All ETDs from UAB

Advisory Committee Chair

Stefan G Kertesz

Advisory Committee Members

Robin Lanzi

Cathy Simpson

Bradley E Lian

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Public Health


Cross-sectional studies of the community and treatment samples suggest substantial comorbidity between depression and illicit drug use disorders. Controversy exists whether such pattern of comorbidity is seen among drug using behaviors and depressive symptoms that fall short of the DSM-IV criteria for a clinical disorder. This dissertation research applied principles of the life course perspective and trajectory modeling to describe heterogeneity and comorbidity of subthreshold depressive symptoms with opioid, cocaine and amphetamine use in middle age. Secondary analysis of community-dwelling adults from the Coronary Artery Risk Development in Young Adults (CARDIA) study was performed. The CARDIA cohort, N=5115 at inception in 1985-86 at ages 18-30, was balanced for race and gender (AA male, AA females, white males, white females) and observed over 20 years. This analysis included 2,684 adults, followed 1990-2006. Depressive symptoms were measured repeatedly on the Center for Epidemiologic Studies Depression Scale (CES-D). The best fitting trajectory model based on a binary indicator [CES-D ¡Ã 16] included 3 groupings of participants: No-Low Depression (60%), Early Moderate Later Decreasing Depression (31%), and Chronically High Depression (9%). The model based on continuous CES-D scores resulted in 5 groupings: Low (50%) Modestly Elevated/Later Declining (36%), Unstable (7%), Increasing (5%), and Chronically High Depressive Symptoms (1%). Chronically high depressive symptoms [CES-D ¡Ã 16] were associated with baseline low social support, adverse childhood family environment, and childhood depression. Persistence of high depressive symptoms was associated with higher baseline hostility and anxiety, persistent economic difficulty at all follow-ups, and single marital status at the end of follow-up. African American females were at increased risk of chronic depression. Depression treatment needs in this sample were unmet, with only 22% of chronically depressed reporting antidepressant intake. Persistent occasional users of stimulants and opioids were more likely to have chronically high depressive symptoms, based on the binary indicator of CES-D ¡Ã16, [OR 3.5(95% CI, 2.2-5.8)]. This was robust for covariates, [AOR 1.9 (1.1-3.4)]. 15-year distinct depressive symptoms trajectories did not predict new drug use at the end of follow-up. Rather, a distinct 18-year drug use trajectory, Early Frequent/Later Occasional Users had a two-fold increase in the odds of reporting acquired depression (CES-D> 16) at the end follow-up. Clinical implications of these findings are discussed.

Included in

Public Health Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.