Community Mental Health Journal

, Volume 55, Issue 7, pp 1147–1151 | Cite as

Depressive Symptoms and Sexually Transmitted Disease: Evidence from a Low-Income Neighborhood of New York City

  • Boshen JiaoEmail author
  • Zafar Zafari
  • Kai Ruggeri
  • Sharifa Z. Williams
Brief Report


We examined the association between sexually transmitted disease (STD) and depressive symptoms. Our analysis utilized the 2015 cross-sectional Washington Heights Community Survey. Multivariable binary logistic regression analysis was used to examine the primary association between having a history of STD and patient health questionnaire-9 (PHQ-9) score while adjusting for potential confounders. Then in separate models, we adjusted for the interaction of social factors with PHQ-9 score to test for modification effect on the primary association. In this low-income neighborhood, STD history was not significantly associated with PHQ-9 score in the overall logistic regression model for the primary association. However, in interaction models, STD and depressive symptoms were associated in sub-groups defined by social factors, namely being Hispanic [odds ratio (OR) 1.08; 95% confidence interval (CI) 1.02–1.15], foreign-born (OR 1.08; 95% CI 1.02–1.15), and having low to moderate social support (OR 1.09; 95% CI 1.02–1.15). Our results demonstrate a need for targeted interventions to be applied to vulnerable subgroups identified.


Depressive symptoms Sexually transmitted disease Low-income neighborhood New York City 



The authors thank Dr. Peter Muennig and Dr. Zohn Rosen for their insightful comments.


Funding for the authors was provided by the Dean’s Office, Columbia University Mailman School of Public Health. The study sponsor had no role in study design; collection, analysis, and interpretation of data; writing the manuscript; and the decision to submit the manuscript for publication

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

The Review by and approval from the appropriate institutional and/or national ethical review committee was not needed in this study because the 2015 Washington Heights Community Survey (WHCS) dataset is publicly available:


  1. Basavaraj, K., Navya, M., & Rashmi, R. (2010). Quality of life in HIV/AIDS. Indian Journal of Sexually Transmitted Diseases, 31(2), 75.Google Scholar
  2. Bengtson, A. M., Pence, B. W., Gaynes, B. N., Quinlivan, E. B., Heine, A. D., O’donnell, J. K., et al. (2016). Improving depression among HIV-infected adults: Transporting the effect of a depression treatment intervention to routine care. Journal of Acquired Immune Deficiency Syndromes, 73(4), 482–488.Google Scholar
  3. Centers for Disease Control and Prevention. (2018a). Reported STDs in the United States, 2017. High burden of STDs threaten millions of Americans. Retrieved from
  4. Centers for Disease Control and Prevention. (2018b). Sexually transmitted disease surveillance 2017. Retrieved from
  5. Charles, B., Jeyaseelan, L., Pandian, A. K., Sam, A. E., Thenmozhi, M., & Jayaseelan, V. (2012). Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India—A community based cross sectional study. BMC Public Health, 12(1), 463.Google Scholar
  6. Chen, Y., Wu, J., Yi, Q., Huang, G., & Wong, T. (2008). Depression associated with sexually transmitted infection in Canada. Sexually Transmitted Infections, 84(7), 535–540.Google Scholar
  7. Cohen, S. (2004). Social relationships and health. American Psychologist, 59(8), 676.Google Scholar
  8. Cunningham, S. D., Kerrigan, D. L., Jennings, J. M., & Ellen, J. M. (2009). Relationships between perceived STD—related stigma, STD—related shame and STD screening among a household sample of adolescents. Perspectives on Sexual and Reproductive Health, 41(4), 225–230.Google Scholar
  9. Dang, B. N., Giordano, T. P., & Kim, J. H. (2012). Sociocultural and structural barriers to care among undocumented Latino immigrants with HIV infection. Journal of Immigrant and Minority Health, 14(1), 124–131.Google Scholar
  10. Darrow, W. W., Montanea, J. E., & Gladwin, H. (2009). AIDS-related stigma among Black and Hispanic young adults. AIDS and Behavior, 13(6), 1178.Google Scholar
  11. Deren, S., Shedlin, M., Kang, S.-Y., & Cortés, D. E. (2011). HIV risk and prevention among Hispanic immigrants in New York: The salience of diversity. Substance Use and Misuse, 46(2–3), 254–263.Google Scholar
  12. Earnshaw, V. A., Bogart, L. M., Dovidio, J. F., & Williams, D. R. (2013). Stigma and racial/ethnic HIV disparities: Moving toward resilience. American Psychologist, 68(4), 225.Google Scholar
  13. Ford, J. V., Ivankovich, M. B., Douglas, J. M., Jr., Hook, E. W., III, Barclay, L., Elders, J., et al. (2017). The need to promote sexual health in America: A new vision for public health action. Sexually Transmitted Diseases, 44(10), 579–585.Google Scholar
  14. Galvan, F. H., Davis, E. M., Banks, D., & Bing, E. G. (2008). HIV stigma and social support among African Americans. AIDS Patient Care and STDs, 22(5), 423–436.Google Scholar
  15. Gao, Y., MacDonald, D., Collins, K. D., Alaghehbandan, R., & Chen, Y. (2010). Role of social support in the relationship between sexually transmitted infection and depression among young women in Canada. Journal of Epidemiology, 20(4), 313–318.Google Scholar
  16. Gonzalez, J. S., Batchelder, A. W., Psaros, C., & Safren, S. A. (2011). Depression and HIV/AIDS treatment nonadherence: A review and meta-analysis. Journal of Acquired Immune Deficiency Syndromes, 58(2), 181–187.Google Scholar
  17. Grieb, S. M. D., Shah, H., Flores-Miller, A., Zelaya, C., & Page, K. R. (2017). HIV-related stigma among Spanish-speaking Latinos in an emerging immigrant receiving city. Journal of Immigrant and Minority Health, 19(4), 868–875.Google Scholar
  18. Grov, C., Golub, S. A., Parsons, J. T., Brennan, M., & Karpiak, S. E. (2010). Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care, 22(5), 630–639.Google Scholar
  19. Hood, J. E., & Friedman, A. L. (2011). Unveiling the hidden epidemic: A review of stigma associated with sexually transmissible infections. Sexual Health, 8(2), 159–170.Google Scholar
  20. Huang, S.-Y., Hung, J.-H., Hu, L.-Y., Huang, M.-W., Lee, S.-C., & Shen, C.-C. J. M. (2018). Risk of sexually transmitted infections following depressive disorder: A nationwide population-based cohort study. Medicine (Baltimore), 97(43), e12539.Google Scholar
  21. Hutton, H. E., Lyketsos, C. G., Zenilman, J. M., Thompson, R. E., & Erbelding, E. J. (2004). Depression and HIV risk behaviors among patients in a sexually transmitted disease clinic. American Journal of Psychiatry, 161(5), 912–914.Google Scholar
  22. Jiao, B., Rosen, Z., Bellanger, M., Belkin, G., & Muennig, P. (2017). The cost-effectiveness of PHQ screening and collaborative care for depression in New York City. PLoS ONE, 12(8), e0184210.Google Scholar
  23. Khan, M. R., Kaufman, J. S., Pence, B. W., Gaynes, B. N., Adimora, A. A., Weir, S. S., et al. (2009). Depression, sexually transmitted infection, and sexual risk behavior among young adults in the United States. Archives of Pediatrics and Adolescent Medicine, 163(7), 644–652.Google Scholar
  24. Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Journal of General Internal Medicine, 32(9), 509–515.Google Scholar
  25. Kroenke, K., Spitzer, R., & Williams, J. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.Google Scholar
  26. Li, L., Lee, S.-J., Thammawijaya, P., Jiraphongsa, C., & Rotheram-Borus, M. J. (2009). Stigma, social support, and depression among people living with HIV in Thailand. AIDS Care, 21(8), 1007–1013.Google Scholar
  27. Logie, C., & Gadalla, T. (2009). Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care, 21(6), 742–753.Google Scholar
  28. Magaña, S. M., Ramírez García, J. I., Hernández, M. G., & Cortez, R. (2007). Psychological distress among Latino family caregivers of adults with schizophrenia: The roles of burden and stigma. Psychiatric Services, 58(3), 378–384.Google Scholar
  29. Magidson, J. F., Blashill, A. J., Wall, M. M., Balan, I. C., Wang, S., Lejuez, C., et al. (2014). Relationship between psychiatric disorders and sexually transmitted diseases in a nationally representative sample. Journal of Psychosomatic Research, 76(4), 322–328.Google Scholar
  30. Malta, M., Bastos, F. I., Strathdee, S. A., Cunnigham, S. D., Pilotto, J. H., & Kerrigan, D. (2007). Knowledge, perceived stigma, and care-seeking experiences for sexually transmitted infections: A qualitative study from the perspective of public clinic attendees in Rio de Janeiro, Brazil. BMC Public Health, 7(1), 18.Google Scholar
  31. Mazzaferro, K. E., Murray, P. J., Ness, R. B., Bass, D. C., Tyus, N., & Cook, R. L. (2006). Depression, stress, and social support as predictors of high-risk sexual behaviors and STIs in young women. Journal of Adolescent Health, 39(4), 601–603.Google Scholar
  32. Nanni, M. G., Caruso, R., Mitchell, A. J., Meggiolaro, E., & Grassi, L. (2015). Depression in HIV infected patients: A review. Current Psychiatry Reports, 17(1), 530.Google Scholar
  33. Rane, M. S., Hong, T., Govere, S., Thulare, H., Moosa, M.-Y., Celum, C., et al. (2018). Depression and anxiety as risk factors for delayed care-seeking behavior in human immunodeficiency virus-infected individuals in South Africa. Clinical Infectious Diseases, 67, 1411–1418.Google Scholar
  34. Richardson, L. P., McCauley, E., Grossman, D. C., McCarty, C. A., Richards, J., Russo, J. E., et al. (2010). Evaluation of the patient health questionnaire-9 item for detecting major depression among adolescents. Pediatrics, 126(6), 1117–1123.Google Scholar
  35. Rios-Ellis, B., Becker, D., Espinoza, L., Nguyen-Rodriguez, S., Diaz, G., Carricchi, A., et al. (2015). Evaluation of a community health worker intervention to reduce HIV/AIDS stigma and increase HIV testing among underserved Latinos in the Southwestern US. Public Health Reports, 130(5), 458–467.Google Scholar
  36. Sauceda, J. A., Wiebe, J. S., Rao, D., Pearson, C. R., & Simoni, J. M. (2013). HIV-related stigma and HIV disclosure among Latinos on the US-Mexico border. In P. Liamputtong (Ed.), Stigma, discrimination and living with HIV/AIDS (pp. 187–203). New York: Springer.Google Scholar
  37. Schumacher, J. E., McCullumsmith, C., Mugavero, M. J., Ingle-Pang, P. E., Raper, J. L., Willig, J. H., et al. (2013). Routine depression screening in an HIV clinic cohort identifies patients with complex psychiatric co-morbidities who show significant response to treatment. AIDS and Behavior, 17(8), 2781–2791.Google Scholar
  38. Shrier, L. A., Harris, S. K., & Beardslee, W. R. (2002). Temporal associations between depressive symptoms and self-reported sexually transmitted disease among adolescents. Archives of Pediatrics and Adolescent Medicine, 156(6), 599–606.Google Scholar
  39. Tull, M. T., & Gratz, K. L. (2013). Major depression and risky sexual behavior among substance dependent patients: The moderating roles of distress tolerance and gender. Cognitive Therapy and Research, 37(3), 483–497.Google Scholar
  40. U.S. Census Bureau. (2010–2014). American Community Survey 5-year estimates. Retrieved from
  41. Villar-Loubet, O. M., Vamos, S., Jones, D. L., Lopez, E., & Weiss, S. M. (2011). A cultural perspective on sexual health: HIV positive and negative monolingual Hispanic women in South Florida. Hispanic Health Care International, 9(2), 82–90.Google Scholar
  42. Wagner, G. J., Ghosh-Dastidar, B., Slaughter, M., Akena, D., Nakasujja, N., Okello, E., et al. (2014). The role of depression in work-related outcomes of HIV treatment in Uganda. International Journal of Behavioral Medicine, 21(6), 946–955.Google Scholar
  43. Walker, E. R., Cummings, J. R., Hockenberry, J. M., & Druss, B. G. (2015). Insurance status, use of mental health services, and unmet need for mental health care in the United States. Psychiatric Services, 66(6), 578–584.Google Scholar
  44. Whetten, K., Shirey, K., Pence, B. W., Yao, J., Thielman, N., Whetten, R., et al. (2013). Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country. PLoS ONE, 8(10), e74771.Google Scholar
  45. Whooley, M. A., de Jonge, P., Vittinghoff, E., Otte, C., Moos, R., Carney, R. M., et al. (2008). Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA, 300(20), 2379–2388.Google Scholar
  46. Williams, S. Z., Chung, G. S., & Muennig, P. A. (2017). Undiagnosed depression: A community diagnosis. SSM-Population Health, 3, 633–638.Google Scholar
  47. Wohl, A. R., Galvan, F. H., Carlos, J.-A., Myers, H. F., Garland, W., Witt, M. D., et al. (2013). A comparison of MSM stigma, HIV stigma and depression in HIV-positive Latino and African American men who have sex with men (MSM). AIDS and Behavior, 17(4), 1454–1464.Google Scholar
  48. World Health Organization. (2004). Guidelines for the management of sexually transmitted infections. Retrieved from
  49. World Health Organization. (2016). Sexually transmitted infections (STIs). Retrieved from

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Boshen Jiao
    • 1
    • 2
    Email author
  • Zafar Zafari
    • 2
    • 3
  • Kai Ruggeri
    • 4
  • Sharifa Z. Williams
    • 2
    • 5
  1. 1.The Comparative Health Outcomes, Policy and Economics (CHOICE) InstituteUniversity of Washington School of PharmacySeattleUSA
  2. 2.Global Research Analytics for Population HealthColumbia University Mailman School of Public HealthNew YorkUSA
  3. 3.Department of Pharmaceutical Health Services ResearchUniversity of Maryland School of PharmacyBaltimoreUSA
  4. 4.Department of Health Policy and ManagementColumbia University Mailman School of Public HealthNew YorkUSA
  5. 5.Social Solutions and Services ResearchNathan S. Kline Institute for Psychiatric ResearchOrangeburgUSA

Personalised recommendations