Background and Objectives
Addictions to heroin or to cocaine are associated with substantial psychiatric comorbidity, including depression. Poly-drug self-exposure (e.g., to heroin, cocaine, cannabis or alcohol) is also common, and may further affect depression comorbidity.
Methods
This case-control study examined the relationship of exposure to the above drugs and depression comorbidity. Participants were recruited from methadone maintenance clinics, and from the community. Adult male and female participants (n=1,201) were ascertained consecutively by experienced licensed clinicians. The instruments used were the SCID-I, and Kreek-McHugh-Schluger-Kellogg (KMSK) scales, which provide a rapid dimensional measure of maximal lifetime self-exposure to each of the above drugs. This measure ranges from no exposure to high unit dose, high frequency, and long duration of exposure.
Results
A multiple logistic regression with stepwise variable selection revealed that increasing exposure to heroin or to cocaine was associated greater odds of depression, with all cases and controls combined. In cases with an opioid dependence diagnosis, increasing cocaine exposure was associated with a further increase in odds of depression. However, in cases with a cocaine dependence diagnosis, increasing exposure to either cannabis or alcohol, as well as heroin, was associated with a further increase in odds of depression.
Discussion and Conclusions
This dimensional analysis of exposure to specific drugs provides insights on depression comorbidity with addictive diseases, and the impact of poly-drug exposure.
Scientific Significance
A rapid analysis of exposure to drugs of abuse reveals how specific patterns of drug and poly-drug exposure are associated with increasing odds of depression.
Grit is associated with positive outcomes in nonclinical samples. However, no studies have examined grit in relation to psychopathology in patients with clinical mood or anxiety disorders. Research and clinical experience suggest that individuals who hoard struggle with characteristics associated with grit, such as task persistence, impulsivity, and self-control. The authors tested the hypothesis that hoarding symptoms are associated with less grit in a sample of individuals (N = 72) presenting for treatment to an anxiety disorders clinic. After covarying symptoms of the four mood and anxiety disorders most commonly comorbid with hoarding disorder (viz. depression, generalized anxiety, social anxiety, and obsessive-compulsive disorder), the authors found that hoarding symptoms were associated with less grit, and the effects were medium-to-large. These results indicate that grit is worthy of investigation in individuals with hoarding disorder using methodologies that permit inferences about causality, and with attention to clinical implications for prevention or treatment.
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