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Strong link between depression rates, opioid-related deaths

Examination of CDC data on opioid-related deaths from 2011 to 2015 revealed that a 1% point increase in state-level depression diagnoses was tied to a 26% increase in opioid analgesic-related deaths, according to a brief report published in Social Psychiatry and Psychiatric Epidemiology.

"We know from prior literature that people who are depressed are more likely to be prescribed opioids, but also that people who are prescribed opioids are more likely to become depressed," Laura Schwab-Reese, PhD, from University of Colorado and Purdue University, said in a press release. “We need to recognize that this is probably a bidirectional relationship.”

Schwab-Reese and Madeline Foley, from University of Colorado, examined the connection between state-level estimates of opioid-related overdose deaths and percent of state populations reporting depression in the U.S. between 2011 and 2015 in a retrospective ecological study.

They used data from the CDC to determine number of opioid analgesic-related overdose deaths in each state, categorizing fatal drug overdoses as those where an opioid analgesic was also indicated as an opioid analgesic-related death. In the first follow-up analysis, they excluded intentional deaths and in the second, they included all opioid-related deaths (ie, illicit opioids). Depression data were collected via the Behavioral Risk Factor Surveillance System.

Covariates in the adjusted models included percent of the state reporting poor/fair health each year, percent of the state population uninsured per year and whether the state had a policy allowing medical marijuana in each year.

Analyses revealed that a 1% point increase in self-reported depression diagnoses was tied to a 26% (95% CI, 1-58) rise in opioid analgesic-related deaths in the U.S. after adjusting for state general health, insurance status and medical marijuana policies. This link remained for unintentional deaths due to opioid analgesic overdose (IRR = 1.31; 95% CI, 1.031.68) and all opioid-related overdose deaths (IRR = 1.33; 95% CI, 1.07-1.67), according to the data.

Schwab-Reese and Foley found that rates of opioid analgesic-related deaths stayed stable on average from 2011 to 2013, with about five deaths per 100,000 persons. However, these rates rose substantially in 2014 to 5.9 deaths per 100,000 persons and 2015 to seven deaths per 100,000 persons. In addition, the rate of depression diagnoses increased from 17.5% in 2011 to about 19% in 2015.

The data showed that South Dakota had the lowest rate of opioid analgesic-related deaths (2.4 deaths per 100,000 persons) and West Virginia had the highest (27.7 deaths per 100,000 persons) in 2015, while Oregon had the highest percentage of depression (26.7%) and Hawaii had the lowest (11.6%).

“As the opioid epidemic in the United States continues to grow at an unprecedented rate, there is a need for public health interventions to reduce opioid overdose deaths,” the researchers wrote. “Future research is necessary to provide empirical support for interventions that reduce opioid overdose deaths by ameliorating mental health issues.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.