Full length articlePatterns of major depression and nonmedical use of prescription opioids in the United States
Introduction
Recent epidemiologic studies have shown that nonmedical use of prescription opioids (NMUPO) and major depression frequently co-occur (Becker et al., 2008, Goldner et al., 2014, Martins et al., 2012). Comorbid forms of drug use and mental illness such as NMUPO and depression pose a greater disease burden than either condition alone, as such cases are more likely to experience more severe psychiatric symptoms (Kessler, 2004), rehospitalization (Appleby et al., 2001), incarceration (Hawthorne et al., 2012), and suicidal behaviors (Effinger and Stewart, 2012). Although nonmedical users of prescription opioids share many sociodemographic and behavioral characteristics with those who experience major depression (younger age, lower annual household income, and other substance use disorders, for example; Becker et al., 2008, Martins et al., 2012), these populations differ on other factors (sex, for example; Martins et al., 2012). The identification of characteristics that are specific to cases of comorbid NMUPO and major depressive episodes (MDE) can inform more effective intervention efforts tailored to this high-risk group. However, to our knowledge, no study has investigated the similarities and differences of populations who report NMUPO in the presences or absence of major depression.
Major depressive episodes and NMUPO are independently related to several of the same sociodemographic and substance use behaviors, including: age (Becker et al., 2008, Pratt and Brody, 2014, Wu et al., 2010), sex (Becker et al., 2008, Pratt and Brody, 2014, Wu et al., 2010), marital status (Becker et al., 2008, Riolo et al., 2005, Wu et al., 2010), and legal and illegal substance use (Becker et al., 2008). Although these risk factors are largely similar in the direction and magnitude of association with each MDE and NMUPO, certain risk factors differ. For example, whereas men are more likely than women to report NMUPO (Becker et al., 2008), women are more likely to have MDE (Hasin et al., 2005). Empirically it is very difficult to disentangle these various risk factors for MDE alone, NMUPO alone, and comorbid MDE and NMUPO. However, a study can estimate the relative frequency of differential factors to investigate the population profiles of persons with independent and comorbid NMUPO and MDE.
In the current study, we analyzed data from a nationally representative sample of the general U.S. population to identify similarities and differences among these populations that may inform more tailored efforts to reduce NMUPO and related harm. Since MDE and NMUPO have similar risk factors—such that age, sex, marital status, education, and substance use are associated with major depression (Pratt and Brody, 2014, Riolo et al., 2005) and also NMUPO (Becker et al., 2008, Wu et al., 2010), we focused our investigation on factors previously shown to be related to both NMUPO and MDE. As such, if evidence suggests that sociodemographic and substance use factors are similar among persons reporting NMUPO-alone and those with comorbid NMUPO and MDE, then more global interventions should be implemented to reduce both NMUPO and MDE. Whereas, the identification of distinct associated factors for independent and comorbid NMUPO and MDE, suggests that intervention efforts should be more tailored to identify those at the highest risk.
Section snippets
Sample
We used data from the National Survey of Drug Use and Health (NSDUH), conducted in 2011 and 2012. As described in more detail elsewhere (SAMHSA, 2013, SAMHSA, 2012), the NSDUH is an ongoing annual national survey that assesses tobacco use, alcohol use and disorders, illicit drug use and disorder, and mental health symptoms in the U.S. The NSDUH respondents are selected from an independent multistage area probability sample of each of the 50 States and District of Columbia, yielding a
Prevalence of past-year MDE and NMUPO (Fig. 1)
Over twice the proportion of respondents reporting past-year NMUPO met criteria for comorbid MDE compared to persons not reporting NMUPO for both adolescents (19.9% versus 7.9%) and adults (15.2% versus 6.4%). Among adolescent and adult respondents, 5.8% (SE = 0.17) and 4.5% (SE = 0.13), respectively, reported any past-year NMUPO, while 8.6% (SE = 0.19) and 6.8% (SE = 0.13) met criteria for past-year MDE. The overall prevalence of comorbid NMUPO and MDE was 1.2% (SE = 0.08) and 0.7% (SE = 0.04) among
Discussion
Using data from a nationally representative sample of adolescents and adults we found that sociodemographic and substance use characteristics were different for persons who reported either past-year NMUPO or MDE alone or comorbid NMUPO and MDE. Notably, compared to persons with neither condition, those with comorbid NMUPO and MDE were more likely to be female, of low annual income, not currently married, and to report an alcohol use disorder or other drug use. This suggests that intervention
Role of funding source
This report was supported by National Institutes of Health grants [T32DA031099, K01DA030449, R03DA037770, and R01HD060072]. The NIH had no further role in study design, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Contributors
DS Fink had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Fink, Martins, and Hu developed the study concept and design. Fink, Cerdá, Keyes, Marshall, Galea, and Martins contributed to the analysis and interpretation of the data. Fink, Hu, and Martins drafted the manuscript. All authors provided a critical revision of the manuscript for important intellectual content and approved the final version of the
Conflict of interest
No conflict declared.
Acknowledgements
N/A.
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