Becky L Genberg1, Jacquie Astemborski2, Glenn Treisman3, Alexia Anagnostopoulos4, Shruti H Mehta5, Gregory D Kirk6, Alison Abraham7. 1. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA. Electronic address: bgenberg@jhu.edu. 2. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA. Electronic address: jastemb1@jhu.edu. 3. Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore 21287, MD, USA. Electronic address: glenn@jhmi.edu. 4. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA; Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Electronic address: Alexia.Anagnostopoulos@usz.ch. 5. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA. Electronic address: smehta@jhu.edu. 6. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore 21287, MD, USA. Electronic address: gdk@jhu.edu. 7. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore 21205, MD, USA; Department of Ophthalmology, The Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore 21287, MD, USA. Electronic address: alison.abraham@jhu.edu.
Abstract
INTRODUCTION: Mental health care may mitigate negative consequences related to substance use and bolster engagement in care for drug dependence. Despite the increased risk of depression among people who inject drugs (PWID), the longitudinal relationship of depression symptoms with depression and drug treatment utilization in this population remains uncharacterized. METHODS: Data on depressive symptoms and depression treatment from current and former PWID in the ALIVE (AIDS Linked to the IntraVenous Experience) community-based cohort who had ≥3 study visits from July 2005 to June 2016 were included. We used logistic regression analysis with generalized estimating equations to examine factors associated with depression treatment in the 12 months following reported major depressive symptoms (CES-D ≥ 23) in the absence of treatment. We further examined the association between depression, depression treatment, and subsequent engagement in drug treatment among those with active substance use or alcohol dependence. RESULTS: Of the 1544 participants, 34% were female, the median age was 51 years, and 91% were African-American. PWID reported major depressive symptoms at 22% of study visits. In adjusted analysis, acute emergency care, suicidal ideation, and recent alcohol or drug treatment were positively associated with initiating depression treatment. Depression was positively associated with subsequent treatment for substance dependence among those actively using (aOR = 1.30, 95% CI: 1.10-1.53). CONCLUSIONS: PWID experience a high burden of depressive symptoms with significant unmet need of treatment for depression. Our findings suggest that mental health providers should bolster connections to chronic disease and alcohol and drug treatment providers.
INTRODUCTION: Mental health care may mitigate negative consequences related to substance use and bolster engagement in care for drug dependence. Despite the increased risk of depression among people who inject drugs (PWID), the longitudinal relationship of depression symptoms with depression and drug treatment utilization in this population remains uncharacterized. METHODS: Data on depressive symptoms and depression treatment from current and former PWID in the ALIVE (AIDS Linked to the IntraVenous Experience) community-based cohort who had ≥3 study visits from July 2005 to June 2016 were included. We used logistic regression analysis with generalized estimating equations to examine factors associated with depression treatment in the 12 months following reported major depressive symptoms (CES-D ≥ 23) in the absence of treatment. We further examined the association between depression, depression treatment, and subsequent engagement in drug treatment among those with active substance use or alcohol dependence. RESULTS: Of the 1544 participants, 34% were female, the median age was 51 years, and 91% were African-American. PWID reported major depressive symptoms at 22% of study visits. In adjusted analysis, acute emergency care, suicidal ideation, and recent alcohol or drug treatment were positively associated with initiating depression treatment. Depression was positively associated with subsequent treatment for substance dependence among those actively using (aOR = 1.30, 95% CI: 1.10-1.53). CONCLUSIONS: PWID experience a high burden of depressive symptoms with significant unmet need of treatment for depression. Our findings suggest that mental health providers should bolster connections to chronic disease and alcohol and drug treatment providers.
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