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This study examined the relationship between\n                      <jats:styled-content>S<\/jats:styled-content>\n                      ubstance\n                      <jats:styled-content>A<\/jats:styled-content>\n                      buse,\n                      <jats:styled-content>V<\/jats:styled-content>\n                      iolence, and Heavy\n                      <jats:styled-content>A<\/jats:styled-content>\n                      lcohol use (SAVA) among BWLH to determine whether this relationship creates distinct syndemic classes and whether class membership was associated with depressive symptoms.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data for this study were drawn from the WAVE sub\u2010study, which included women enrolled in the WIHS (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0363) collected between April 2016 and April 2017 in four US cities. Latent class analysis was used to identify subgroups based on cannabis use, alcohol use, substance use, and violence. Regression analyses explored the association between baseline syndemic class membership and depressive symptoms at 6, 12, and 18 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three latent classes were identified: \u201csyndemic,\u201d \u201cnon\u2010syndemic low substance use,\u201d and \u201cnon\u2010syndemic moderate cannabis use.\u201d Women in the syndemic class, characterized by higher levels of substance use and violence, had significantly higher depressive symptoms compared to those in the non\u2010syndemic classes. Longitudinal regression revealed that membership in the syndemic class was associated with a 54% increased risk of depressive symptoms at 6 months, 34% at 12 months, and 51% at 18 months. Bidirectional analyses indicated that baseline violence was associated with increased risk for substance use, and vice versa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings highlight the high prevalence of SAVA syndemic factors and their association with depressive symptoms among BWLH and the need for integrated and culturally competent care that addresses both mental health and syndemic factors to improve outcomes for this vulnerable population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.71609","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T07:25:27Z","timestamp":1785482727000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Substance Abuse, Violence and Unhealthy Alcohol Use Syndemic Predicts Depression: A Longitudinal Study of Black Women Living With HIV in Four US Cities"],"prefix":"10.1002","volume":"16","author":[{"given":"T.","family":"Dyer","sequence":"first","affiliation":[{"name":"School of Public Health, Department of Epidemiology and Biostatistics University of Maryland  College Park Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Turpin","sequence":"additional","affiliation":[{"name":"College of Public Health, Department of Global and Community Health George Mason University  Fairfax Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Boyd","sequence":"additional","affiliation":[{"name":"College of Social Work The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Mittal","sequence":"additional","affiliation":[{"name":"School of Public Health, Department of Family Science University of Maryland  College Park Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Najib","sequence":"additional","affiliation":[{"name":"School of Public Health, Department of Epidemiology and Biostatistics University of Maryland  College Park Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Owusu","sequence":"additional","affiliation":[{"name":"School of Public Health, Department of Epidemiology and Biostatistics University of Maryland  College Park Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Watson","sequence":"additional","affiliation":[{"name":"Centers For Disease Control and Prevention National HIV Surveillance Branch  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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