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ABSTRACT
Background: Comorbid psychiatric and substance use disorders are common and associated with poorer treatment engagement, retention, and outcomes. This study examines the presence of depressive symptoms and the demographic and clinical correlates in a diverse sample of substance abuse treatment seekers to better characterize patients with co-occurring depressive symptoms and substance use disorders and understand potential treatment needs. Methods: Baseline data from a randomized clinical effectiveness trial of a computer-assisted, Web-delivered psychosocial intervention were analyzed. Participants (N = 507) were recruited from 10 geographically diverse outpatient drug treatment programs. Assessments included the self-report Patient Health Questionnaire, and measures of coping strategies, social functioning, physical health status, and substance use. Results: One fifth (21%; n = 106) of the sample screened positive for depression; those screening positive for depression were significantly more likely to screen positive for anxiety (66.9%) and posttraumatic stress disorder (PTSD; 42.9%). After controlling for anxiety and PTSD symptoms, presence of depressive symptoms remained significantly associated with fewer coping strategies (P = .001), greater impairment in social adjustment (P < .001), and poorer health status (P < .001), but not to days of drug use in the last 90 days (P = .14). Conclusions: Depression is a clinically significant problem among substance abusers, and, in this study, patients who screened positive for depression were more likely to have co-occurring symptoms of anxiety and PTSD. Additionally, the presence of depressive symptoms was associated with fewer coping strategies and poorer social adjustment. Coping skills are a significant predictor of addiction outcomes, and it may be especially important to screen for and enhance coping among depressed patients. Evidence-based interventions that target coping skills and global functioning among substance abusers with depressive symptoms may be important adjuncts to usual treatment.
ACKNOWLEDGMENTS
Dr. Nunes served on the Lilly Advisory Board (completed 2012) and receives medication for a research study from Alkermes/Cephalon, Inc. No other potential conflicts of interest have been reported.
FUNDING
This work was supported by grants from the National Drug Abuse Treatment Clinical Trials Network (CTN), National Institute on Drug Abuse (NIDA): U10 DA13035 (Nunes; Rotrosen), U10 DA15831 (Carroll; Weiss), U10 DA013034 (Stitzer; Schwartz), U10 DA013732 (Winhusen), U10 DA013720 (Szapocznik; Metsch), U10 DA020024 (Trivedi), U10 DA015815 (McCarty; Sorensen), U10 DA013045 (Ling), and U10 DA013714 (Donovan; Roll). Additional grant support was provided by NIDA K24 DA022412 (Nunes). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
AUTHOR CONTRIBUTIONS
Katherine Sanchez was lead author, did the research and writing, and contributed to the interpretation of results. Robrina Walker and Tracy L. Greer contributed writing, revision, and to the collection of data. Aimee N. C. Campbell contributed to the research conception and design, collection of data, analysis, interpretation of the results, writing, and revisions. Mei-Chen Hu conducted the data analysis and Bruce D. Grannemann assisted in the interpretation of the results. Edward V. Nunes and Madhukar H. Trivedi are CTN Node Principal Investigators and contributed the research conception and design of the trial.