Concern about adolescent mental health is growing among European public health organisations and the scientific community. Between 1990 and 2021, cases of depression and anxiety disorders in the 10 to 24-year-old population steadily increased; however, this growth has accelerated in recent years. Adolescents are taking an increasing number of anxiolytic, hypnotic and sedative drugs (whether prescribed or not), and consumption rates are also higher among girls.
One of the main lines of research of the EHU’s OPIK – Social Determinants of Health and Demographic Change research group is to analyse how social factors and population health are linked. “For years, we have been seeing a significant gender gap in the consumption of psychotropic drugs among young people in both the Basque Country and Spain, and now we have been able to analyse consumption at a European level,” explained the EHU researcher Xabi Martinez-Mendia .
Using the 2019 ESPAD survey (European School Survey Project on Alcohol and other Drugs), the OPIK group researchers analysed data on nearly 97,000 15 to 16-year-old adolescents in 32 European countries: “We saw that there are major differences in consumption between European countries,” said Martinez-Mendia. For example, in general and regardless of gender, the consumption of psychotropic drugs among adolescents in Greece and Slovenia was 6%; in Italy it was 10% and in Latvia 28%.
Yet “it is worth pointing out that in nearly all European countries, girls consume more than boys,” explained the EHU researcher . “In Spain, for example, the overall consumption was 14.1%: 14.6% for girls and 13.6% for boys. And that gender gap is also very different between one country and another.”
Factors determining psychotropic drug consumption among adolescents
The OPIK researchers wanted to find out whether economic factors within a country (wage disparity and per capita Gross Domestic Product) and gender inequalities could account for such differences between one country and another. Rather than studying these factors in isolation, they took their interaction into account. In the study they combined individual sociodemographic variables with country-level characteristics to obtain a wealth of comprehensive information. And so they found that “to some extent many country-level factors influence the differences in adolescent psychotropic drug consumption”, concluded Martinez-Mendia.
The results showed that adolescents consume fewer psychotropic substances in countries with greater social and economic disparity, in other words, those with the greatest gender and economic inequality and the lowest per capita GDP. What is more, the gender gap is also wider in these countries; in particular, consumption among boys falls, while girls account for the biggest percentage in these countries. By contrast, wealthier countries with greater equality had higher rates, but consumption by boys and girls was more similar.
For example, “Norway has one of the highest GDPs and is one of the countries with the best gender equality indicators, and even though the level of psychotropic drug consumption is significant (14% have used a psychotropic drug at some point), girls and boys are more or less the same in the survey. Hungary, on the other hand, is a country with average GDP, but with significant gender inequality. Overall consumption there is 12.3% (not so far from the Norwegian percentage), but the gender gap is large: 14.8% of girls and 9.8% of boys have consumed these substances. In other words, consumption is lower, but the gap is wider,” said the EHU researcher.
So the researchers found statistically significant links between the consumption of psychotropic drugs in clinical and non-clinical settings, and a society's gender inequality and economic level. “We have pointed the way,” he explained. Now, other factors would need to be analysed to explain all these data better: “Cultural, socioeconomic, and health system factors, etc. All kinds of diffuse aspects come into play. For example: how does a country's population tend to deal with mental health problems? Are they referred to the healthcare system? What do doctors tend to do when it comes to prescribing psychotropic drugs? Do girls tend to be prescribed more?”
This study is the first in Europe to examine how a country's social determining factors may influence the use of anxiolytics among adolescents by gender. This study makes a significant contribution to research on the mental health of European adolescents. However, “the specific cases are varied, as are the trends; that is why it is important to create unified statistical models to be able to quantify more general trends. We would now need to focus on cultural factors, medicalisation processes and their gender impacts”, he concluded.
Additional information
Xabi Martinez-Mendia is a PhD student in the OPIK – Social Determinants of Health and Demographic Change research group. This study is part of his thesis. His thesis supervisors are Amaia Bacigalupe and Yolanda González-Rabago.
Bibliographic reference
Xabi Martinez-Mendia, Amaia Bacigalupe, Antonio Moreno-Llamas
Gender differences in adolescent anxiolytic, hypnotic and sedative use across 32 European countries: a multilevel analysis of the influence of country-level gender inequality and economic factors
European Journal of Public Health
18-Mar-2026