title: What are the Patterns Between Depression, Smoking, Unhealthy Alcohol Use, and Other Substance Use Among Individuals Receiving Medical Care? A Longitudinal Study of 5479 Participants.
abstract: To evaluate and characterize the structure of temporal patterns of depression, smoking, unhealthy alcohol use, and other substance use among individuals receiving medical care, and to inform discussion about whether integrated screening and treatment strategies for these conditions are warranted. Using the Veterans Aging Cohort Study (VACS) we measured depression, smoking, unhealthy alcohol use and other substance use (stimulants, marijuana, heroin, opioids) and evaluated which conditions tended to co-occur within individuals, and how this co-occurrence was temporally structured (i.e. concurrently, sequentially, or discordantly). Current depression was associated with current use of every substance examined with the exception of unhealthy alcohol use. Current unhealthy alcohol use and marijuana use were also consistently associated. Current status was strongly predicted by prior status (p < 0.0001; OR = 2.99-22.34) however, there were few other sequential relationships. Associations in the HIV infected and uninfected subgroups were largely the same with the following exceptions. Smoking preceded unhealthy alcohol use and current smoking was associated with current depression in the HIV infected subgroup only (p < 0.001; OR = 1.33-1.41 and p < 0.001; OR = 1.25-1.43). Opioid use and current unhealthy alcohol use were negatively associated only in the HIV negative subgroup (p = 0.01; OR = 0.75). Patterns of depression, smoking, unhealthy alcohol use, and other substance use were temporally concordant, particularly with regard to depression and substance use. These patterns may inform future development of more integrated screening and treatment strategies.
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: Kelly V
authors.initials: KV
authors.lastname: Ruggles
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: Yixin
authors.initials: Y
authors.lastname: Fang
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Tate
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Mentor
authors.affiliation: National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bryant
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, NY, USA. Scott.Braithwaite@nyumc.org.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Braithwaite
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000437:Alcoholism / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology; D000074609:Marijuana Use / Q000453:epidemiology*; D008875:Middle Aged; D016017:Odds Ratio; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Alcohol use; Depression; HIV; Smoking; Substance use