Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990–2019: Systematic review and meta-analysis

Hunt, Glenn E.; Malhi, Gin S; Lai, Harry Man Xiong; Cleary, Michelle

doi:10.1016/j.jad.2020.01.141

Cited by 162 publications

(93 citation statements)

References 126 publications

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“…In 2018, nearly 20% of US adults experienced mental illness, and nearly 20% of those with mental illness experienced a co-occurring substance use disorder (SUD) 1 . That same year, more than 4 million US adults with a SUD experienced a major depressive episode, and well over 500,000 of those specifically had an opioid use disorder (OUD) [1][2][3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

Association of co-occurring opioid or other substance use disorders with increased healthcare utilization in patients with depression

et al. 2021

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Substance use disorders (SUDs) commonly co-occur with mental illness. However, the ongoing addiction crisis raises the question of how opioid use disorder (OUD) impacts healthcare utilization relative to other SUDs. This study examines the utilization patterns of patients with major depressive disorder (MDD) and: (1) co-occurring OUD (MDD-OUD); (2) a co-occurring SUD other than OUD (MDD-NOUD); and (3) no co-occurring SUD (MDD-NSUD). We analyzed electronic health records (EHRs) derived from multiple health systems across the New York City (NYC) metropolitan area between January 2008 and December 2017. 11,275 patients aged ≥18 years with a gap of 30–180 days between 2 consecutive MDD diagnoses and an antidepressant prescribed 0–180 days after any MDD diagnosis were selected, and prevalence of any SUD was 24%. Individuals were stratified into comparison groups and matched on age, gender, and select underlying comorbidities. Prevalence rates and encounter frequencies were measured and compared across outpatient, inpatient, and emergency department (ED) settings. Our key findings showed that relative to other co-occurring SUDs, OUD was associated with larger increases in the rates and odds of using substance-use-related services in all settings, as well as services that integrate mental health and substance abuse treatments in inpatient and ED settings. OUD was also associated with larger increases in total encounters across all settings. These findings and our proposed policy recommendations could inform efforts towards targeted OUD interventions, particularly for individuals with underlying mental illness whose treatment and recovery are often more challenging.

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Section: Introductionmentioning

confidence: 99%

Association of co-occurring opioid or other substance use disorders with increased healthcare utilization in patients with depression

et al. 2021

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“…It is, however, influenced by age (being more marked in older opioid addicts), by the setting of the treatment, and by the flow of time ( Table 3 ). Its presence in opioid addiction can be better understood by considering the strong association between mood and substance use disorders, in terms of psychopathological risk factors, neurobiology, and epidemiology [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. The presence, in individuals with substance use disorders, of symptoms such as worthlessness, sadness, and hopelessness about the future may be explained by biochemical changes observed in the reward, motivational, and inhibitory systems.…”

Section: Discussionmentioning

confidence: 99%

Delineating the Psychic Structure of Substance Use and Addictions, from Neurobiology to Clinical Implications: Ten Years Later

Pani

Maremmani

Pacini³

et al. 2020

JCM

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The diagnosis of substance use disorder is currently based on the presence of specifically identified behavioral symptoms. In addition, other psychiatric signs and symptoms accompany addictive behavior, contributing to the full picture of patients’ psychopathologic profile. Historically, such symptoms were confined within the framework of “comorbidity”, as comorbid psychiatric disorders or personality traits. However, an alternative unitary view of the psychopathology of addiction, inclusive of related psychiatric symptoms, has been claimed, with the support of epidemiological, neurobiological, and neuropsychological evidence. In the present article, we highlight the research advancements that strengthen this unified perspective. We then give an account of our group’s definition of a specific SCL-90-based construct of the psychopathology of addiction. Lastly, we discuss the benefits that can be expected to be acquired in the evaluation and treatment of patients with a longitudinal approach including psychological/psychiatric predisposing features, addictive behavior, and psychiatric manifestations.

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“…Where this issue has been studied, an increase in related consequences has occurred concurrently with an increase in CU in the states that have legalized medical cannabis (14). These negative consequences include increases in the prevalence of serious mental illness (14) and emergency department consultations for cannabis-related mood disorders, as well as suicide and intentional self-harm (12,27,28). It is important to underline that potentially positive effects of CU, such as decreased anxiety, have not been systematically studied (28).…”

Section: Context and Impact Of Legalizationmentioning

confidence: 99%

“…Similarly, a Canadian study found the 12-month prevalence of CD to be 7-fold higher in those with MDD, while cannabis abuse was 3.5-fold higher (66). In a metaanalysis of the prevalence of comorbid substance use in people suffering from MDD, the point prevalence of CUD was 0.117 (27). In addition, in a community-based study, a one standard deviation increase in depression in adolescence was associated with a 50% increased likelihood of CUD (67, 68).…”

Section: Relationship Between Cannabis and Depression: Prevalence Datamentioning

confidence: 99%

Down and High: Reflections Regarding Depression and Cannabis

et al. 2021

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In light of the recent changes in the legal status of cannabis in Canada, the understanding of the potential impact of the use of cannabis by individuals suffering from depression is increasingly considered as being important. It is fundamental that we look into the existing literature to examine the influence of cannabis on psychiatric conditions, including mood disorders. In this article, we will explore the relationship that exists between depression and cannabis. We will examine the impact of cannabis on the onset and course of depression, and its treatment. We have undertaken a wide-ranging review of the literature in order to address these questions. The evidence from longitudinal studies suggest that there is a bidirectional relationship between cannabis use and depression, such that cannabis use increases the risk for depression and vice-versa. This risk is possibly higher in heavy users having initiated their consumption in early adolescence. Clinical evidence also suggests that cannabis use is associated with a worse prognosis in individuals with major depressive disorder. The link with suicide remains controversial. Moreover, there is insufficient data to determine the impact of cannabis use on cognition in individuals with major depression disorder. Preliminary evidence suggesting that the endogenous cannabinoid system is involved in the pathophysiology of depression. This will need to be confirmed in future positron emission tomography studies. Randomized controlled trials are needed to investigate the potential efficacy of motivational interviewing and/or cognitive behavioral therapy for the treatment of cannabis use disorder in individuals with major depressive major disorder. Finally, although there is preclinical evidence suggesting that cannabidiol has antidepressant properties, randomized controlled trials will need to properly investigate this possibility in humans.

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Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990–2019: Systematic review and meta-analysis

Cited by 162 publications

References 126 publications

Association of co-occurring opioid or other substance use disorders with increased healthcare utilization in patients with depression

Association of co-occurring opioid or other substance use disorders with increased healthcare utilization in patients with depression

Delineating the Psychic Structure of Substance Use and Addictions, from Neurobiology to Clinical Implications: Ten Years Later

Down and High: Reflections Regarding Depression and Cannabis

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