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Stress, drug use, and depression are interconnected, but less is understood about sources of stress among adults with co-occurring drug use and depressive symptoms. The current study aimed to identify sources of stress and correlates among these adults. Data come from a cross-sectional baseline survey, including participants (n = 336) 18 to 55 years old, who reported past 6-month heroin or cocaine use and depressive symptoms. Exploratory factor analysis was conducted to identify sources of stress. Chi-square and multivariable Poisson regression with robust error variance were used to explore correlates of each factor. Three sources of stress were identified: financial stress related to drugs, stress due to community features, and stress involving a person's network. Past 6-month injection drug use (aPR = 1.34, 95% CI 1.07-1.67), perceived lack of control over drug use (aPR = 1.80, 95% CI 1.41-2.30), and difficulty abstaining from drug use (aPR = 1.55, 95% CI 1.22-1.97) were associated with an increased risk of high drug-related financial stress. Neighborhood disorder (aPR = 2.42, 95% CI 1.80-3.24) and sleeping on the street (aPR = 1.37, 95% CI 1.04-1.80) were associated with an increased risk of high community-level stress. Past 6-month injection drug use (aPR = 1.28, 95% CI 1.04-1.58), perceived lack of control over drug use (aPR = 1.37, 95% CI 1.10-1.70), and drug use stigma was associated with an increased prevalence of high drug network stress (aPR = 1.32, 95% CI 1.05-1.65). Stress is a complex construct, including distinct sources and correlates. Further understanding of sources of stress is beneficial in recognizing potentially modifiable challenges faced by individuals who use drugs and experience depressive symptoms.

Sources of Stress among Adults with Co-occurring Drug Use and Depressive Symptoms