Gender and the Association between Long-Term Prescription Opioid Use and New-Onset Depression

Joanne Salas, Jeffrey F. Scherrer, Brian K. Ahmedani, Laurel A. Copeland, Kathleen K. Bucholz, Mark D. Sullivan, Thomas Burroughs, F. David Schneider, Patrick J. Lustman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Women have a higher prevalence of chronic noncancer pain conditions and report more severe pain, yet, it is not known if the association between long-term opioid analgesic use (OAU) and risk of a new depression episode (NDE) differs according to gender. We analyzed patient data from the Veterans Health Administration (VHA; 2000–2012; n = 70,997) and a large private-sector health care organization (2003–2012; n = 22,981) to determine whether long-term OAU and risk of NDE differed according to gender. Patients were free of depression and OAU for 2 years before baseline. OAU duration was defined as 1 to 30, 31 to 90 and more than 90 days, and NDE was defined according to International Classification of Diseases, Ninth Revision codes. Gender-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs). Propensity scores and subsequent inverse probability of treatment weighting controlled for confounding. In the VHA, more than 90 compared with 1- to 30-day OAU was more strongly associated with NDE among female than male patients (female: HR = 1.79 [95% confidence interval (CI), 1.45–2.22] vs male HR = 1.25 [95% CI, 1.16–1.34], P =.002). In private sector patients, there was no gender difference in the association between more than 90-day OAU and NDE (female HR = 1.97 [95% CI, 1.64–2.37] vs male HR = 1.99 [95% CI, 1.44–2.74]). Risk of NDE after long-term OAU is similar in men and women in private sector patients but may differ for VHA patients. Future prospective studies are needed to identify mechanisms for the association between longer OAU and NDE. Perspective Existing research is mixed regarding gender differences in outcomes after long-term prescription opioid use. This study found both genders have increased risk of an NDE after more than 90 days of opioid use. Women and men may benefit from closer monitoring of mood associated with chronic opioid use.

Original languageEnglish (US)
Pages (from-to)88-98
Number of pages11
JournalJournal of Pain
Volume19
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Opioid Analgesics
Prescriptions
Depression
Private Sector
Confidence Intervals
Veterans Health
Propensity Score
United States Department of Veterans Affairs
International Classification of Diseases
Proportional Hazards Models
Chronic Pain
Organizations
Prospective Studies
Delivery of Health Care
Pain

Keywords

  • depression
  • epidemiology
  • gender
  • Opioids
  • pain

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Salas, J., Scherrer, J. F., Ahmedani, B. K., Copeland, L. A., Bucholz, K. K., Sullivan, M. D., ... Lustman, P. J. (2018). Gender and the Association between Long-Term Prescription Opioid Use and New-Onset Depression. Journal of Pain, 19(1), 88-98. https://doi.org/10.1016/j.jpain.2017.09.004

Gender and the Association between Long-Term Prescription Opioid Use and New-Onset Depression. / Salas, Joanne; Scherrer, Jeffrey F.; Ahmedani, Brian K.; Copeland, Laurel A.; Bucholz, Kathleen K.; Sullivan, Mark D.; Burroughs, Thomas; Schneider, F. David; Lustman, Patrick J.

In: Journal of Pain, Vol. 19, No. 1, 01.01.2018, p. 88-98.

Research output: Contribution to journalArticle

Salas, J, Scherrer, JF, Ahmedani, BK, Copeland, LA, Bucholz, KK, Sullivan, MD, Burroughs, T, Schneider, FD & Lustman, PJ 2018, 'Gender and the Association between Long-Term Prescription Opioid Use and New-Onset Depression', Journal of Pain, vol. 19, no. 1, pp. 88-98. https://doi.org/10.1016/j.jpain.2017.09.004
Salas J, Scherrer JF, Ahmedani BK, Copeland LA, Bucholz KK, Sullivan MD et al. Gender and the Association between Long-Term Prescription Opioid Use and New-Onset Depression. Journal of Pain. 2018 Jan 1;19(1):88-98. https://doi.org/10.1016/j.jpain.2017.09.004
Salas, Joanne ; Scherrer, Jeffrey F. ; Ahmedani, Brian K. ; Copeland, Laurel A. ; Bucholz, Kathleen K. ; Sullivan, Mark D. ; Burroughs, Thomas ; Schneider, F. David ; Lustman, Patrick J. / Gender and the Association between Long-Term Prescription Opioid Use and New-Onset Depression. In: Journal of Pain. 2018 ; Vol. 19, No. 1. pp. 88-98.
@article{5ffd9e7601cd47a49f875049409f9553,
title = "Gender and the Association between Long-Term Prescription Opioid Use and New-Onset Depression",
abstract = "Women have a higher prevalence of chronic noncancer pain conditions and report more severe pain, yet, it is not known if the association between long-term opioid analgesic use (OAU) and risk of a new depression episode (NDE) differs according to gender. We analyzed patient data from the Veterans Health Administration (VHA; 2000–2012; n = 70,997) and a large private-sector health care organization (2003–2012; n = 22,981) to determine whether long-term OAU and risk of NDE differed according to gender. Patients were free of depression and OAU for 2 years before baseline. OAU duration was defined as 1 to 30, 31 to 90 and more than 90 days, and NDE was defined according to International Classification of Diseases, Ninth Revision codes. Gender-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs). Propensity scores and subsequent inverse probability of treatment weighting controlled for confounding. In the VHA, more than 90 compared with 1- to 30-day OAU was more strongly associated with NDE among female than male patients (female: HR = 1.79 [95{\%} confidence interval (CI), 1.45–2.22] vs male HR = 1.25 [95{\%} CI, 1.16–1.34], P =.002). In private sector patients, there was no gender difference in the association between more than 90-day OAU and NDE (female HR = 1.97 [95{\%} CI, 1.64–2.37] vs male HR = 1.99 [95{\%} CI, 1.44–2.74]). Risk of NDE after long-term OAU is similar in men and women in private sector patients but may differ for VHA patients. Future prospective studies are needed to identify mechanisms for the association between longer OAU and NDE. Perspective Existing research is mixed regarding gender differences in outcomes after long-term prescription opioid use. This study found both genders have increased risk of an NDE after more than 90 days of opioid use. Women and men may benefit from closer monitoring of mood associated with chronic opioid use.",
keywords = "depression, epidemiology, gender, Opioids, pain",
author = "Joanne Salas and Scherrer, {Jeffrey F.} and Ahmedani, {Brian K.} and Copeland, {Laurel A.} and Bucholz, {Kathleen K.} and Sullivan, {Mark D.} and Thomas Burroughs and Schneider, {F. David} and Lustman, {Patrick J.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jpain.2017.09.004",
language = "English (US)",
volume = "19",
pages = "88--98",
journal = "Journal of Pain",
issn = "1526-5900",
publisher = "Churchill Livingstone",
number = "1",

}

TY - JOUR

T1 - Gender and the Association between Long-Term Prescription Opioid Use and New-Onset Depression

AU - Salas, Joanne

AU - Scherrer, Jeffrey F.

AU - Ahmedani, Brian K.

AU - Copeland, Laurel A.

AU - Bucholz, Kathleen K.

AU - Sullivan, Mark D.

AU - Burroughs, Thomas

AU - Schneider, F. David

AU - Lustman, Patrick J.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Women have a higher prevalence of chronic noncancer pain conditions and report more severe pain, yet, it is not known if the association between long-term opioid analgesic use (OAU) and risk of a new depression episode (NDE) differs according to gender. We analyzed patient data from the Veterans Health Administration (VHA; 2000–2012; n = 70,997) and a large private-sector health care organization (2003–2012; n = 22,981) to determine whether long-term OAU and risk of NDE differed according to gender. Patients were free of depression and OAU for 2 years before baseline. OAU duration was defined as 1 to 30, 31 to 90 and more than 90 days, and NDE was defined according to International Classification of Diseases, Ninth Revision codes. Gender-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs). Propensity scores and subsequent inverse probability of treatment weighting controlled for confounding. In the VHA, more than 90 compared with 1- to 30-day OAU was more strongly associated with NDE among female than male patients (female: HR = 1.79 [95% confidence interval (CI), 1.45–2.22] vs male HR = 1.25 [95% CI, 1.16–1.34], P =.002). In private sector patients, there was no gender difference in the association between more than 90-day OAU and NDE (female HR = 1.97 [95% CI, 1.64–2.37] vs male HR = 1.99 [95% CI, 1.44–2.74]). Risk of NDE after long-term OAU is similar in men and women in private sector patients but may differ for VHA patients. Future prospective studies are needed to identify mechanisms for the association between longer OAU and NDE. Perspective Existing research is mixed regarding gender differences in outcomes after long-term prescription opioid use. This study found both genders have increased risk of an NDE after more than 90 days of opioid use. Women and men may benefit from closer monitoring of mood associated with chronic opioid use.

AB - Women have a higher prevalence of chronic noncancer pain conditions and report more severe pain, yet, it is not known if the association between long-term opioid analgesic use (OAU) and risk of a new depression episode (NDE) differs according to gender. We analyzed patient data from the Veterans Health Administration (VHA; 2000–2012; n = 70,997) and a large private-sector health care organization (2003–2012; n = 22,981) to determine whether long-term OAU and risk of NDE differed according to gender. Patients were free of depression and OAU for 2 years before baseline. OAU duration was defined as 1 to 30, 31 to 90 and more than 90 days, and NDE was defined according to International Classification of Diseases, Ninth Revision codes. Gender-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs). Propensity scores and subsequent inverse probability of treatment weighting controlled for confounding. In the VHA, more than 90 compared with 1- to 30-day OAU was more strongly associated with NDE among female than male patients (female: HR = 1.79 [95% confidence interval (CI), 1.45–2.22] vs male HR = 1.25 [95% CI, 1.16–1.34], P =.002). In private sector patients, there was no gender difference in the association between more than 90-day OAU and NDE (female HR = 1.97 [95% CI, 1.64–2.37] vs male HR = 1.99 [95% CI, 1.44–2.74]). Risk of NDE after long-term OAU is similar in men and women in private sector patients but may differ for VHA patients. Future prospective studies are needed to identify mechanisms for the association between longer OAU and NDE. Perspective Existing research is mixed regarding gender differences in outcomes after long-term prescription opioid use. This study found both genders have increased risk of an NDE after more than 90 days of opioid use. Women and men may benefit from closer monitoring of mood associated with chronic opioid use.

KW - depression

KW - epidemiology

KW - gender

KW - Opioids

KW - pain

UR - http://www.scopus.com/inward/record.url?scp=85033554566&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85033554566&partnerID=8YFLogxK

U2 - 10.1016/j.jpain.2017.09.004

DO - 10.1016/j.jpain.2017.09.004

M3 - Article

C2 - 29030323

AN - SCOPUS:85033554566

VL - 19

SP - 88

EP - 98

JO - Journal of Pain

JF - Journal of Pain

SN - 1526-5900

IS - 1

ER -