Depression, Substance Use and the Role of Race as a Moderator

Background: The co-occurrence of depression and substance abuse is a complex public health issue. However, there is little evidence on whether this relationship is moderated by race.

Methods: This study examined the moderating role of race/ethnicity in the relationship between depression and substance use, using data from the 2019 National Survey on Drug Use and Health (NSDUH). Logistic and Poisson regression models were used to examine the relationship between major depressive episodes (MDE) and each substance use (i.e., alcohol, nicotine, and illicit drugs), and polysubstance use, respectively. All models included an interaction between MDE and race/ethnicity to examine whether race/ethnicity moderated these relationships.

Results: Among participants in the sample (n=42,182), 4,467 (10.6%) reported a MDE in the past year. Race/ethnicity moderated the positive relationship between MDE and nicotine (p-value <.001) and illicit drug use (p=0.04), such that it was more pronounced for Hispanics relative to Non-Hispanic Whites. A statistically significant MDE-alcohol use relationship was found for non-Hispanic blacks (p=.02) and non-Hispanic others (p<.001) only, while the positive relationship between MDE and polysubstance use was more pronounced for non-Hispanic others (p=.003) and Hispanics (p=.005), relative to Non-Hispanic Whites.

Conclusions: The study’s findings show that the relationship between substance use and depression differs by race/ethnicity. These findings highlight the need for expanded prevention and treatment services for racial and ethnic minorities.