Abstract
Condom use is the most affordable method to prevent sexually transmitted infections (STIs). Anxiety, depression, and substance use have been used as covariates of condom use, but little is known about the possibility of synergistic effects. The objective of this study was to determine the synergist effect of depression, anxiety, and substance use in unsafe sex. Individuals receiving residential treatment for substance use were recruited in 21 centers in Mexico City. Data on substance use, depression (PHQ-9), anxiety (GAD-7), and condom use (number of unsafe sex occasions) was collected. Four Poisson regression models were adjusted to compare the additive or interactive effect of these variables. We found that model 2 (anxiety and depression interactive model) showed a better fit when compared with its additive-only counterpart (model 1), χ2[1] = 29.538, p < .001; model 4 (anxiety, depression, and substance use interactive model) had a better fit that model 3 (anxiety, depression, and substance use additive model), χ2[1] = 23.479, p < .001. Models with interactive terms produced better predictions of condom use. Only depression symptoms displayed a synergistic effect with substance use. These findings may be the result of unique components of the symptoms, and they stress the importance of including interactive terms when testing the associations or the effects of mental health variables in health outcomes, particularly in condom use.
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Data is available on request to the corresponding author.
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Acknowledgments
A special acknowledgment to Angel Alvarez-Roman for its contribution in the fieldwork.
Funding
This study was funded by the Sectoral Fund for Research in Health and Social Security (FOSISS) project number 262500 awarded to RMN. During this study, LVG received funding from the National Council of Science and Technology (CONACYT) through a doctoral grant no. 383294.
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Villalobos-Gallegos, L., Medina-Mora, M.E., Marín-Navarrete, R. et al. Testing the Synergistic Effects of Depression, Anxiety, and Substance Use in Unsafe Sex: a Cross-sectional Study. Int J Ment Health Addiction 19, 1951–1962 (2021). https://doi.org/10.1007/s11469-020-00291-3
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DOI: https://doi.org/10.1007/s11469-020-00291-3