Depression and its association with adverse childhood experiences in people with substance use disorders and comorbid medical illness recruited during medical hospitalization

Helene L Philogene-Khalid; Eric Cunningham; Daohai Yu; Jaclyn E Chambers; Adam Brooks; Xiaoning Lu; Mary F Morrison

doi:10.1016/j.addbeh.2020.106489

Depression and its association with adverse childhood experiences in people with substance use disorders and comorbid medical illness recruited during medical hospitalization

Addict Behav. 2020 Nov:110:106489. doi: 10.1016/j.addbeh.2020.106489. Epub 2020 Jun 4.

Authors

Helene L Philogene-Khalid¹, Eric Cunningham², Daohai Yu³, Jaclyn E Chambers⁴, Adam Brooks⁵, Xiaoning Lu³, Mary F Morrison⁶

Affiliations

¹ Department of Psychiatry, Temple University, 100 E. Lehigh Ave, Philadelphia, PA 19125, USA; Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA. Electronic address: helene.khalid@tuhs.temple.edu.
² Department of Psychiatry, Temple University, 100 E. Lehigh Ave, Philadelphia, PA 19125, USA.
³ Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, 3440 North Broad St, Philadelphia, PA 19140, USA.
⁴ UC Berkeley School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, Berkeley, CA 94720, USA.
⁵ Addiction Services, Public Health Management Corporation, Philadelphia, PA, USA.
⁶ Department of Psychiatry, Temple University, 100 E. Lehigh Ave, Philadelphia, PA 19125, USA; Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA.

Abstract

Aims: People who have experienced adverse childhood experiences (ACEs) are more susceptible to substance use disorder (SUD) and depression. The present study examined depression prevalence in hospitalized patients with SUD and examined the association of individual ACEs with major depression. Depression rates 3 months after discharge were also examined.

Methods: Medical inpatients with SUD were recruited from Temple University Hospital. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) at baseline and 3 months post-discharge. Participants were also assessed using an ACE scale at baseline.

Results: Of 79 baseline participants, 48% (38) had moderate to severe major depressive disorder (MDD) with PHQ-9 scores ≥15. Among those with baseline MDD, 38% (9/24) continued to have MDD 3 months post discharge, and 42.9% (12/28) of those without MDD at baseline met criteria at 3 months. Sixty-three percent (50/79) of the participants reported 4+ ACEs at baseline. Two ACEs, Household Incarceration and Household Mental Illness, were significantly associated with having MDD at baseline and 3 months (adjusted mean PHQ-9 total score increase (SE) and p-value: 2.97 (1.35), p < .05; 5.32 (1.37), p < .005, respectively).

Conclusions: In this exploratory study, nearly half of medical inpatients with substance use disorder had moderate to severe major depression, with a similar percentage of participants having MDD as outpatients at 3 months. Approximately two thirds of participants reported four or more adverse childhood experiences at baseline. Inpatient medical hospitalization should be utilized as an opportunity to engage people with SUD in multidisciplinary treatment including psychiatric, trauma informed care, and substance abuse treatment.

Keywords: Adverse Childhood Experience; Hospitalization; Major Depressive Disorder; Substance Use Disorder.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adverse Childhood Experiences*
Aftercare
Child
Depression
Depressive Disorder, Major* / epidemiology
Hospitalization
Humans
Patient Discharge
Substance-Related Disorders* / epidemiology

Grants and funding

T32 DA007237/DA/NIDA NIH HHS/United States