• The association of stress with anxiety and depression: Evidence from a community health needs assessment

      Tournous, Nicloe La; Bagwell-Adams, Grace; University of Georgia (Georgia Public Health Association, 2016)
      Background: Mental illness affects approximately 1 in 5 Americans, making mental health an important area of study for public health. Much research has been conducted on two of the most prevalent mental health disorders, anxiety and depression. However, the association of stress with these disorders, especially specific types of stress (e.g., financial, health, relationship), has been under-studied at the local level. This study aimed to gain insight into the relationship between stress, anxiety, and depression in Athens-Clarke County, Georgia. Methods: Data collected in the 2015 Athens-Clarke County Community Health Needs Assessment were analyzed using linear regression models to explore the association between stress and anxiety and depression. Results: When the data were aggregated, the presence of stress in a respondent’s household was associated with a 17.8% (p<0.001; t=5.21) increase in the likelihood of reporting the presence of anxiety and a 10.0% (p<0.01; t=2.96) increase in the likelihood of reporting the presence of depression. Significant associations with mental health status were also found for race, insurance status, perceptions of neighborhood safety, and discrimination. Conclusions: The results demonstrated that, in Athens-Clarke County, Georgia, stress was significantly and positively associated with both anxiety and depression. Financial, home environment, and neighborhood safety stressors were the strongest predictors of household mental health disorders. These results have implications for public health policy and clinical professionals, including the possibility of tailoring treatment strategies to the types of stress present in a patient’s life. Further research is needed to explore this relationship in other communities.
    • Associations between major depression, health-risk behaviors, and medication adherence among HIV-positive adults receiving medical care in Georgia

      Clubreth, Rachel; Dube, Shanta; Maggio, David; Georgia State University; Georgia Department of Public Health (Georgia Public Health Association, 2016)
      Background: There are approximately 1.2 million people in the United States living with HIV, and 25.6% of HIV-positive adults suffer from depression. The purpose of this study is to examine the contribution of depression to substance use and medication adherence among HIV-positive adults receiving medical care for HIV in Georgia. Methods: Secondary data with a probability sample of 775 HIV-positive adults who took part in the 2009-2013 Georgia Medical Monitoring Project (MMP) were analyzed. Descriptive analyses and multivariate logistic regressions were conducted to assess relationships between depression and current cigarette smoking, injection drug use, other non-injection drug use, and medication adherence, adjusting for sociodemographic covariates (age, gender, race, and education). All analyses accounted for non-response and complex sampling design. Results: Among HIV-positive adults in Georgia, 8.5% met the criteria for major depression, including 13.7% of women and 6.5% of men. Heterosexual adults had a higher percentage of major depression (10.7%) compared to adults who identified as bisexual (7.4%) or homosexual (5.8%). Major depression was also higher among adults with a high school diploma or GED (12.7%) compared to adults with a higher level of education (5.2%). Major depression was associated with a greater odds of current cigarette smoking (AOR 2.7; 95% CI: 1.5, 5.2) and other non-injection drug use (2.5; 95% CI: 1.4, 4.4), after adjusting for sociodemographic variables. The three measures of medication adherence were not statistically significantly associated with major depression. Conclusions: As previously observed for the general population, we found, among HIV-positive adults, significant associations between depression and smoking and other non-injection drug use. Because HIV-positive adults have ongoing encounters with healthcare providers, screening and treatment for depression and other co-morbid substance use is needed to reduce an additional health burden in this population.
    • Associations between multi-level contextual factors and mental health service utilization in adolescents with comorbid depression and substance-use: Moderating role of school connectedness on racial/ethnic disparities in service utilization

      Thornton, Kate; Georgia State University (Georgia Public Health Association, 2017)
      Background: Comorbid depression and substance use has been a prevalent issue in adolescent health. Although rates have remained relatively stable, their level is still alarming and efforts to see a decrease have led leaders and organizations to call for research to better understand factors related to both depression and substance use as well as how these factors may change when these disorders occur together. Methods: Data from the National Survey on Drug Use and Health (NSDUH) were utilized to pursue the research objectives for this study. The NSDUH is an ongoing cross-sectional survey of the civilian and non-institutionalized population of the United States. Multi-level logistic regression procedures were used to determine the relationship between mental health care utilization and research variables in adolescents with comorbid depression and substance-use. Results: Multi-level modeling showed that the model that controlled for individual-level and family-level factors was able to best predict mental health care use (model 4, -2LL=945,303, p << 0.001). In addition, school attachment was shown to be positively associated with mental health care use in all models tested, including the best-fit model selected (OR=2.18;(95% CI 2.13, 2.22). Other contextual factors that were significantly associated with mental health care use were gender (OR=1.92;95% CI 1.88, 1.94), parental attachment (OR=1.72; 95% CI 1.70, 1.74), and poverty (OR=1.59; 95% CI 1.58, 1.62). In addition, the school attachment and race/ethnicity interaction term was found to be significant with an odds ratio of 3.02 (95% CI 2.96, 3.22). Conclusions: This research has shown the importance of contextual factors, specifically the school environment, on the service use of comorbid adolescents. Particularly interesting in the world of mental health promotion is the use of schools as key coordinators in providing specialty mental health services to adolescents, especially for those who suffer from service use disparities.