Survival Probabilities and Predictors of Major Depressive Episode Incidence Among Individuals With Various Types of Substance Use Disorders

Ahmed N. Hassan, MD, FRCPC, MPH^a,b,c ; Bernard Le Foll, MD, PhD^a,b,c,d

J Clin Psychiatry 2021;82(5):20m13637

ABSTRACT

Objective: This study aimed to estimate the survival probabilities related to the occurrence of major depressive episodes (MDEs) after the onset of substance use disorders (SUDs) using data from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III.

Methods: The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 was used to diagnose SUD, and psychiatric diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Individuals with incidents of various SUDs with no prior history of MDEs (n = 5,987 with alcohol use disorder [AUD], 1,353 with cannabis use disorder [CUD], 351 with opioid use disorder [OUD], 827 with stimulant use disorder [STUD], and 5,363 with nicotine use disorder [NUD]) were included. The survival probabilities of these groups were compared to those of a control group without an SUD (n = 20,034). Outcome measures included the number of years from the age at SUD onset until MDE occurrence or the time of the interview.

Results: The probabilities of experiencing MDEs after 1 year were 3.56%, 4.80%, 7.78%, 8.46%, and 5.31% for AUD, CUD, OUD, STUD, and NUD, respectively. The groups differed statistically significantly from each other and from the control group (P < .0001). Individuals with AUD and STUD, respectively, had a lower and higher probability of having an MDE compared to those with other SUDs. Young age, family history of depression, anxiety disorder presence, and failure to achieve full remission consistently predicted an MDE for all substances.

Conclusions: The findings highlight that users of all studied substances have an increased probability of having an MDE over the lifespan.

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