Gender Differences for New-Onset Depression Following Long-Term Opioid Use

In Veterans Health Association patients, new-onset depression was more common among women than men using long-term opioids.

In the general population, longer-term opioid use was associated with new-onset depression at a similar rate between men and women, according to the results of a recent study published in The Journal of Pain. However, in patients of the Veterans Health Association (VHA), new-onset depression was more common among women than among men using long-term opioids.

In this retrospective study of patients from the VHA (n=70,997) and a large private-sector healthcare organization (n=22,981), researchers compared the association of long-term opioid use and risk for new-onset depression defined by International Classification of Diseases-9 codes between genders. At baseline, patients were free of depression and opioid use for at least 2 years.

Compared with opioid use for 1 to 30 days, opioid use for >90 days was more strongly associated with new-onset depression among women compared with men in the VHA population (hazard ratio [HR] 1.79 vs 1.25; P =.002).

In the private-sector population, however, researchers noted no difference in association between opioid use >90 days and new-onset depression between genders (HR 1.97 vs 1.99 for female vs male).

In an interview with Psychiatry Advisor, Joanne Salas, MPH, of the Department of Family and Community Medicine at St Louis University School of Medicine in Missouri, said that the results were surprising because, “we expected women in both populations to have a far greater risk of depression following chronic opioid use because of the increased vulnerability of depression in women as well as increasing evidence of long-term opioid use, use at higher doses, and overdose in women among private sector samples.”

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Nonetheless, she noted that risk for new-onset depression increased with long-term opioid use in both populations, supporting a role for clinicians to “repeatedly screen for depression during the course of opioid treatment.”


Salas J, Scherrer JF, Ahmedani BK, et al. Gender and the association between long-term prescription opioid use and new onset depression [published online October 10, 2017]. J Pain. doi:10.1016/j.jpain.2017.09.004