Depressive features suggest pull toward self-stigma in those with substance use disorders

Researchers found positive associations between depressive features and self-stigma for those with substance use disorders, with the pull to self-stigma likely stronger than in the reverse, per a study published in BMC Psychiatry.

“Depression is a major mental health problem affecting more than 350 million people worldwide, including Taiwan [in which] the prevalence has increased by 25% from 2007 to 2016,” Mohsen Saffari, of Baqiyatallah University of Medical Sciences in Tehran, Iran, and colleagues wrote. “Unfortunately, many people with depression suffer from addictive behaviors, particularly those relating to substance use.”

Saffari and colleagues sought to evaluate the cross-sectional and longitudinal relationships between features of depression and self-stigma in people with concordant substance use disorders.

Their study included 319 individuals, aged 20 years or older and diagnosed with substance use disorders (85.5% male; mean age, 42.2 years) who were recruited from a psychiatric center in Taiwan by convenience sampling. All were assessed for features of depression and self-stigma at four times over a period of 9 months utilizing the depression subscale of the Depression Anxiety Stress Scales (DASS-21) and Self-Stigma Scale-Short S (SSS-S), respectively.

Repeated-measures analyses of variance, Pearson correlations and cross-lagged models using structural equation modeling examined cross-sectional and temporal associations between depression and self-stigma were undertaken.

Results showed that, in the study sample, 112 participants were heroin users, 151 used amphetamines and 56 others used alcohol. A total of 163 participants were married.

Participants with heroin use had the highest levels of self-stigma in all domains (mean, 2.52-2.96), followed by those with amphetamine use (mean, 2.16-2.71) and alcohol use (mean, 1.76-2.21) at baseline. Individuals with heroin use had significantly higher levels of depression (mean, 9.77) than those with amphetamine use (mean, 6.36), but not those with alcohol use (mean, 9.51).

Data additionally revealed positive cross-sectional associations between depressive features and all assessed forms of self-stigma over time (0.13<r<0.92). Three models of cross-lagged associations between different forms of self-stigma and depressive features indicated good fit indices (comparative fit index>0.98). The direction of associations between depressive features towards self-stigma was stronger than the opposite direction.

“These findings suggest the relevance of addressing depressive features in people with SUDs in order to prevent the generation of self-stigma,” Saffari and colleagues wrote.