美國成年人與⻘少年之重大憂鬱發作與物質使用:來 自 2021 至 2024 年全國藥物使用與健康調查之證據

Abstract

背景：憂鬱症盛行率近年持續上升，且常與物質使用行為並存，使其公共衛生影響更加複雜。既有研究指出，憂鬱與物質使用之間可能存在雙向關聯，包括以物質使用緩解憂鬱症狀、物質使用導致或加劇情緒問題，以及兩者共享社會人口學與環境風險因素。然而，重大憂鬱發作與不同類型物質使用之關聯，尤其是在成年人與青少年族群中的差異，仍需進一步釐清。目的：本研究旨在估計美國成年人與青少年過去一年重大憂鬱發作及特定物質使用行為之盛行狀況，並檢視過去一年重大憂鬱發作與物質使用狀態及使用頻率之關聯。同時，本研究亦探討在調整重大憂鬱發作狀態與調查年份後，與物質使用結果相關之社會人口學因素。方法：本研究使用2021至2024年美國全國藥物使用與健康調查（National Survey on Drug Use and Health, NSDUH）未加權公開使用資料，分別分析成年人與青少年樣本。主要自變項為過去一年重大憂鬱發作狀態，依據NSDUH調查邏輯與DSM-5相關標準界定。物質使用結果包括終生裸蓋菇素使用、過去一個月致幻劑使用、酒精使用、大麻使用與香菸使用，以及上述部分物質於過去一個月的使用頻率。本研究以邏輯斯迴歸分析物質使用狀態，並以線性迴歸分析物質使用頻率，同時調整社會人口學變項與調查年份。 結果：成年人分析結果顯示，相較於未經歷過去一年重大憂鬱發作者，經歷過去一年重大憂鬱發作者有較高勝算出現過去一個月酒精使用、香菸使用、大麻使用、致幻劑使用，以及終生裸蓋菇素使用。青少年樣本亦呈現相似趨勢，且部分物質使用結果與重大憂鬱發作之關聯強度更高。整體而言，在所分析的物質中，終生裸蓋菇素使用與過去一個月致幻劑使用在有過去一年重大憂鬱發作者中較為常見。此外，物質使用相關之社會人口學特徵會依年齡族群與物質類型而有所不同。結論：在本研究樣本中，美國成年人與青少年若經歷過去一年重大憂鬱發作，較可能出現終生裸蓋菇素使用及過去一個月酒精、大麻、香菸與致幻劑使用。這些關聯之強度會因物質類型與社會人口學特徵而有所差異，且青少年族群中重大憂鬱發作與物質使用結果之關聯尤其值得重視。研究結果支持在公共衛生實務中整合心理健康與物質使用預防策略，並進一步處理可能同時影響憂鬱與物質使用之共同風險因素。

Background: The prevalence of depression has been rising and is further complicated by other factors such as substance use. There are strong bidirectional associations between depression and concurrent substance use and while the temporal nature of this relationship is not clearly understood, there are several possible bidirectional pathways and shared risk factors that could contribute to these associations. Objectives: This study aimed to estimate the prevalence of past-year major depressive episode (MDE), examine its associations with specific substance use outcomes among U.S. adults and adolescents, and identify sociodemographic correlates of substance use outcomes after adjusting for past-year MDE status and survey year. Methods: Unweighted National Survey on Drug Use and Health (NSDUH) public-use files from 2021-2024 were used to evaluate U.S. adults and adolescents, separately. Logistic and linear regression analyses were performed to examine associations between past-year MDE status and specified substance use outcomes, adjusting for sociodemographic covariates and survey year. Past-year MDE status was determined through the NSDUH survey logic tree. Substance use outcomes included past-month use status and past-month use frequency of hallucinogens, alcohol, marijuana, and cigarettes, as well as lifetime psilocybin use status. Results: Adult findings showed that past-year MDE was associated with higher odds of past-month alcohol (OR = 2.18, 95% CI = 2.10, 2.27), cigarette (OR = 1.48, 95% CI = 1.42, 1.54), marijuana (OR = 1.97, 95% CI = 1.90, 2.04), and hallucinogen use (OR = 2.34, 95% CI = 2.12, 2.59), and lifetime psilocybin use (OR = 2.18, 95% CI = 2.10, 2.27) compared to those without past-year MDE. Similarly, in adolescents, past-year MDE was associated with higher odds of past-month alcohol, (OR = 2.26, 95% CI = 2.08, 2.45), cigarette (OR = 2.97, 95% CI = 2.51, 3.51), marijuana (OR = 2.83, 95% CI = 2.60, 3.07), and hallucinogen use (OR = 3.24, 95% CI = 2.38, 4.41), and lifetime psilocybin use (OR = 2.90, 95% CI = 2.46, 3.42) compared to those without past-year MDE. Among the substances evaluated, both the prevalence and odds of lifetime psilocybin use and past-month hallucinogen use were higher among those with past-year MDE. Finally, sociodemographic characteristics also varied between age group and substance type. Conclusion: Within the study population, U.S. adults and adolescents with past-year MDE had higher odds of lifetime psilocybin use and past-month alcohol, marijuana, cigarette, and hallucinogen use than those without past-year MDE. The magnitude of these associations varied by substance type and sociodemographic characteristics. Adolescents with past-year MDE had especially strong associations with substance use outcomes. These findings highlight the need for integrated mental health and substance use prevention as well as systemic level changes to address certain shared risk factors.