Major depression, alcohol and drug use disorders do not appear to account for the sexually transmitted disease and HIV epidemics in the southern United States.

OBJECTIVE Sexually transmitted disease (STD) and HIV infection are occurring at epidemic rates in the southern region of the United States. Depression and substance use disorders are associated with sexual risk behavior, so we investigated whether regionwide societal rates of major depression or substance use disorders could explain the higher southern rates. METHODS Data came from two surveys, the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992, N = 42,862) and the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC; 2001-2002, N = 43,093). Outcome variables included Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) major depressive disorder and substance use disorders (abuse/dependence), binge drinking, and lifetime drinker versus abstainer. Southern region was contrasted to all others. Because the STD/HIV epidemics affect blacks, especially young black women (18-44 years) disproportionately, we examined the relationships among region, depression, and substances in these subpopulations separately. RESULTS DSM-IV alcohol and cannabis abuse or dependence and being a lifetime drinker were significantly lower in the south than elsewhere in both the NLAES and NESARC with similar trends for DSM-IV cocaine abuse/dependence. CONCLUSIONS Counter to hypotheses, higher societal rates of depression or substance use disorders cannot account for the epidemic of STDs and HIV infection in the southern United States. Further studies are needed to determine if alcohol and drug disorders, being more deviant when they occur in the south, are more strongly associated with sexual risk behavior there than elsewhere.