# Association Between Heroin Use and Depression: NHANES 2005–2018

## TL;DR

This study finds that heroin use is linked to a higher risk of depression, especially in younger adults and smokers, using data from a large US survey.

## Contribution

The study provides population-level evidence of an association between heroin use and depression, adjusted for multiple confounders.

## Key findings

- Lifetime heroin use was associated with an 85% increased risk of clinically significant depression.
- The association was strongest among individuals who started using heroin before age 20.4.
- The relationship between heroin use and depression was modified by age and smoking status.

## Abstract

Heroin use and major depression are each leading contributors to global disability and premature mortality, yet evidence for a specific association between the two remains fragmented and is often derived from small, treatment‐seeking samples. We conducted a cross‐sectional analysis of nationally representative data from the 2005–2018 National Health and Nutrition Examination Survey, including 19 022 US adults aged ≥ 20 years with complete information on heroin use, depression status, and relevant covariates. Clinically significant depression was defined as a PHQ‐9 score ≥ 10. After multivariable adjustment for sociodemographic, behavioural, and clinical factors, including polysubstance use and chronic medical conditions, lifetime heroin use was independently associated with depression (adjusted OR = 1.85, 95% CI 1.43–2.40; p < 0.001). Subgroup analyses demonstrated that this association was robust and modified by age and smoking status, with significant interaction effects observed (p for interaction < 0.05). Restricted cubic spline analysis among participants with a history of heroin use (n = 439) revealed a non‐linear relationship between age at first heroin use and depression risk (p for non‐linearity = 0.032), with the highest predicted probability of depression among individuals who initiated use at or before 20.4 years of age. These findings indicate that lifetime heroin use is associated with a substantially increased risk of clinically significant depression in the general US population, particularly among younger adults and current smokers, underscoring the need for integrated screening and concurrent treatment of substance‐use and mood disorders.

Graphical summary illustrating the association between lifetime heroin use and increased odds of clinically significant depression in US adults, with stronger effects observed among younger individuals and current smokers.