The intersection of violence, substance use, depression, and STDs: testing of a syndemic pattern among patients attending an urban STD clinic

J Natl Med Assoc. 2010 Jul;102(7):614-20. doi: 10.1016/s0027-9684(15)30639-8.


Objectives: High rates of psychosocial and health problems have been identified among patients attending sexually transmitted disease (STD) clinics, who are disproportionately urban, have low income, and are racial/ethnic minorities. This study sought to determine whether these problems co-occurred and whether they indicated the presence of a syndemic.

Methods: Patients (N = 1557, 46% female, 64% African American) attending an urban STD clinic completed a computerized survey assessing childhood sexual abuse (CSA), depressive symptoms, binge drinking, marijuana use, intimate partner violence (IPV), and sexual risk behavior. Medical records were reviewed to determine incident STD diagnosis.

Results: The psychosocial and health problems were interrelated. Endorsing more psychosocial problems was associated with a greater likelihood of having multiple sexual partners and STD diagnosis. Interactions between CSA and marijuana use and between CSA and IPV predicted STD diagnosis.

Conclusions: Numerous psychosocial and health problems co-occur among urban STD clinic patients. There was some evidence of a syngergistic relationship (i.e., a syndemic) between these conditions, resulting in worsened sexual health outcomes. Health care needs to be multidisciplinary to address the multiple psychosocial and health problems faced by STD clinic patients. Research needs to identify factors that may underlie these comorbid conditions.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Ambulatory Care Facilities
  • Depression / epidemiology*
  • Female
  • Humans
  • Male
  • Sexually Transmitted Diseases / epidemiology*
  • Substance-Related Disorders / epidemiology*
  • United States / epidemiology
  • Urban Population
  • Violence / statistics & numerical data*