Brief Report: Reduced Use of Illicit Substances, Even Without Abstinence, Is Associated With Improved Depressive Symptoms Among People Living With HIV

Overview

Journal J Acquir Immune Defic Syndr

Specialty Infectious Diseases

Date 2018 Jul 24

PMID 30036277

Citations 10

Authors

Joseph A Delaney

Robin M Nance

Bridget M Whitney

Frederick L Altice

Xinyuan Dong

Maria Esther Perez Trejo

Mika Matsuzaki

Faye S Taxman

Geetanjali Chander

Irene Kuo

Rob Fredericksen

Lauren N Strand

Joseph J Eron

Elvin Geng

Mari M Kitahata

William C Mathews

Kenneth Mayer

Richard D Moore

Michael S Saag

Sandra Springer

Redonna Chandler

Shoshana Kahana

Heidi M Crane

Affiliations

Soon will be listed here.

Abstract

Purpose: Substance use is linked with poor outcomes among people living with HIV (PLWH) and is associated with mental health disorders. This analysis examines the impact of decreasing substance use, even without abstinence, on depressive symptoms among PLWH.

Methods: Data are from PLWH enrolled in the Centers for AIDS Research Network of Integrated Clinical Sites cohort. Participants completed longitudinal assessments of substance use (modified ASSIST) and depressive symptoms (PHQ-9). Changes in substance use frequency were categorized as abstinence, reduced use, and nondecreasing use. Adjusted linear mixed models with time-updated change in substance use frequency and depressive symptom scores were used to examine associations between changes in the use of individual substances and depressive symptoms. Analyses were repeated using joint longitudinal survival models to examine associations with a high (PHQ-9 ≥10) score.

Results: Among 9905 PLWH, 728 used cocaine/crack, 1016 used amphetamine-type substances (ATS), 290 used illicit opiates, and 3277 used marijuana at baseline. Changes in ATS use were associated with the greatest improvements in depressive symptoms: stopping ATS led to a mean decrease of PHQ-9 by 2.2 points (95% CI: 1.8 to 2.7) and a 61% lower odds of PHQ-9 score ≥10 (95% CI: 0.30 to 0.52), and decreasing ATS use led to a mean decrease of 1.7 points (95% CI: 1.2 to 2.3) and a 62% lower odds of PHQ-9 score ≥10 (95% CI: 0.25 to 0.56). Stopping and reducing marijuana and stopping cocaine/crack use were also associated with improvement in depressive symptoms.

Conclusions: We demonstrated that both substance use reduction and abstinence are associated with improvements in depressive symptoms over time.

Citing Articles

A Scoping Review of Observational Research on Cannabis Use for Symptom Management in HIV and Cancer: Implications for Cannabis Nursing.

Cho H, Kalina E, Wu J, Cook R, Salloum R, Liu Y J Clin Nurs. 2024; 34(2):422-429.

PMID: 39603980 PMC: 11747838. DOI: 10.1111/jocn.17565.

Severity and Number of Substances Used are Independently Associated with Antiretroviral Therapy Adherence Over Time among People with HIV in the Current Treatment Era.

Ma J, Delaney J, Ruderman S, Nance R, Hahn A, Drumright L AIDS Behav. 2024; 29(2):468-479.

PMID: 39465466 DOI: 10.1007/s10461-024-04532-7.

Racial, ethnic, and age disparities in the association of mental health symptoms and polysubstance use among persons in HIV care.

Davy-Mendez T, Sarovar V, Levine-Hall T, Lea A, Leibowitz A, Luu M PLoS One. 2023; 18(11):e0294483.

PMID: 38015975 PMC: 10684077. DOI: 10.1371/journal.pone.0294483.

Psychodynamic Therapies for the Treatment of Substance Addictions: A PRISMA Meta-Analysis.

Zuccon M, Topino E, Musetti A, Gori A J Pers Med. 2023; 13(10).

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Depressive Symptoms, the Impact on ART Continuation, and Factors Associated with Symptom Improvement Among a Cohort of People Living with HIV in British Columbia, Canada.

Pakhomova T, Tam C, Wang L, Salters K, Moore D, Barath J AIDS Behav. 2023; 28(1):43-58.

PMID: 37632606 DOI: 10.1007/s10461-023-04156-3.

References

Reddon H, Pettes T, Wood E, Nosova E, Milloy M, Kerr T . Incidence and predictors of mental health disorder diagnoses among people who inject drugs in a Canadian setting. Drug Alcohol Rev. 2017; 37 Suppl 1:S285-S293. PMC: 5940561. DOI: 10.1111/dar.12631. View

Labbe A, OCleirigh C, Stein M, Safren S . Depression CBT treatment gains among HIV-infected persons with a history of injection drug use varies as a function of baseline substance use. Psychol Health Med. 2015; 20(7):870-7. PMC: 4501908. DOI: 10.1080/13548506.2014.999809. View

Manea L, Gilbody S, McMillan D . Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ. 2011; 184(3):E191-6. PMC: 3281183. DOI: 10.1503/cmaj.110829. View

Berger-Greenstein J, Cuevas C, Brady S, Trezza G, Richardson M, Keane T . Major depression in patients with HIV/AIDS and substance abuse. AIDS Patient Care STDS. 2007; 21(12):942-55. DOI: 10.1089/apc.2006.0153. View

Koob G . Negative reinforcement in drug addiction: the darkness within. Curr Opin Neurobiol. 2013; 23(4):559-63. DOI: 10.1016/j.conb.2013.03.011. View

Zhou X, Qin B, Del Giovane C, Pan J, Gentile S, Liu Y . Efficacy and tolerability of antidepressants in the treatment of adolescents and young adults with depression and substance use disorders: a systematic review and meta-analysis. Addiction. 2014; 110(1):38-48. DOI: 10.1111/add.12698. View

DAlessandro M, Conti C, Gambi F, Falasca K, Doyle R, Conti P . Antidepressant therapy can improve adherence to antiretroviral regimens among HIV-infected and depressed patients. J Clin Psychopharmacol. 2007; 27(1):58-61. DOI: 10.1097/JCP.0b013e31802f0dd1. View

Grelotti D, Hammer G, Dilley J, Karasic D, Sorensen J, Bangsberg D . Does substance use compromise depression treatment in persons with HIV? Findings from a randomized controlled trial. AIDS Care. 2016; 29(3):273-279. PMC: 5560264. DOI: 10.1080/09540121.2016.1226479. View

Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T . Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010; 8(4):348-53. PMC: 2906530. DOI: 10.1370/afm.1139. View

10.

Sweeting M, Thompson S . Joint modelling of longitudinal and time-to-event data with application to predicting abdominal aortic aneurysm growth and rupture. Biom J. 2011; 53(5):750-63. PMC: 3443386. DOI: 10.1002/bimj.201100052. View

11.

Ickovics J, Hamburger M, Vlahov D, Schoenbaum E, Schuman P, Boland R . Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA. 2001; 285(11):1466-74. DOI: 10.1001/jama.285.11.1466. View

12.

Shubber Z, Mills E, Nachega J, Vreeman R, Freitas M, Bock P . Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis. PLoS Med. 2016; 13(11):e1002183. PMC: 5127502. DOI: 10.1371/journal.pmed.1002183. View

13.

Crane P, Gibbons L, Willig J, Mugavero M, Lawrence S, Schumacher J . Measuring depression levels in HIV-infected patients as part of routine clinical care using the nine-item Patient Health Questionnaire (PHQ-9). AIDS Care. 2010; 22(7):874-85. PMC: 3410748. DOI: 10.1080/09540120903483034. View

14.

Cook J, Grey D, Burke J, Cohen M, Gurtman A, Richardson J . Depressive symptoms and AIDS-related mortality among a multisite cohort of HIV-positive women. Am J Public Health. 2004; 94(7):1133-40. PMC: 1448411. DOI: 10.2105/ajph.94.7.1133. View

15.

Farinpour R, Miller E, Satz P, Selnes O, Cohen B, Becker J . Psychosocial risk factors of HIV morbidity and mortality: findings from the Multicenter AIDS Cohort Study (MACS). J Clin Exp Neuropsychol. 2003; 25(5):654-70. DOI: 10.1076/jcen.25.5.654.14577. View

16.

Altice F, Kamarulzaman A, Soriano V, Schechter M, Friedland G . Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010; 376(9738):367-87. PMC: 4855280. DOI: 10.1016/S0140-6736(10)60829-X. View

17.

Laird N, Ware J . Random-effects models for longitudinal data. Biometrics. 1982; 38(4):963-74. View

18.

Cholera R, Gaynes B, Pence B, Bassett J, Qangule N, MacPhail C . Validity of the Patient Health Questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. J Affect Disord. 2014; 167:160-6. PMC: 4264106. DOI: 10.1016/j.jad.2014.06.003. View

19.

Safren S, OCleirigh C, Bullis J, Otto M, Stein M, Pollack M . Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial. J Consult Clin Psychol. 2012; 80(3):404-15. PMC: 3365619. DOI: 10.1037/a0028208. View

20.

Crane H, Lober W, Webster E, Harrington R, Crane P, Davis T . Routine collection of patient-reported outcomes in an HIV clinic setting: the first 100 patients. Curr HIV Res. 2007; 5(1):109-18. DOI: 10.2174/157016207779316369. View