title: Complexities of cocaine users presenting to the emergency department with chest pain: interactions between depression symptoms, alcohol use, and race.
abstract: Chest pain is the most frequent cocaine-related medical event for which patients seek treatment in inner-city emergency departments (EDs). Given that depression increases risk for poor substance use and cardiac outcomes, knowledge of correlates of depressive symptoms among these out-of-treatment cocaine users is crucial to developing interventions for these inner-city populations that frequently present to the ED. A total of 219 individuals presenting to an inner-city ED with chest pain and recent cocaine use were divided into 2 groups based on scoring positive (42%) for moderate-to-severe depression on the Patient Health Questionnaire (PHQ-9). The depression symptoms group reported a significantly greater number of standard drinks per drinking occasion (7.1 versus 4.6) and a greater number of heavy drinking days (9 versus 5). A significant 3-way interaction effect found males and non-white females reporting a greater number of heavy drinking days were more likely to be in the depression symptoms group, whereas white females with a greater number of heavy drinking days were more likely to be in the nondepression symptoms group. Depression is clearly a problem among not-in-treatment cocaine users presenting to an inner-city ED; heavy drinking in concert with cocaine use increases the risk for depression, with important interactions by race and gender.
authors.affiliation: From the Department of Psychiatry (JMW), University of Toledo, Toledo, OH; Department of Psychiatry (MAW, LSM), University of Michigan, Ann Arbor MI; and Division of Health Services Research, Department of Psychiatry (GMC, BMB), University of Arkansas for Medical Sciences and HSR&D VA Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, Little Rock, AR.
authors.forename: John M
authors.initials: JM
authors.lastname: Wryobeck
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Walton
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Curran
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Massey
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Booth