they had unpleasant sensations in their stomach, as in the groups of "somatic symptoms" and "depressive thoughts," 19.8% "has lost interest in things." The results shown in Table 4 of this study corroborate all of these same findings.

There was another study that aimed to investigate depression among students of two public university nursing courses from the interior of São Paulo(2), it found that 40.2% of the participants had depression (mild, moderate and severe). Although there was a high prevalence of symptoms of common mental disorders found in the sample, we found no association between the problematic alcohol use and such symptoms.



This study investigated the prevalence of problematic alcohol use, tobacco use and the occurrence of common mental disorders among nursing college students.

Although many students reported that they had tried alcohol, only 5.3% of them found that the use of this substance was problematic. This small number may be related to the fact that the majority of respondents were female; this group has already been described in the literature as consuming less alcohol than men. The tobacco experiment had a significant percentage of students; however, few reported current consumption. As for common mental disorders, it was observed that a significant number of participants showed positive responses to the group of symptoms "depressed mood/anxious." These results recommend increasing knowledge on this subject among the nursing college students at the institution studied.

The tracking and monitoring of licit psychoactive substance use and common mental disorders provides important information about the magnitude of this phenomenon, in the university setting. The university is a privileged environment of discussion, where all ideological strands have or should have a voice, therefore it is necessary to have a large academic approach, either through integration across the board in proposing curriculum or seminars with the participation of various areas of knowledge on alcohol abuse, tobacco use and emotional distress among college students.

The comparison of results allows for more consistent prevention planning programs with features that address the needs of each community, contribute to the development of preventive strategies, and search for better quality of life for students.

A limiting factor of this and other studies of the university population is the fact that it was conducted in the school environment; students may feel embarrassed to describe their substance use, even being guaranteed anonymity in responding to the questionnaires and being informed about the confidentiality of information provided.



Thank you to the National Secretary of Drug Policy of the Ministry of Justice (NSDPMJ), the Ribeirão Nursing School at the University of São Paulo, and the Collaborating Center of the World Health Organization for the Development of Nursing, for the opportunity to conduct this study and becoming an Alcohol and Other Psychoactive Drugs Specialist.



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Clarissa Mendonça Corradi-Webster
Universidade de São Paulo
Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto
Departamento de Psicologia
Av. Bandeirantes, 3900
Bairro: Monte Alegre
CEP: 14040-901, Ribeirão Preto, SP, Brasi

Received: Dec. 10th 2013
Accepted: Apr. 22nd 2014