• Kayla N Tormohlen, Karin E Tobin, and Carl Latkin.
• Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 888, Baltimore, MD, 21205, USA. ktormoh1@jhu.edu.
• J Urban Health. 2019 Jun 1; 96 (3): 379-389.

AbstractStress, drug use, and depression are interconnected, but less is understood about sources of stress among adults with co-occurring drug use and depressive symptoms. The current study aimed to identify sources of stress and correlates among these adults. Data come from a cross-sectional baseline survey, including participants (n = 336) 18 to 55 years old, who reported past 6-month heroin or cocaine use and depressive symptoms. Exploratory factor analysis was conducted to identify sources of stress. Chi-square and multivariable Poisson regression with robust error variance were used to explore correlates of each factor. Three sources of stress were identified: financial stress related to drugs, stress due to community features, and stress involving a person's network. Past 6-month injection drug use (aPR = 1.34, 95% CI 1.07-1.67), perceived lack of control over drug use (aPR = 1.80, 95% CI 1.41-2.30), and difficulty abstaining from drug use (aPR = 1.55, 95% CI 1.22-1.97) were associated with an increased risk of high drug-related financial stress. Neighborhood disorder (aPR = 2.42, 95% CI 1.80-3.24) and sleeping on the street (aPR = 1.37, 95% CI 1.04-1.80) were associated with an increased risk of high community-level stress. Past 6-month injection drug use (aPR = 1.28, 95% CI 1.04-1.58), perceived lack of control over drug use (aPR = 1.37, 95% CI 1.10-1.70), and drug use stigma was associated with an increased prevalence of high drug network stress (aPR = 1.32, 95% CI 1.05-1.65). Stress is a complex construct, including distinct sources and correlates. Further understanding of sources of stress is beneficial in recognizing potentially modifiable challenges faced by individuals who use drugs and experience depressive symptoms.

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