Comorbid depression and substance abuse among safety-net clients in Los Angeles: a community participatory study.
OBJECTIVE
Depression and substance abuse are common among low-income adults from racial-ethnic minority groups who receive services in safety-net settings, although little is known about how clients differ by service setting. This study examined characteristics and service use among depressed, low-income persons from minority groups in underresourced communities who did and did not have a substance abuse history.


METHODS
The study used cross-sectional baseline client data (N=957) from Community Partners in Care, an initiative to improve depression services in Los Angeles County. Clients with probable depression (eight-item Patient Health Questionnaire) from substance abuse programs were compared with depressed clients with and without a history of substance abuse from primary care, mental health, and social and community programs. Sociodemographic, health status, and services utilization variables were examined.


RESULTS
Of the 957 depressed clients, 217 (23%) were from substance abuse programs; 269 (28%) clients from other sectors had a substance abuse history, and 471 (49%) did not. Most clients from substance abuse programs or with a substance abuse history were unemployed and impoverished, lacked health insurance, and had high rates of arrests and homelessness. They were also more likely than clients without a substance abuse history to have depression or anxiety disorders, psychosis, and mania and to use emergency rooms.


CONCLUSIONS
Clients with depression and a substance abuse history had significant psychosocial stressors and high rates of service use, which suggests that communitywide approaches may be needed to address both depression and substance abuse in this safety-net population.
Dr. Chang is with the Department of General Internal Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (e-mail: evelynchang.md@gmail.com ). Dr. Wells, Dr. Tang, and Dr. Chung are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Dr. Wells and Dr. Chung conducted this work in their roles with the RAND Corporation. Mr. Gilmore is with Behavioral Health Services, Inc., Los Angeles, California. Dr. Morgan is with the Division of General Internal Medicine, Harbor-UCLA Medical Center, Los Angeles. Ms. Sanders is with The House of Uhuru, Los Angeles. A summary of these findings was presented at a meeting of the California-Hawaii Regional Society of General Internal Medicine, Los Angeles, February 2, 2013, and at a meeting of the AcademyHealth Behavioral Health Interest Group, Baltimore, June 22, 2013.
Evelyn T
ET
Chang
Kenneth B
KB
Wells
James
J
Gilmore
Lingqi
L
Tang
Anna U
AU
Morgan
Starr
S
Sanders
Bowen
B
Chung
D000328:Adult; D003156:Community Mental Health Services; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology*