Associations of sexually transmitted disease diagnosis among those with depression and anxiety

background   Chlamydia is the most reported bacterial infection, contributing to the estimated 110 million prevalent sexually transmitted diseases (STD) in the United States in 2008. Two other diagnoses, past year depression and anxiety, are reported by more than 6.7% and 10% (respectively) of adults, can predict risk sexual behaviors, and are increasingly managed within the primary care context. However, the interactions of these conditions affecting millions of individuals are poorly understood. Given the increasing consolidation of sexual and mental health under the auspice of the Patient-Centered Medical Home, we sought to examine associations between mental illness and STD.

methods                      We utilized data from the 2012 National Survey on Drug Use and Health, a cross-sectional survey of the civilian, non-institutionalized US population aged 12 years or older. We examined data on 18-25 years-olds to identify factors obtainable through either the patient’s health record (clinically-based) or provided as a query response by the patient (patient-provided) associated with STD diagnosis in the past year (STDyr) among those with either MDE or ANX. This age frame was chosen to represent those eligible for routine STD screening.

results             There were 18,239 participants aged 18-25 years. MDE prevalence was 14.86% and ANX prevalence was 8.24%, each more common among females, whites, and low income earners; and STDy prevalence was 2.32%. Those with MDE were more likely to report a STDyr (OR=1.8; CI=1.31-2.47) and this difference remained after controlling for gender and race (AOR=1.61, CI=1.17- 2.21). The association between MDE and STDyr varied greatly by gender, with no increased risk among males, but a much greater risk for females with MDE (4.67% vs 2.92%; p<0.001). Mental health medication prescription, and alcohol, marijuana, and other illegal drug use were significantly associated as well. No similar associations were observed between ANX and STDyr.

conclusions     Individuals with MDE are at increased risk of STD, and purposeful consideration of possible interactive effects of mental health and risky sexual activity should be made within the primary care context. While several factors significantly associated with STD risk have been observed, further work remains to better model STD risk among those with mental illness.