Depressive, anxiety and stress symptoms among university students from Bogotá, Colombia and electronic nicotine delivery systems (ENDS) use: Findings from a prevalence survey 2021

Abstract The use of electronic nicotine delivery systems (ENDS) has increased in recent years, particularly among young people. The association between mental health disorders and conventional cigarettes is well established. However, information on ENDS use and mental health is still emerging. This study i) determines the frequency of depression, anxiety and stress symptoms among university students in Bogotá, Colombia, ii) examines the association between sociodemographic variables and mental health symptoms, and iii) analyses whether there is an association between tobacco and/or ENDS use and depression, anxiety and/or stress. The study is cross-sectional, analytical, retrospective and based on a multistage random sample. 3850 students from 21 universities completed an online survey and were included as participants. We assessed demographic variables, tobacco use, ENDS use and symptoms of depression, anxiety and stress. 667 participants from our sample had a previous diagnosis of a mental disorder, and the most common diagnoses were any type of anxiety disorder (7.27%) or depressive disorder (6.70%). Ever use of conventional cigarettes was 63.71% and ever use of ENDS was 31%. More than 65% of the participants had mild symptoms of depression, anxiety and stress. However, between 16.4% and 19.5% of participants reported severe or very severe symptoms of these three diagnoses. Severe or very severe symptoms were more likely to be reported by women, public university students and those from higher socio-economic backgrounds. Those who reported having tried conventional cigarettes or ENDS had more severe or extremely severe symptoms than those who had never tried them. Multivariate analysis using ordinal logistic regression showed that depression, anxiety and stress levels were more severe in participants who had tried ENDS. In addition, having nuclear family members, family members or close friends with a history of nicotine use was positively associated with higher levels of depression, anxiety and stress.