Trends in the Co-occurrence and Association Between Heavy Episodic Drinking and Generalized Anxiety Among Adolescents Between 2013 and 2023 in Finland

Abstract The diverging trends of decreasing alcohol use and increasing anxiety symptoms among adolescents raise a question, has the strength of the well-known association between these issues also changed. This study examined changes in the co-occurrence and associations between heavy episodic drinking (HED) and generalized anxiety (GA) among Finnish adolescents between 2013 and 2023. From the repeated cross-sectional Finnish School Health Promotion Study ( N = 874 110, age 13–20 years) we estimated self-reported GA symptoms and HED. The proportion of those with both HED and moderate to severe GA increased from 2.9% in 2013 to 3.6% in 2023, indicating a 21.5% relative difference. The association between GA symptoms and HED was stable during the study period (ORs 1.06–1.07). Although the association has been stable, there has been a rise in the proportion of adolescents experiencing both conditions concurrently over the past decade. This calls for strengthening the integration of mental health and substance use prevention and services.