Substance Abuse and Comorbid Depression: A Cross-Sectional Survey-Based Study Exploring Comorbidities and Depression Severity Using PHQ-9 among Female Substance Users in Pakistan Post-COVID-19

Introduction: In Pakistan, females with substance use (FSU) remain critically neglected despite an estimated 1.5 million users. Post-COVID-19, the drug use patterns among FSU remain largely elusive. Depression, though common among users, is rarely addressed in primary care. This study used PHQ-9 to assess depression among treatmentseeking female substance users. It explored the prevalent types of substances misused, the underlying motivations for use, and the potential consequences of substance misuse on the general health of women. Method: A cross-sectional survey was carried out among 200 female substance users and 200 controls from rehabilitation centers in Rawalpindi/Islamabad. Results: Misuse of nicotine (62%), cannabis (18%), opioids (alcohol and morphine) (10%), and methamphetamine (8%) was prevalent, while prescription drugs and LSD misuse remained low (2%). A considerable number of participants were consumers of nicotine pouches (12%), vapes (23%), and cigarettes (27%). Binge drinking was reported by 20% of alcohol users. PHQ-9 scores were significantly higher in substance users (11.42 ± 0.86) than non-users (8.68 ± 0.73) (p