Many patients who receive treatment for depression in safety net settings also have substance use disorders.

Cover: Comorbid Depression and Substance Abuse Among Safety-Net Clients in Los Angeles

Comorbid Depression and Substance Abuse Among Safety-Net Clients in Los Angeles

A Community Participatory Study

Published in: Psychiatric Services, v. 66, no. 3, Mar. 2015, p. 285-294

Posted on RAND.org on December 08, 2014

by Evelyn T. Chang, Kenneth B. Wells, James Gilmore, Lingqi Tang, Anna U. Morgan, Starr Sanders, Bowen Chung

Research Questions

  1. How common is a substance abuse history among depressed clients being treated in safety-net settings?
  2. Do depressed clients with and without a substance abuse history differ in health status and services utilization?
  3. How satisfied are depressed clients with community mental health services?

OBJECTIVE: Depression and substance abuse are common among low-income adults from racial-ethnic minority groups who receive services in safety-net settings, although little is known about how clients differ by service setting. This study examined characteristics and service use among depressed, low-income persons from minority groups in underresourced communities who did and did not have a substance abuse history. METHODS: The study used cross-sectional baseline client data (N=957) from Community Partners in Care, an initiative to improve depression services in Los Angeles County. Clients with probable depression (eight-item Patient Health Questionnaire) from substance abuse programs were compared with depressed clients with and without a history of substance abuse from primary care, mental health, and social and community programs. Sociodemographic, health status, and services utilization variables were examined. RESULTS: Of the 957 depressed clients, 217 (23%) were from substance abuse programs; 269 (28%) clients from other sectors had a substance abuse history, and 471 (49%) did not. Most clients from substance abuse programs or with a substance abuse history were unemployed and impoverished, lacked health insurance, and had high rates of arrests and homelessness. They were also more likely than clients without a substance abuse history to have depression or anxiety disorders, psychosis, and mania and to use emergency rooms. CONCLUSIONS: Clients with depression and a substance abuse history had significant psychosocial stressors and high rates of service use, which suggests that communitywide approaches may be needed to address both depression and substance abuse in this safety-net population.

Key Findings

  • About half of the depressed individuals studied had substance abuse histories.
  • Most clients with both depression and substance abuse histories were unemployed, poor, lacked health insurance, and had high rates of arrest and homelessness.
  • They were also more likely to have depression, psychosis, and mania and use emergency rooms.
  • Most clients were satisfied with community mental health services.

Recommendation

Communitywide approaches may be needed to address both depression and substance abuse in this safety-net population.

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