Ecstasy users: Risk factors for depressive and anxiety symptomatology

Abstract

Considerable research has been conducted looking at ecstasy and psychological functioning, particularly mood. However, the nature of the relationship between ecstasy and mood remains unclear. Few studies have examined what factors increase the likelihood that someone who uses ecstasy will experience mood symptoms in the short or long term. The current thesis aimed to develop a greater understanding of the relationship between ecstasy and mood by identifying risk factors for depressive and anxiety symptomatology in a sample of ecstasy users. Constructed as a thesis by publication, the thesis begins with review of the relevant literature and an overall introduction to the research project and design. Three articles are then presented in a series of chapters. The first article, titled ‘Depressive and anxiety symptomatology in ecstasy users: The relative contribution of genes, trauma, life stress and drug use’ has been published in Psychopharmacology. The research presented in this article aimed to determine the relationship between ecstasy use and depressive/anxiety symptomatology, after controlling for known environmental and genetic (polymorphism of the serotonin transporter gene) risk factors for depression and anxiety disorders. The second article is titled ‘Subacute effects of ecstasy on mood: An exploration of associated risk factors’. This article has been submitted to Journal of Psychopharmacology. Using a prospective design, the research reported in this article aimed to explore potential risk factors for depressive and anxiety symptoms in the short term, including ecstasy use. The third article, titled ‘Coping style and ecstasy use motives as predictors of current mood symptoms in ecstasy users’ has been submitted to Journal of Affective Disorders. The primary aim of this article was to determine whether the severity of mood symptoms in ecstasy users was predicted by coping style or ecstasy use motives. Data for the three papers were collected from two studies. Study one consisted of a community sample of 184 18-35 year olds who had taken ecstasy at least once in the past 12 months. Participants (87 males; 97 females) completed a semi-structured interview, self-report questionnaires and provided a saliva sample. Study 2 used a subsample of ecstasy users from study one to prospectively explore predictors of mood change over a one-week period. Individuals who took ecstasy during the follow up (n=35) were compared with those who abstained (n=21). Mood symptoms were assessed using the Mood and Anxiety Symptom Questionnaire, Kessler 10, a subjective mood rating, and the depression, anxiety and hostility items of the clinician-rated Brief Psychiatric Rating Scale. Ecstasy use motives and coping style were measured with the Drinking/Drug Motives Questionnaire and the Coping Inventory for Stressful Situations, respectively. Timeline methods were used to collect information on lifetime and recent ecstasy use, as well as recent other drug use and life stress. Trauma exposure was assessed using the Composite International Diagnostic Interview (CIDI) - Trauma List. Participants also provided demographic, psychiatric and sleep behaviour information. Genomic deoxyribonucleic acid (DNA) was extracted from participant saliva samples. The results of study one indicated that neither lifetime nor recent ecstasy use were associated with the severity of current mood symptoms, either alone or in combination with a genetic risk factor. Rather, lifetime trauma, recent stressful life events, coping style, ecstasy use motives and other drug use factors significantly predicted the severity of depressive and anxiety symptoms. Consistent with these findings, Study two (Article two) found that lowered mood and increased psychological distress were associated with self-reported quality of sleep and the number of stressful life events experienced during the one-week follow up, and not by ecstasy use. These results highlight the need to consider the role of environmental factors in the relationship between ecstasy use and mood symptoms, as well as the importance of coping skills training for managing stressful life events for people with co-occurring depressive/anxiety symptoms and substance use.