title: The intersection of violence, substance use, depression, and STDs: testing of a syndemic pattern among patients attending an urban STD clinic.
abstract: OBJECTIVE
  High rates of psychosocial and health problems have been identified among patients attending sexually transmitted disease (STD) clinics, who are disproportionately urban, have low income, and are racial/ethnic minorities. This study sought to determine whether these problems co-occurred and whether they indicated the presence of a syndemic.
  
  
  METHODS
  Patients (N = 1557, 46% female, 64% African American) attending an urban STD clinic completed a computerized survey assessing childhood sexual abuse (CSA), depressive symptoms, binge drinking, marijuana use, intimate partner violence (IPV), and sexual risk behavior. Medical records were reviewed to determine incident STD diagnosis.
  
  
  RESULTS
  The psychosocial and health problems were interrelated. Endorsing more psychosocial problems was associated with a greater likelihood of having multiple sexual partners and STD diagnosis. Interactions between CSA and marijuana use and between CSA and IPV predicted STD diagnosis.
  
  
  CONCLUSIONS
  Numerous psychosocial and health problems co-occur among urban STD clinic patients. There was some evidence of a syngergistic relationship (i.e., a syndemic) between these conditions, resulting in worsened sexual health outcomes. Health care needs to be multidisciplinary to address the multiple psychosocial and health problems faced by STD clinic patients. Research needs to identify factors that may underlie these comorbid conditions.
authors.affiliation: Center for Health and Behavior, 430 Huntington Hall, Syracuse University, Syracuse, NY 13244, USA. tsenn@syr.edu
authors.forename: Theresa E
authors.initials: TE
authors.lastname: Senn
authors.forename: Michael P
authors.initials: MP
authors.lastname: Carey
authors.forename: Peter A
authors.initials: PA
authors.lastname: Vanable
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D014754:Violence / Q000706:statistics & numerical data*