Associations Between Reductions in Depressive Symptoms and Reductions in Pain and Anxiety Symptoms and Substance Use: Emulation of a Randomized Trial
Maria R. Khan, PhD, MPH,
Mary Acri, PhD,
Kaoon (Francois) Ban, MPH,
Joy D. Scheidell, PhD, MPH,
Elizabeth R. Stevens, PhD, MPH,
Prima Manandhar-Sasaki, MSc,
Dyanna Charles, MPH,
Natalie E. Chichetto, PhD, MSW,
Stephen Crystal, PhD,
Adam J. Gordon, MD, MPH,
Brandon D.L. Marshall, PhD,
E. Jennifer Edelman, MD, MHS,
Amy C. Justice, MD, PhD,
Scott R. Braithwaite, MD, MS,
Ellen C. Caniglia, ScD
Affiliations
Maria R. Khan, PhD, MPH
Department of Population Health, New York University Grossman School of Medicine, New York, New York; Address correspondence to: Maria R. Khan, PhD, MPH, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, Floor 17, New York NY 10016.
Mary Acri, PhD
Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York
Kaoon (Francois) Ban, MPH
Department of Population Health, New York University Grossman School of Medicine, New York, New York
Joy D. Scheidell, PhD, MPH
Department of Population Health, New York University Grossman School of Medicine, New York, New York
Elizabeth R. Stevens, PhD, MPH
Department of Population Health, New York University Grossman School of Medicine, New York, New York
Prima Manandhar-Sasaki, MSc
Department of Population Health, New York University Grossman School of Medicine, New York, New York
Dyanna Charles, MPH
Department of Population Health, New York University Grossman School of Medicine, New York, New York
Natalie E. Chichetto, PhD, MSW
Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida
Stephen Crystal, PhD
Center for Health Services Research, Institute for Health, Rutgers University, New Brunswick, New Jersey
Adam J. Gordon, MD, MPH
Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Brandon D.L. Marshall, PhD
Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
E. Jennifer Edelman, MD, MHS
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
Amy C. Justice, MD, PhD
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
Scott R. Braithwaite, MD, MS
Department of Population Health, New York University Grossman School of Medicine, New York, New York
Ellen C. Caniglia, ScD
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine
Introduction: Depressive symptoms are linked with pain, anxiety, and substance use. Research estimating whether a reduction in depressive symptoms is linked to subsequent reductions in pain and anxiety symptoms and substance use is limited. Methods: Using data from the Veterans Aging Cohort Study, a multisite observational study of U.S. veterans, the authors used a target trial emulation framework to compare individuals with elevated depressive symptoms (Patient Health Questionnaire-9 score ≥ 10) who experienced reductions in depressive symptoms (Patient Health Questionnaire-9 score < 10) with those whose symptoms persisted (Patient Health Questionnaire-9 score ≥ 10) at the next follow-up visit (on average, 1 year later). Using inverse probability of treatment weighting, the authors estimated ORs and 95% CIs for associations between depressive symptom reduction status and improvement on the following: anxiety symptoms, pain symptoms, unhealthy alcohol use, and use of tobacco, cannabis, cocaine, and/or illicit opioids. Results: Reductions in depressive symptoms were associated with reductions in pain symptoms (OR=1.43, 95% CI=1.01, 2.02), anxiety symptoms (OR=2.50, 95% CI=1.63, 3.83), and illicit opioid use (OR=2.07, 95% CI=1.13, 3.81). Depressive symptom reductions were not associated with reductions in unhealthy alcohol use (OR=0.85, 95% CI=0.48, 1.52) or use of tobacco (OR=1.49, 95% CI=0.89, 2.48), cannabis (OR=1.07, 95% CI=0.63, 1.83), or cocaine (OR=1.28, 95% CI=0.73, 2.24). Conclusions: Reducing depressive symptoms may potentially reduce pain and anxiety symptoms and illicit opioid use. Future work should determine whether reductions achieved through antidepressant medications, behavioral therapy, or other means have comparable impact.
