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Vainionpää R, Tiisanoja A, Kokkola O, Riipinen P, Anttonen V. Association Between Self-Reported Oral Health and Dental Fear Among Illicit Drug Users in Northern Finland. Clin Exp Dent Res 2024; 10:e70055. [PMID: 39689106 DOI: 10.1002/cre2.70055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 11/28/2024] [Accepted: 12/02/2024] [Indexed: 12/19/2024] Open
Abstract
OBJECTIVES About 10% of adults in northern Finland have severe dental fear, but there is a lack of detailed knowledge about dental fear among illicit drug users. The aim of the study was to evaluate the prevalence of dental fear and its association with self-reported oral health and health behavior as well as background factors of the customers of substance abuse services living in the region of Oulu, Northern Ostrobothnia, Finland. MATERIALS AND METHODS One hundred seventeen volunteers, either active or former illicit drug users, were interviewed face-to-face about their background factors, health and health behaviors, and use of illicit drugs. The Modified Dental Anxiety Scale (MDAS) was used to assess a situation-specific level of dental anxiety. For analyses, Pearson's χ2 test, Fisher's exact test, ANOVA, and logistic regression analysis were performed. RESULTS Three out of four participants had at least moderate dental fear (MDAS ≥ 10) and 24% had severe dental fear (MDAS ≥ 19), with the average MDAS being 14.0 (SD 5.7). Participants in drug rehabilitation reported significantly more dental fear than the rest of the participants. Severe dental fear was associated (adjusted) with previous painful experiences OR 10.8 (2.3-52.0) and poor behavior by dental personnel OR 4.1 (1.2-13.9). CONCLUSIONS Dental fear is common among illicit drug users, and it is, particularly, associated with previous painful experiences and poor behavior by dental personnel.
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Affiliation(s)
- Raija Vainionpää
- Faculty of Medicine, Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Antti Tiisanoja
- Faculty of Medicine, Research Unit of Population Health, University of Oulu, Oulu, Finland
- Social and Health Services, Oulu, Finland
| | - Outi Kokkola
- Faculty of Medicine, Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center and University Hospital of Oulu, University of Oulu, Oulu, Finland
| | - Pirkko Riipinen
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Vuokko Anttonen
- Faculty of Medicine, Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center and University Hospital of Oulu, University of Oulu, Oulu, Finland
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Santos MJMC, Zare E, McDermott P, Santos Junior GC. Multifactorial Contributors to the Longevity of Dental Restorations: An Integrated Review of Related Factors. Dent J (Basel) 2024; 12:291. [PMID: 39329857 PMCID: PMC11431144 DOI: 10.3390/dj12090291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/30/2024] [Accepted: 09/09/2024] [Indexed: 09/28/2024] Open
Abstract
PURPOSE This integrated review aims to identify and analyze the multifactorial contributors to the longevity of direct restorations, focusing on tooth-, patient-, and dentist-related factors. MATERIALS AND METHODS A search of the literature was performed using an electronic database, PubMed/Medline, Web of Science, and Scopus, on papers published between 1980 and 2024. The titles and abstracts of papers that evaluated aspects categorized into tooth-related, patient-related, and dentist-related factors influencing restoration failure were selected and screened. Full-text assessments were conducted, and the extracted data were compiled, summarized, and synthesized. The reference lists of the collected papers were also screened, and relevant citations were included in this review. Data were gathered from clinical and laboratorial studies, systematic reviews, and meta-analyses to provide a comprehensive understanding of restoration longevity. RESULTS Among the tooth-related factors, multiple-surface restorations, deep margins, tooth location, and tooth vitality significantly impact restoration survival. Patient-related factors such as medical conditions, risk predictors of caries, age, sex, parafunctional habits, smoking, periodontal health, number of restorations, and socioeconomic status all play crucial roles. Regarding dentist-related factors, the decision-making process, age, experience, and dentist manual dexterity are vital aspects. Furthermore, the technique used, including isolation methods for moisture control, as well as the type of dental practice (large group vs. small practice), notably influenced the restoration survival. CONCLUSIONS The longevity of dental restorations is influenced by a complex interplay of tooth-related, patient-related, and dentist-related factors. Strategies to improve restoration outcomes should consider all these multifactorial contributors. Continuing professional education, diligent patient guidance on the factors that influence restoration survival, careful material selection and restorative technique, and tailored individual treatment are crucial factors to reduce failure rates and improve the lifespan of restorations.
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Affiliation(s)
| | - Elham Zare
- Interdisciplinary Medical Science, Schulich School of Medicine and Dentistry, London, ON N6A 3K7, Canada;
| | - Peter McDermott
- Schulich School of Medicine and Dentistry, Western University London, London, ON N6A 3K7, Canada; (M.J.M.C.S.); (P.M.)
| | - Gildo Coelho Santos Junior
- Schulich School of Medicine and Dentistry, Western University London, London, ON N6A 3K7, Canada; (M.J.M.C.S.); (P.M.)
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Bastien G, Abboud A, McAnulty C, Elkrief L, Ledjiar O, Socias ME, Le Foll B, Bahji A, Brissette S, Marsan S, Jutras-Aswad D. Impact of Depressive Symptom Severity on Buprenorphine/Naloxone and Methadone Outcomes in People With Prescription-Type Opioid Use Disorder: Results From a Pragmatic Randomized Controlled Trial. J Dual Diagn 2024; 20:189-200. [PMID: 38580298 DOI: 10.1080/15504263.2024.2329267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To evaluate the impact of depressive symptom severity on opioid use and treatment retention in individuals with prescription-type opioid use disorder (POUD). METHOD We analyzed data from a multi-centric, pragmatic, open-label, randomized controlled trial comparing buprenorphine/naloxone to methadone models of care in 272 individuals with POUD. Opioid use was self-reported every two weeks for 24 weeks using the Timeline Followback. Depressive symptom severity was self-reported with the Beck Depression Inventory at baseline, week 12 and week 24. RESULTS Baseline depressive symptom severity was not associated with opioid use nor treatment retention. At week 12, moderate depressive symptoms were associated with greater opioid use while mild to severe depressive symptoms were associated with lowered treatment retention. At week 24, moderate depressive symptoms were associated with greater opioid use. CONCLUSIONS Ongoing depressive symptoms lead to poorer outcomes in POUD. Clinicians are encouraged to use integrative approaches to optimize treatment outcomes. This study was registered in ClinicalTrials.gov (NCT03033732) on January 27th, 2017, prior to participants enrollment.
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Affiliation(s)
- Gabriel Bastien
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Anita Abboud
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Christina McAnulty
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Laurent Elkrief
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Omar Ledjiar
- Unité de recherche clinique appliquée, Centre hospitalier universitaire Ste-Justine, Montréal, Québec, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anees Bahji
- Department of Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Brissette
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Stéphanie Marsan
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
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Kar H, Gania AM, Bandy A, Ud Din Dar N, Rafiq F. Psychiatric comorbidities and concurrent substance use among people who inject drugs: a single-centre hospital-based study. Sci Rep 2023; 13:19053. [PMID: 37925494 PMCID: PMC10625634 DOI: 10.1038/s41598-023-45633-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023] Open
Abstract
The management of people who inject drugs (PWID) is compounded by the presence of psychiatric comorbidities leading to frequent relapses and poor treatment outcomes. Early identification and treatment of psychiatric comorbidities should be included in the management to enhance treatment outcomes. The objective of this study was to estimate the prevalence of psychiatric comorbidities and concurrent substance use among opioid injectors. This hospital-based, cross-sectional study was conducted from March 2021 to August 2022. This study included opioid injectors of all ages and both sexes. The Mini International Neuropsychiatric Interview-7 (MINI-7) and WHO-ASSIST were used to determine psychiatric comorbidities and concurrent substance use, respectively. Both crude and adjusted odds ratios were calculated to assess associations among demographic variables, concurrent substance use and psychiatric comorbidities. Among the 328 opioid injectors, the overall prevalence of psychiatric comorbidities was 88.1%, with the majority (68.6%) having more than one comorbidity. The most common psychiatric comorbidities were panic disorder (41.2%), social anxiety disorder (40.5%), and antisocial personality disorder (39.3%). Concurrent use of alcoholic beverages doubled the risk of ASPD (odds ratio 2.14 (1.24-3.72)). Cocaine (odds ratio 2.36 (1.10-5.03)) and amphetamines (odds ratio 7.68 (2.21-26.65)) increased the risk of OCD. Daily heroin injections were negatively associated (odds ratio 0.18 (0.03-0.94)) with psychotic disorders. Younger age (adjusted odds ratio 0.20 (0.79-0.53)) and never married status (adjusted odds ratio 2.62 (1.06-6.47)) were the only significant variables in the regression analysis. In conclusion, opioid injectors had a higher prevalence of numerous psychiatric comorbidities. The most common comorbidity was anxiety disorders. Concurrent use of tobacco, cannabis, cocaine, inhalants, etc., greatly increased the risk of psychiatric comorbidities.
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Affiliation(s)
- Hadiya Kar
- Department of Psychiatry, SKIMS Medical College, Bemina, Srinagar, 190018, India.
| | - Abdul Majid Gania
- Department of Psychiatry, SKIMS Medical College, Bemina, Srinagar, 190018, India
| | - Altaf Bandy
- College of Medicine, Shaqra University, Shaqra, 15571, Kingdom of Saudi Arabia
| | - Nizam Ud Din Dar
- Department of Psychiatry, SKIMS Medical College, Bemina, Srinagar, 190018, India
| | - Farhana Rafiq
- Department of Psychiatry, SKIMS Medical College, Bemina, Srinagar, 190018, India
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Saleem HT, West NS, Likindikoki S. Prevalence and predictors of depressive and anxiety symptoms in a sample of women who use drugs in Tanzania: the key role of drug use stigma. BMC Psychiatry 2023; 23:517. [PMID: 37464339 DOI: 10.1186/s12888-023-05008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Globally, women who use drugs face multiple health vulnerabilities, including poor mental health. Little is known about the mental health burden among women who use drugs in sub-Saharan Africa. This cross-sectional study examined the prevalence and predictors of depressive and anxiety symptoms among a sample of women who use drugs in Dar es Salaam, Tanzania. METHODS We administered a cross-sectional survey to a non-random sample of 200 women who use drugs in Dar es Salaam between November 2018 and March 2019. We used descriptive statistics to characterize the study sample and fitted separate logistic regression models to assess depressive and anxiety symptoms and their predictors. RESULTS The percentages of women reporting depressive and anxiety symptoms were 67.5% and 43.7%, respectively. Internalized drug use stigma (AOR = 1.34, 95% CI: 1.03-1.75) and prior attempts to stop heroin use (AOR = 2.99, 95% CI: 1.28-7.00) were associated with depressive symptoms. Enacted drug use stigma from health workers (AOR = 2.02, 95% CI: 1.34-3.04) and anticipated drug use stigma from family (AOR = 1.49, 95% CI: 1.02-2.16) were associated with anxiety symptoms. CONCLUSIONS Depressive and anxiety symptoms were high among our study sample, with higher reports of symptoms of depression than anxiety. Drug use stigma was a key factor that contributed to elevated symptoms of depression and anxiety.
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Affiliation(s)
- Haneefa T Saleem
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Nora S West
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Samuel Likindikoki
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Rabinowitz JA, Ellis JD, Wells J, Strickland JC, Maher BS, Hobelmann JG, Huhn A. Correlates and consequences of anxiety and depressive symptom trajectories during early treatment for alcohol use. Alcohol 2023; 108:44-54. [PMID: 36473635 PMCID: PMC10033438 DOI: 10.1016/j.alcohol.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/05/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
We investigated whether latent trajectories of anxiety and depressive symptoms were associated with clinically relevant variables including treatment attrition among individuals seeking treatment for alcohol use. Participants were drawn from 78 addiction treatment centers and included individuals in treatment for alcohol use, had in-treatment data, and screened positive for anxiety (n = 6147) or depressive symptoms (n = 6197) at intake. Anxiety and depressive symptoms were measured weekly during the first month of treatment. Three trajectories of anxiety symptoms (i.e., Persistent Moderate Anxiety Symptoms, Remitting Moderate Anxiety Symptoms, and Remitting Mild Anxiety Symptoms) and depressive symptoms (i.e., Increasing Moderate Depressive Symptoms, Persistent Moderate Depressive Symptoms, and Remitting Mild Depressive Symptoms) were identified. Women, younger individuals, and individuals who endorsed greater past month benzodiazepine use and depressive symptoms at intake were more likely to be in the Persistent Moderate Anxiety Symptoms trajectory relative to the Remitting Mild Anxiety Symptoms subgroup. Women, individuals who screened positive for anxiety at intake, and individuals reporting past month heroin use were more likely to be in the Increasing Moderate Depressive Symptoms trajectory relative to the Remitting Mild Depressive Symptom trajectory. Trajectories characterized by persistent moderate anxiety and depressive symptoms during the first month of treatment were more likely to drop out of treatment compared to individuals who reported low symptom levels. Findings indicate heterogeneity in the clinical course of anxiety and depressive symptoms among individuals in treatment for alcohol use and highlight that persistently high anxiety and depressive symptoms may pose an impediment to successful treatment completion. Results also demonstrate the importance of considering demographic and clinical characteristics at treatment intake as they may have significant implications for the unfolding of anxiety and depressive symptoms during treatment and subsequent outcomes.
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Affiliation(s)
- Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathan Wells
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Ashley Addiction Treatment, USA
| | - Brion S Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Andrew Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Ashley Addiction Treatment, USA
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Suhail M, Sohrab SS, Kamal M, Azhar EI. Role of hepatitis c virus in hepatocellular carcinoma and neurological disorders: an overview. Front Oncol 2022; 12:913231. [PMID: 35965577 PMCID: PMC9372299 DOI: 10.3389/fonc.2022.913231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
The hepatitis C virus (HCV) causes serious issues, affecting 71 million people globally. The most common manifestations range from chronic hepatitis to liver cirrhosis, leading to hepatocellular carcinoma. Many mechanisms are known to play an important role in HCV-induced HCC. The interaction of viral proteins with host cells results in oxidative stress damage, liver inflammation, and irregularities in signaling pathways. These results in the activation of oncogenes and metabolic disturbances, liver fibrosis, and angiogenesis. Additionally, some non-coding RNAs (ncRNAs) and toll-like receptors have been identified and play a significant role in HCC development. This virus is also associated with impairment of the central nervous system, resulting in acute or sub-acute encephalopathy and inflammatory disorders. Neurological disorders are associated with the inflammatory responses of many cells, including microglia and astrocytes. Additionally, there are many other extrahepatic manifestations, including neurological disorders such as depression and fatigue, in 50% of infected patients. These manifestations include neuro-invasion, immune-mediated damage, neurotransmitter alterations, sensory-motor polyneuropathy, sensitivity loss, weakness of the leg, and cryoglobulinemia, which significantly results in a reduced quality of life. HCV infection may be improved using an appropriate diagnosis and direct antiviral therapy for sustained virological response. However, the success of therapy depends on the symptoms and organ damage, diagnosis, and therapeutic strategies applied. Some published reports have discussed that HCV is associated with both HCC and neurological disorders. Additionally, it has also been observed that individuals with HCC also develop neurological disorders compared with individuals with HCV alone. This review aims to provide an overview of the latest information about the relationship between HCV-induced HCC and their role in neurological disorders. Additionally, we have also discussed the progress made in the diagnosis, physio-pathological mechanisms, and strong antiviral therapies developed for HCV infection and HCC, as well as the latest advancements made in the study of the neurological disorders associated with HCV infection.
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Affiliation(s)
- Mohd Suhail
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sayed Sartaj Sohrab
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- *Correspondence: Sayed Sartaj Sohrab,
| | - Mohammad Amjad Kamal
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- West China School of Nursing/Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Enzymoics Novel Global Community Educational Foundation, Hebersham, NSW, Australia
| | - Esam Ibraheem Azhar
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
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Saki F, Cheraghi M, Mohamadian H, Ghorbanyjavadpour F. Oral Health-Related Quality of Life Among Narcotic and Stimulant Users Referred to Maintenance Methadone Therapy Centers in Ahvaz City: Iran. Front Public Health 2022; 10:850550. [PMID: 35669740 PMCID: PMC9163318 DOI: 10.3389/fpubh.2022.850550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We aimed to assess quality of life related to oral health in narcotic or stimulant users those were referred to maintenance methadone therapy (MMT) centers in Ahvaz City, Iran. METHODS It was a cross-sectional study based on exploratory approach which has conducted on 187 narcotic and stimulant users in Ahvaz city; during 15th May till September 2020. Data was selected by available non-random sampling method. The data collection tools included the demographic variables and the standard OHIP-14 questionnaires. All tests were used as descriptive statistics, Kolmogorov-Smirnov tests, independent t-test, one-way analysis of variance. P-values of less than 0.05 was considered significant. RESULTS The mean and standard deviation of the participants' age was 36.03 ± 8.98 years. The quality-of-life scores related to oral health were totally 34.89 ± 6.50 as well as 37.37 and 33.96 in narcotic and stimulant users, respectively. The total quality of life related to OHIP-14 did not have a significant relationship with variables of age, life companions, level of education, number of children, economic status, employment status, insurance status, underlying disease, toothbrush use status, last dentist visit, and number of missing teeth (P > 0.05). However, a significant difference was found between the quality of life related to oral health based on the type of substance used (narcotic or stimulant), so that the mean quality of life related to oral health was higher in narcotic than stimulant users (P < 0.05). CONCLUSION Quality of life related to OHIP-14 was more unfavorable in stimulant users than narcotic users. So, policy makers and authorities are required to focus their interventions and research programs to improve health-related quality of life in users, especially stimulant.
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Affiliation(s)
- Fatemeh Saki
- Department of Community Oral Health, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maria Cheraghi
- Social Determinant of Health Research Center, Department of Community Oral Health, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hashem Mohamadian
- Department of Health Education and Promotion, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fataneh Ghorbanyjavadpour
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Le SM, Trouiller P, Duong TH, Khuat THO, Pham MK, Vallo R, Rapoud D, Quillet C, Nguyen TL, Nguyen QD, Nham TTT, Hoang TG, Feelemyer J, Vu HV, Moles JP, Doan HQ, Laureillard D, Des Jarlais DC, Nagot N, Michel L. Development and assessment of a community-based screening tool for mental health disorders among people who inject drugs. Drug Alcohol Rev 2022; 41:697-705. [PMID: 34786755 PMCID: PMC10150937 DOI: 10.1111/dar.13402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The prevalence of mental health disorders among people who use drugs is high and well documented. This hard-to-reach population faces a very low awareness and access to mental health care, especially in developing countries. The objectives of this study were to design and assess a quick screening tool (QST) that community-based organisations (CBO) could routinely apply to a Vietnamese population of people who inject drugs (PWID), in order to refer them appropriately to mental health specialists. METHODS We devised a tool that included nine questions covering anxiety, depression, suicide risk and psychotic symptomatology. Its use required no specific background and 2 h training. Specificity and sensitivity of the QST were assessed in a population of 418 PWID recruited via respondent driven sampling, using the Mini International Neuropsychiatric Interview questionnaire plus clinical evaluation as a reference standard. Acceptability was assessed using a self-administered anonymous questionnaire submitted to all CBO members who used the QST. RESULTS CBO members considered the QST easy to use, relevant and helpful to deal with mental health issues. Area under the curve for detection of any symptom using the QST was 0.770. The maximum sensitivity and specificity were reached with a cut-off of 2 [sensitivity was 71.1% (95% confidence interval 62.4, 78.8), specificity was 75.9% (70.5, 80.7)]. DISCUSSION AND CONCLUSIONS The QST appeared to be both efficient and well accepted. Given the burden of mental health problems among hard-to-reach PWID in developing countries, community-based screenings such as this one could be a particularly appropriate response.
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Affiliation(s)
- Sao M Le
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Philippe Trouiller
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
| | - Thi H Duong
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Thi H O Khuat
- Supporting Community Development Initiatives, Hanoi, Vietnam
| | - Minh K Pham
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Delphine Rapoud
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Catherine Quillet
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Thuy L Nguyen
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Quang D Nguyen
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Thi G Hoang
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Hai V Vu
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Jean-Pierre Moles
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Hong Q Doan
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Didier Laureillard
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Place du Professeur Robert Debré, Nîmes, France
| | | | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
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Gonçalves B, Pires R, Sousa Ferreira A, Gama Marques J, Paulino M, Henriques-Calado J. Maladaptive personality traits in depressive and substance use disorders: A study with the PID-5. Scand J Psychol 2021; 63:136-143. [PMID: 34714937 DOI: 10.1111/sjop.12783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/10/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
Studies on the relationship between personality and depressive disorders (DD) or substance use disorders (SUD) often refer to the normal personality model and focus mainly on the "big" factors. Domain level results with the Personality Inventory for DSM-5 (PID-5) tend to be consistent with NEO-PI-R or NEO-FFI results, however facet level results in the specific characteristics of these disorders are scarce. The main objective of this study was to characterize DD and SUD's maladaptive personality traits through the PID-5. A sample of DD was compared with a sample of SUD, with a sample of other disorders, and with a community sample. A sample of the general Portuguese population (N = 693) and a heterogeneous clinical sample (N = 310) were studied. Participants responded to the PID-5 and to the Brief Symptom Inventory (BSI). Depressivity, Irresponsibility and Anhedonia were the main characteristics of DD. However, high values in Depressivity and in depressive symptomatology were present in all the clinical subsamples. Irresponsibility, Deceitfulness and Callousness were the main characteristics of SUD. The occurrence of DD, SUD or Other disorders could be predicted using multinonomial logisitic regression analysis, and PID-5 facets as independent variables. These results are in line with comorbidity data and tend to confirm the PID-5 validity.
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Affiliation(s)
- Bruno Gonçalves
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal.,Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Rute Pires
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal.,Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Ana Sousa Ferreira
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal.,Instituto Universitário de Lisboa, Business Research Unit (BRU-IUL), Lisboa, Portugal
| | - João Gama Marques
- Clinica de Psiquiatria Geral e Transcultural, Hospital Julio de Matos, Lisboa, Portugal.,Clinica Universitária de Psiquiatria e de Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Henriques-Calado
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal.,Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
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11
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Faccioli J, Nardelli S, Gioia S, Riggio O, Ridola L. Neurological and psychiatric effects of hepatitis C virus infection. World J Gastroenterol 2021; 27:4846-4861. [PMID: 34447230 PMCID: PMC8371503 DOI: 10.3748/wjg.v27.i29.4846] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/07/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection is widespread and affects 71 million people worldwide. Although hepatic manifestations are the most frequent, ranging from chronic hepatitis to cirrhosis and hepatocellular carcinoma, it is also associated with several extrahepatic manifestations. Infected patients may present non-specific neurological symptoms, regardless of the presence of liver cirrhosis. Several pathogenetic mechanisms underlying neurological symptoms have been hypothesized: neuroinvasion, immune-mediated damage, neurotransmitter alterations and cryoglobulinemia. Alterations of the central nervous system include cerebral vasculopathy, acute or subacute encephalopathy and inflammatory disorders. HCV infection may be responsible for neuropathies, of which the most frequent form is symmetrical axonal sensory or sensory-motor polyneuropathy which causes loss of leg sensitivity and weakness. Up to 50% of patients with HCV infection may experience cognitive decline and psychological disorders, such as depression and fatigue. HCV associated neurocognitive disorder is independent of the presence of liver cirrhosis and affects different domains than in patients with hepatic encephalopathy. It can be studied using specific tests that mainly explore executive functions, verbal learning and verbal recall. These disorders significantly reduce the quality of life. The new antiviral therapies improve the extrahepatic symptoms of HCV infection and their success depends on the achievement of sustained virological response. However, the effect of therapy may differ depending on the type of organ involved; neurological symptoms can be irreversible if there is organic liver damage. The aim of this review is to provide a critical overview of physiopathological mechanisms, diagnostic and therapeutic strategies of the neurological and psychiatric effects of HCV infection.
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Affiliation(s)
- Jessica Faccioli
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome 00185, Italy
| | - Silvia Nardelli
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome 00185, Italy
| | - Stefania Gioia
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome 00185, Italy
| | - Oliviero Riggio
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome 00185, Italy
| | - Lorenzo Ridola
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome 00185, Italy
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12
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Adams M, Sionean C, Broz D, Lewis R, Wejnert C. Serious Mental Illness Among Young People Who Inject Drugs: An Assessment of Injection Risks and Healthcare Use. J Infect Dis 2021; 222:S401-S409. [PMID: 32877554 DOI: 10.1093/infdis/jiaa238] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data on behavioral correlates of mental illness among young people who inject drugs (PWID) are limited. We examine injection risks and healthcare use among young PWID with probable serious mental illness (PSMI). METHODS People who inject drugs were recruited and interviewed in 20 US cities for 2015 National HIV Behavioral Surveillance. Probable serious mental illness was assessed using the Kessler-6 screening scale. Bivariate analyses using log-linked Poisson regression with generalized estimating equations adjusted for design covariates were conducted to examine associations between PSMI and behaviors among PWID ages 18-29 years. RESULTS Of 1769 young PWID, 45% had PSMI. Compared to those without PSMI, PWID with PSMI were more likely to report injecting more than once a day, receptive syringe sharing, sharing of other injection equipment, and unmet needs for medical care and substance use disorder (SUD) treatment. Those with PSMI were less likely to use syringe services programs than those without PSMI. CONCLUSIONS Approximately half of young PWID had PSMI. People who inject drugs with PSMI engaged in high-risk injection behaviors and encountered barriers to healthcare. Human immunodeficiency virus prevention programs such as Syringe Services Programs (SSPs) could benefit from screening for mental illness among young PWID and strong linkage to healthcare, including mental health and SUD treatment.
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Affiliation(s)
- Monica Adams
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Catlainn Sionean
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Dita Broz
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Rashunda Lewis
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Cyprian Wejnert
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
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13
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Rizk MM, Herzog S, Dugad S, Stanley B. Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders. CURRENT ADDICTION REPORTS 2021; 8:194-207. [PMID: 33747710 PMCID: PMC7955902 DOI: 10.1007/s40429-021-00361-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 01/05/2023]
Abstract
Purpose of Review Suicide is a major public health concern and a leading cause of death in the US. Alcohol and opioid use disorders (AUD/OUD) significantly increase risk for suicidal ideation, attempts, and death, and are the two most frequently implicated substances in suicide risk. We provide a brief overview of shared risk factors and pathways in the pathogenesis of AUD/OUD and suicidal thoughts and behaviors. We also review clinical recommendations on inpatient care, pharmacotherapy, and psychotherapeutic interventions for people with AUD/OUD and co-occurring suicidal ideation and behavior. Recent Findings Among people with an underlying vulnerability to risk-taking and impulsive behaviors, chronic alcohol intoxication can increase maladaptive coping behaviors and hinder self-regulation, thereby increasing the risk of suicide. Additionally, chronic opioid use can result in neurobiological changes that lead to increases in negative affective states, jointly contributing to suicide risk and continued opioid use. Despite significantly elevated suicide risk in individuals with AUD/OUD, there is a dearth of research on pharmacological and psychosocial interventions for co-occurring AUD/OUD and suicidal ideation and behavior. Summary Further research is needed to understand the effects of alcohol and opioid use on suicide risk, as well as address notable gaps in the literature on psychosocial and pharmacological interventions to lower risk for suicide among individuals with AUD/OUD.
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Affiliation(s)
- Mina M. Rizk
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry, Faculty of Medicine, Minia University, Egypt, Egypt
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
| | - Sanjana Dugad
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Barbara Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY USA
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 42, New York, NY 10032 USA
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14
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Ghabrash MF, Bahremand A, Veilleux M, Blais-Normandin G, Chicoine G, Sutra-Cole C, Kaur N, Ziegler D, Dubreucq S, Juteau LC, Lestage L, Jutras-Aswad D. Depression and Outcomes of Methadone and Buprenorphine Treatment Among People with Opioid Use Disorders: A Literature Review. J Dual Diagn 2020; 16:191-207. [PMID: 32089124 DOI: 10.1080/15504263.2020.1726549] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: Depression is the most common psychiatric comorbidity among people with opioid use disorders (OUDs). However, whether and how comorbid depression is associated with the outcomes of opioid agonist therapy (OAT) remains poorly understood. The objective of this review was to identify and describe the association between depression and main outcomes (opioid use and treatment retention) of methadone and buprenorphine treatment among people with OUDs. Methods: A literature review was conducted by searching five electronic databases (MEDLINE, PubMed, Embase, Evidence-Based Medicine Reviews [EBMR], and Cumulative Index of Nursing and Allied Health Literature [CINAHL] Complete) from January 1970 to April 2019. Two independent reviewers screened titles and abstracts of the identified records by using pre-established eligibility criteria. Next, full texts were reviewed and studies that met inclusion criteria were selected. Finally, a descriptive synthesis of extracted data was performed. Results: In total, 12,296 records were identified and 18 studies that met inclusion criteria were retained. Of these, six studies reported reduced opioid use and seven reported increased opioid use during methadone or buprenorphine treatment. In addition, three studies reported an increased retention rate and four documented a decreased retention rate during methadone or buprenorphine treatment. The remaining studies did not find any significant association between depression and opioid use or treatment retention. Overall, the evidence did not demonstrate a consistent association between depression and outcomes of methadone or buprenorphine treatment. Conclusions: Although the inconsistent nature of the current evidence prohibited us from drawing definitive conclusions, we posit that the presence of depression among OUDs patients may not always predict negative outcomes related to retention and drug use during the course of OAT. Particularly, the hypothesis that adequate treatment of depression can improve treatment retention is promising and is in line with the call for increased efforts to provide integrated care for comorbid mental health disorders and addiction. Future studies with rigorous methodology are essential to better characterize the complex interplay between depression, OAT, and OUDs.
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Affiliation(s)
- Maykel Farag Ghabrash
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Arash Bahremand
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Martine Veilleux
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Geneviève Blais-Normandin
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Gabrielle Chicoine
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada
| | - Catherine Sutra-Cole
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Navdeep Kaur
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada
| | - Daniela Ziegler
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada
| | - Simon Dubreucq
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Louis-Christophe Juteau
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada.,Department of Family and Emergency Medicine, Université de Montréal, Montréal, Canada
| | - Laurent Lestage
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Didier Jutras-Aswad
- Centre de Recherche, Centre Hospitalier, Université de Montréal (CRCHUM), Montréal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
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15
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Frequency of injecting among people who inject drugs: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102619. [PMID: 31864107 DOI: 10.1016/j.drugpo.2019.102619] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/29/2019] [Accepted: 12/03/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND People who inject drugs (PWID) do so at varying frequencies. More frequent injecting is associated with skin and soft tissue infection, blood borne viruses, and overdose. The aims of this review are to estimate the prevalence of injecting frequency among PWID and compare these estimates to current needle-syringe distribution coverage estimates, and identify socio-demographic and risk characteristics, and harms associated with daily or more injecting. METHODS We conducted a systematic review of the peer-reviewed and grey literature from 2008 to 2018 and extracted needle-syringe distribution coverage data from a recent systematic review. We generated country-, region-, and global-level estimates of daily or more injecting. We also ran meta-regression analyses to determine associations between daily or more injecting and socio-demographic characteristics, injecting risk behaviour, non-fatal overdose, injection site skin infection, and blood borne virus prevalence. RESULTS Our search resulted in 61,077 sources, from which 198 studies were eligible for inclusion in this review. There were 74 countries with estimates for injecting frequency. Globally, we estimated that 68.1% (95%CI 64.5-71.6%) of PWID, equating to approximately 10.5 (95% UI 6.8-15.0) million people, inject daily or more frequently. There was a higher percentage of participants reporting daily or more injecting among samples with shorter injecting careers, more male participants and higher reporting of opioids as their main drug injected. Daily or more injecting was also associated with samples reporting a higher prevalence of HIV and hepatitis C antibody (anti-HCV), non-fatal overdose, and receptive needle sharing in the previous month. IMPLICATIONS WHO recently recommended a needle-syringe distribution target of 300 needles per PWID per year which is unlikely to be sufficient for the majority of PWID injecting daily or more who are out of drug treatment. FUNDING The Australian National Drug and Alcohol Research Centre, Australian National Health and Medical Research Council, University of New South Wales.
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16
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Malik E, Adelson M, Sason A, Schreiber S, Peles E. Outcome of Patients With High Depressive Symptoms on Admission to Methadone Maintenance Treatment. J Dual Diagn 2019; 15:281-290. [PMID: 31530109 DOI: 10.1080/15504263.2019.1656353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Comorbidity of depression among individuals with opioid addiction is highly prevalent, but their outcome in methadone maintenance treatment (MMT) is not well determined.Methods: Characteristics and outcomes (retention until December 2017) of newly admitted and already (5.5 ± 4 years) in MMT patients with available Hamilton Depression Rating Scale (HAM-D) scores on admission were studied.Results: During psychiatric intake on admission, 70 (21.2%) of 330 patients were diagnosed with high depressive symptoms beyond the cutoff (HAM-D scores ≥ 18). Depressed and nondepressed groups had a similar proportion of females (20% and 23.8%) and age at admission (43.0 ± 10.5 and 43.7 ± 10.4 years), but the depressed group had higher Brief Psychiatric Rating Scale (BPRS) scores (21.4 ± 8.6 vs. 7.0 ± 7.3, respectively; p < .0005), a higher proportion of minority (non-Jewish faith; 28.6% vs.15.4%; p =.02), and a higher proportion of positive urine screening results for cocaine (55.7% vs. 34.4%; p = .001) and for benzodiazepines on admission (74.3% vs. 57.5%; p = .01). Retention after 1 year was similar (79% and 80.7%), but depressed patients had higher rates of cocaine (40.8% vs. 25.5%; p = .05) and benzodiazepine use (59.2% vs. 41.8%; p = .04) and a shorter cumulative retention (5.6 years, 95% confidence interval [CI; 4.3, 7.0]) than the nondepressed patients (6.8 years, 95% CI [6.1, 7.5]; p = .05). Of the 263 evaluated while already in MMT, 23.5% were depressed, characterized with more females (43.5% vs. 23.4%) and with a history of rape (34.5% vs. 7.6%).Conclusions: Newly admitted depressed and nondepressed patients succeeded similarly in the first year retention in treatment, despite their cocaine and benzodiazepine co-abuse. The depression was characterized with females and with rape history in those who were already in MMT. Adequate intervention is recommended for both depressed groups to improve long-term retention and outcome.
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Affiliation(s)
- Elad Malik
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Adelson
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Sason
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shaul Schreiber
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Einat Peles
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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17
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Le TA, Le MQT, Dang AD, Dang AK, Nguyen CT, Pham HQ, Vu GT, Hoang CL, Tran TT, Vuong QH, Tran TH, Tran BX, Latkin CA, Ho CSH, Ho RCM. Multi-level predictors of psychological problems among methadone maintenance treatment patients in difference types of settings in Vietnam. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:39. [PMID: 31533764 PMCID: PMC6751619 DOI: 10.1186/s13011-019-0223-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/20/2019] [Indexed: 01/17/2023]
Abstract
Background Methadone, a long-acting opioid agonist maintenance treatment (MMT) is used to treat opioid addiction by preventing opioid withdrawal and reducing cravings. However, it is important to note that mental conditions may persist, or even remain undetected while methadone maintenance treatment is ongoing. This study aimed to examine the level of psychological problems among MMT patients at public and private health facilities and identify associated factors. Method From January to September 2018, a cross-sectional study was performed in Nam Dinh province, one of the largest epicenters providing HIV/AIDS surveillance and treatment services in the North of Vietnam. 395 male respondents currently receiving MMT agreed to participate in a face-to-face interview. Depression, Anxiety and Stress Scale-21 (DASS-21) were used to assess psychological problems among patients. Results The percentage of patients suffering from mild to extremely severe anxiety was the highest among psychological problems (18%). 2.8% of participants had mild depressive symptoms and the percentage of those having mild or moderate stress was approximately 4%. In addition, the longer treatment duration, the lower mental health scores regarding three types of psychological problems. Respondents who received MMT services in public health facilities were more likely to have a higher score of all psychological problems. Participants who lived with partners or spouse, having higher monthly family income had a lower likelihood of having severe depression and stress status. Freelancers or blue-collars/farmers had lower score of depression and anxiety compared to people being unemployed. Conclusion This study suggests that among our sample, MMT patients receiving treatment in public health facilities might have higher rate of psychological problems, including depression, anxiety, and stress than that of those in the private health facility. These results highlight the necessity of taking psychological counseling adequately for MMT patients and psychological assessment should be prioritized in the early stage of treatment.
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Affiliation(s)
- Tuan Anh Le
- National Institute of Hygiene and Epidemiology, Hanoi, 100000, Vietnam.,Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Mai Quynh Thi Le
- National Institute of Hygiene and Epidemiology, Hanoi, 100000, Vietnam
| | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Hanoi, 100000, Vietnam
| | - Anh Kim Dang
- Institute for Global Health Innovations, Duy Tan University, Postal address: No. 73 Hoang Cau street, Hanoi, Da Nang, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Postal address: No. 73 Hoang Cau street, Hanoi, Da Nang, Vietnam.
| | - Hai Quang Pham
- Institute for Global Health Innovations, Duy Tan University, Postal address: No. 73 Hoang Cau street, Hanoi, Da Nang, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, 700000, Vietnam
| | - Chi Linh Hoang
- Center of Excellence in Behavior Medicine, Nguyen Tat Thanh University, Ho Chi Minh, 700000, Vietnam
| | - Tung Thanh Tran
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, 700000, Vietnam
| | - Quan-Hoang Vuong
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong, Hanoi, 100803, Vietnam.,Faculty of Economics and Finance, Phenikaa University, Yen Nghia, Ha Dong, Hanoi, 100803, Vietnam
| | - Tung Hoang Tran
- Institute of Orthopaedic and Trauma Surgery, Vietnam - Germany Hospital, Hanoi, 100000, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, 119074, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavior Medicine, Nguyen Tat Thanh University, Ho Chi Minh, 700000, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore.,Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, Singapore, 117599, Singapore
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18
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Engagement in treatment for depression among people who inject drugs in Baltimore, Maryland. J Subst Abuse Treat 2019; 106:107-112. [PMID: 31540605 DOI: 10.1016/j.jsat.2019.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/31/2019] [Accepted: 09/04/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Mental health care may mitigate negative consequences related to substance use and bolster engagement in care for drug dependence. Despite the increased risk of depression among people who inject drugs (PWID), the longitudinal relationship of depression symptoms with depression and drug treatment utilization in this population remains uncharacterized. METHODS Data on depressive symptoms and depression treatment from current and former PWID in the ALIVE (AIDS Linked to the IntraVenous Experience) community-based cohort who had ≥3 study visits from July 2005 to June 2016 were included. We used logistic regression analysis with generalized estimating equations to examine factors associated with depression treatment in the 12 months following reported major depressive symptoms (CES-D ≥ 23) in the absence of treatment. We further examined the association between depression, depression treatment, and subsequent engagement in drug treatment among those with active substance use or alcohol dependence. RESULTS Of the 1544 participants, 34% were female, the median age was 51 years, and 91% were African-American. PWID reported major depressive symptoms at 22% of study visits. In adjusted analysis, acute emergency care, suicidal ideation, and recent alcohol or drug treatment were positively associated with initiating depression treatment. Depression was positively associated with subsequent treatment for substance dependence among those actively using (aOR = 1.30, 95% CI: 1.10-1.53). CONCLUSIONS PWID experience a high burden of depressive symptoms with significant unmet need of treatment for depression. Our findings suggest that mental health providers should bolster connections to chronic disease and alcohol and drug treatment providers.
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19
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Yeoh SW, Holmes ACN, Saling MM, Everall IP, Nicoll AJ. Depression, fatigue and neurocognitive deficits in chronic hepatitis C. Hepatol Int 2018; 12:294-304. [PMID: 29931590 DOI: 10.1007/s12072-018-9879-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
Abstract
Patients with chronic hepatitis C virus (HCV) infection experience a range of symptoms including depression, fatigue and neurocognitive deficits, impairing quality of life. Depression, in particular, may be reactive to increased psychosocial stress, and the physical symptoms of advanced HCV or associated comorbidities. However, even patients at an early stage of HCV infection, with minimal hepatic inflammation or comorbidities, report more depressive symptoms and fatigue than the general population. Similarly, specific neurocognitive deficits occur in early stage HCV infection and are independent of the presence of depression or encephalopathy. Therefore, intracerebral neurobiological changes associated with HCV may potentially explain these symptoms. These changes may arise from infiltration of the brain by peripherally induced cytokines, as well as direct neuropathic effects of HCV viral particles penetrating the blood-brain barrier. These phenomena parallel those reported in human immunodeficiency virus (HIV) infection. HCV-associated intracerebral changes include upregulated inflammatory responses, altered neurotransmitter levels, hormonal dysregulation, and release of neurotoxic substances. These may subsequently lead to abnormal neuronal conduction and function in areas of the brain governing affective responses, emotional processing, motivation, attention and concentration. Although direct-acting antiviral medications lead to high rates of HCV clearance, intracerebral changes may not be subsequently reversed and symptoms of depression, fatigue and neurocognitive deficits may persist. There is an ongoing role for multidisciplinary care and pharmacotherapy to manage these symptoms in HCV patients. Furthermore, there may be opportunities for future therapies to specifically target and ameliorate HCV-associated intracerebral changes.
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Affiliation(s)
- Sern Wei Yeoh
- Department of Gastroenterology, Eastern Health, 3 West, Building B, 8 Arnold St, Box Hill, VIC, 3128, Australia.
| | - Alex C N Holmes
- Department of Psychiatry, University of Melbourne, Level 1 North, Main Block, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Michael M Saling
- Melbourne School of Psychological Sciences, 12th Floor, Redmond Barry Building, Parkville Campus, University of Melbourne, Parkville, VIC, Australia, 3010.,Department of Clinical Neuropsychology, Austin Health, Heidelberg Repatriation Hospital, 300 Waterdale Rd, Ivanhoe, VIC, 3079, Australia.,Florey Institute for Neuroscience and Mental Health, 30 Royal Parade, Parkville, VIC, 3052, Australia
| | - Ian P Everall
- Department of Psychiatry, University of Melbourne, Level 1 North, Main Block, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia.,Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK
| | - Amanda J Nicoll
- Department of Gastroenterology, Eastern Health, 3 West, Building B, 8 Arnold St, Box Hill, VIC, 3128, Australia.,Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
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Alizadeh M, Zahedi-Khorasani M, Miladi-Gorji H. Treadmill exercise attenuates the severity of physical dependence, anxiety, depressive-like behavior and voluntary morphine consumption in morphine withdrawn rats receiving methadone maintenance treatment. Neurosci Lett 2018; 681:73-77. [PMID: 29859324 DOI: 10.1016/j.neulet.2018.05.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 09/30/2022]
Abstract
This study was designed to examine whether treadmill exercise would attenuate the severity of physical dependence, methadone-induced anxiety, depression and voluntary morphine consumption in morphine withdrawn rats receiving methadone maintenance treatment (MMT). The rats were chronically treated with bi-daily doses (10 mg/kg, at 12 h intervals) of morphine for 14 days. The exercising rats receiving MMT were forced to run on a motorized treadmill for 30 days during morphine withdrawal. Then, rats were tested for the severity of morphine dependence, the elevated plus-maze (EPM), sucrose preference test (SPT) and voluntary morphine consumption using a two-bottle choice (TBC) paradigm. The results showed that naloxone- precipitated opioid withdrawal signs were decreased in exercising morphine-dependent rats receiving MMT than sedentary rats. Also, the exercising morphine-dependent rats receiving MMT exhibited an increased time on open arms, preference for sucrose and a lower morphine preference ratio than sedentary rats. We conclude that treadmill exercise decreased the severity of physical dependence, anxiety/depressive-like behaviors and also the voluntary morphine consumption in morphine withdrawn rats receiving MMT. Thus, exercise may benefit in the treatment of addicts during MMT.
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Affiliation(s)
- Maryam Alizadeh
- Laboratory of Animal Addiction Models, Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran; Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran; Student Research Committee, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Mahdi Zahedi-Khorasani
- Laboratory of Animal Addiction Models, Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran; Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Hossein Miladi-Gorji
- Laboratory of Animal Addiction Models, Research Center of Physiology, Semnan University of Medical Sciences, Semnan, Iran; Department of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
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21
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Holliday RC, Braithwaite RL, Yancey E, Akintobi T, Stevens-Watkins D, Smith S, Powell CL. Substance Use Correlates of Depression among African American Male Inmates. J Health Care Poor Underserved 2018; 27:181-93. [PMID: 27133518 DOI: 10.1353/hpu.2016.0058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Substance use correlates of depressive symptoms among incarcerated adult male African American substance users were examined in the current study. Frequency of drug use was assessed with 12 items specific to an individual's substance use. The Patient Depression Questionnaire (PHQ-9) was used to assess symptoms of depression. Approximately 90% of the sample displayed symptoms of depression ranging from minimal to severe. Regression models revealed that three substance use variables demonstrated a significant predictor of depression, including alcohol (β = .16, p= .03), hallucinogens (β =-.17, p =.021), and ecstasy (β =-.14, p= .05). The study findings indicate a need to consider the role of specific substances with regard to symptoms of depression. The results are discussed in the context of transition planning for jail inmates.
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22
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Frontal cortex dysfunction as a target for remediation in opiate use disorder: Role in cognitive dysfunction and disordered reward systems. PROGRESS IN BRAIN RESEARCH 2018; 239:179-227. [DOI: 10.1016/bs.pbr.2018.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
We conducted a cross-sectional study in Tuyen Quang Province, a mountainous province in northern Vietnam, to examine rates of psychological distress among 241 patients receiving methadone maintenance treatment (MMT). Using the Kessler psychological distress Scale, we found that approximately one-fourth (26.8%) of respondents suffered from mental health pathologies. Physical health problems, current drug use, and alcohol abuse were found to be associated with mental health problems among the participants. Our findings highlight the high prevalence of psychological distress among MMT patients in northern Vietnam, and the need to integrate mental and physical health care services, as well as behavioral health counseling, into currently existing MMT clinics in this region.
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Stein MD, Santiago Rivera OJ, Anderson BJ, Bailey GL. Perceived need for depression treatment among persons entering inpatient opioid detoxification. Am J Addict 2017; 26:395-399. [PMID: 28453912 DOI: 10.1111/ajad.12554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/15/2017] [Accepted: 03/27/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Depression is common among persons with opioid use disorder. We examined the perceived need for depression treatment (PNDT) among opioid-dependent patients and the relationship of PNDT to depression screening result. METHODS Between May and December 2015, we surveyed consecutive persons (n = 440) seeking inpatient opioid detoxification. We used the Patient Health Questionnaire-2 (PHQ-2) to screen for depression. To assess perceived need for depression services, participants were asked, "Do you believe you should be treated for depression?" Response options were recorded into four categories: "Not Depressed (ND)," "Perceive Need for Depression Treatment (PNDT)," "Depressed/Don't Want Treatment," and "Currently Treated." RESULTS Participants' mean age was 32.3 (±8.7) years; 70.7% were male. Nearly two out of three persons screened positive for depression yet only 8.2% were being treated for depression prior to admission. Screening positive for depression was associated with a 2.95 (95%CI 1.82-4.81, p < .005) fold increase in the expected odds of PNDT. But nearly half of those depressed (48%) did not perceive the need for treatment. Approximately 40% of the participants (n = 177) perceived that they were not depressed; of these persons, 52% screened positive for depression. DISCUSSION AND CONCLUSIONS Detoxification program staff should screen patients for depression, and if a clinical diagnosis is confirmed, discuss treatment options, exploring the level of interest in mental health treatment for depression. SCIENTIFIC SIGNIFICANCE Screening for and addressing depression, including patients' interest in treatment, should be central to post-detoxification aftercare planning. (Am J Addict 2017;26:395-399).
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Affiliation(s)
- Michael D Stein
- Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts.,Butler Hospital, Providence, Rhode Island
| | | | | | - Genie L Bailey
- Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts.,Warren Alpert Medical School of Brown University, Providence, Rhode Island
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25
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Ho YF, Ng MH, Tsai CC, Lee CH, Tsai D, Chou JY, Huang CL, Shao WC, Lin TY, Chen VCH, Gossopi M. Major depression and related factors among heroin users who received methadone maintenance treatment in Taiwan: a case control study. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.3109/14659891.2015.1021866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yi-Feng Ho
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - Mei-Hing Ng
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - Chi-Chin Tsai
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - Chao-Hui Lee
- Department of Clinical Psychology, Taipei City Hospital, Song-De Branch, Taipei, Taiwan
| | - Duujian Tsai
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jen-Yu Chou
- Graduate Institute for Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chieh-Liang Huang
- Centre for Drug Abuse & Addiction, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Chuan Shao
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - Tsang-Yaw Lin
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chung Shan Medical University, Taichung, Taiwan
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Taiwan Chang Gung University, Taiwan
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26
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Yi S, Tuot S, Chhoun P, Pal K, Choub SC, Mburu G. Prevalence and correlates of psychological distress among drug users in Phnom Penh, Cambodia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 36:25-32. [PMID: 27450717 DOI: 10.1016/j.drugpo.2016.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/12/2016] [Accepted: 06/01/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Compared to the general population, drug users are at increased risk of both poor mental health and HIV infection. The aim of this study was to determine the prevalence and correlates of high psychological distress among drug users in Cambodia. METHODS In April 2014, a two-stage cluster sampling method was used to randomly select 169 drug users from hotspots in Phnom Penh. Psychological distress was measured using General Health Questionnaire (GHQ-12). Bivariate and multivariable analyses were conducted to identify factors associated with levels of psychological distress among this population. RESULTS Our study found high prevalence of attempted suicide (15.3%), drug related arrests (46.2%), and incarceration (31.4%). Of the 169 participants, 42.0% were found to have high levels of psychological distress, indicating poor mental health. After adjustment, high levels of psychological distress were independently associated with suicidal ideation (p<0.001), higher frequency of drug use (p=0.02), sharing of needles or syringes (p=0.005), and having been sent to a rehabilitation centre (p=0.02). In addition, participants who perceived their overall health as being poor or very poor were more likely to have high levels of psychological distress (p=0.002). CONCLUSION Integration of mental health within HIV and needle and syringe exchange programmes is required to address psychological distress among drug users in Cambodia. Health system interventions, such as screening, referral, and training of health providers, need to be strengthened. In addition, interventions addressing social determinants of mental health and mitigation of frequent arrests and improving conditions in rehabilitation centres are required.
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Affiliation(s)
- Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia; Center for Global Health Research, Touro University California, USA.
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Khuondyla Pal
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | | | - Gitau Mburu
- International HIV/AIDS Alliance, Brighton, UK; Division of Health Research, Lancaster University, Lancaster, UK
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Stein MD, Kanabar M, Anderson BJ, Lembke A, Bailey GL. Reasons for Benzodiazepine Use Among Persons Seeking Opioid Detoxification. J Subst Abuse Treat 2016; 68:57-61. [PMID: 27431047 DOI: 10.1016/j.jsat.2016.06.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/06/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Over the past decade, patients admitted to addiction treatment programs have reported increasing rates of concurrent opioid and benzodiazepine (BZD) use. This drug combination places individuals at high risk for accidental overdose. Little is known about reasons for BZD use among individuals seeking treatment for opioid use disorders. METHODS We surveyed consecutive persons initiating inpatient opioid detoxification and identified 176 out of 438 who reported BZD use in the past 30 days and/or had a positive toxicology. RESULTS Forty percent of persons surveyed used a BZD in the month prior to admission, and 25% of these met criteria for BZD dependence (DSM IV). BZD users averaged 32.0 years of age, 63.6% were male, 85.2% used heroin, and reported, on average, 13.3 (±11.2) days of BZD use during the past month. Alprazolam (Xanax) was the most commonly used BZD (52%), and buying it on the street the most common source (48%). The most commonly reported reason for BZD use was 'to manage anxiety' (42.6%), followed by 'to get or enhance a high' (27.7%), 'to help with sleep' (11.4%), and 'to decrease opioid withdrawal' (10.2%). The most common reason for BZD use was significantly associated (p<.001) with most likely source of BZDs, with persons who got their BZDs from a prescriber (23%) more likely to report BZD anxiety as their primary reason for use, while persons who bought BZDs on "the street" (48%) had the highest likelihood of reporting using BZD to get or enhance a high. Participants using BZDs most commonly for anxiety did not endorse lower anxiety than those using BZDs for other reasons. CONCLUSIONS Two in five persons seeking detoxification for an opioid use disorder used a BZD in the prior month. Anxiety was the most common reason patients reported using a benzodiazepine, but they also reported using BZDs to enhance a 'high' and manage opioid withdrawal. Evidence-based discussions about the risks of combining BZDs and opioids, and alternatives to BZDs should be a high priority in detoxification settings.
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Affiliation(s)
- Michael D Stein
- Behavioral Medicine Division, Butler Hospital, Providence, RI, 02906, USA; Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA.
| | - Mitika Kanabar
- Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Bradley J Anderson
- Behavioral Medicine Division, Butler Hospital, Providence, RI, 02906, USA
| | - Anna Lembke
- Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA; Stanley Street Treatment and Resources, Inc., Fall River, MA 02720, USA
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Michalopoulos LM, Jiwatram-Negrón T, Choo MKK, Kamarulzaman A, El-Bassel N. The association between psychosocial and structural-level stressors and HIV injection drug risk behavior among Malaysian fishermen: A cross-sectional study. BMC Public Health 2016; 16:464. [PMID: 27250497 PMCID: PMC4890521 DOI: 10.1186/s12889-016-3125-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 05/13/2016] [Indexed: 11/24/2022] Open
Abstract
Background Malaysian fishermen have been identified as a key-affected HIV population with HIV rates 10 times higher than national rates. A number of studies have identified that psychosocial and structural-level stressors increase HIV injection drug risk behaviors. The purpose of this paper is to examine psychosocial and structural-level stressors of injection drug use and HIV injection drug risk behaviors among Malaysian fishermen. Methods The study employs a cross-sectional design using respondent driven sampling methods. The sample includes 406 fishermen from Pahang state, Malaysia. Using multivariate logistic regressions, we examined the relationship between individual (depression), social (adverse interactions with the police), and structural (poverty-related) stressors and injection drug use and risky injection drug use (e.g.., receptive and non-receptive needle sharing, frontloading and back-loading, or sharing drugs from a common container). Results Participants below the poverty line had significantly lower odds of injection drug use (OR 0.52, 95 % CI: 0.27-0.99, p = 0.047) and risky injection drug use behavior (OR 0.48, 95 % CI: 0.25-0.93, p = 0.030). In addition, participants with an arrest history had higher odds of injection use (OR 19.58, 95 % CI: 9.81-39.10, p < 0.001) and risky injection drug use (OR 16.25, 95 % CI: 4.73-55.85, p < 0.001). Participants with depression had significantly higher odds of engaging in risky injection drug use behavior (OR 3.26, 95 % 1.39-7.67, p = 0.007). Focusing on participants with a history of injection drug use, we found that participants with depression were significantly more likely to engage in risky drug use compared to participants below the depression cutoff (OR 3.45, 95 % CI: 1.23-9.66, p < 0.02). Conclusions Findings underscore the need to address psychosocial and structural-level stressors among Malaysian fishermen to reduce HIV injection drug risk behaviors. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3125-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lynn Murphy Michalopoulos
- Social Intervention Group, Global Health and Mental Health Unit of the Social Intervention Group, Global Health Research Center of Central Asia, Columbia University, School of Social Work, New York, NY, USA.
| | - Tina Jiwatram-Negrón
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University, School of Social Work, New York, NY, USA
| | - Martin K K Choo
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nabila El-Bassel
- Social Intervention Group, Global Health Research Center of Central Asia, Columbia University, School of Social Work, New York, NY, USA
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Wu Y, Yan S, Bao Y, Lian Z, Qu Z, Liu Z. Cross-sectional study of the severity of self-reported depressive symptoms in heroin users who participate in a methadone maintenance treatment program. SHANGHAI ARCHIVES OF PSYCHIATRY 2016; 28:35-41. [PMID: 27688642 PMCID: PMC4984614 DOI: 10.11919/j.issn.1002-0829.215127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Methadone maintenance treatment (MMT) is widely recognized as an effective method of
combatting narcotic addiction. MMT reduces heroin withdrawal symptoms and, thus, makes it possible to
provide the psychological and social support that is essential to the rehabilitation of drug users. Aim Compare the severity of depressive symptoms in heroin users who are currently receiving MMT to that
of heroin users who are not receiving MMT. Methods We administered the 13-item version of the Beck Depression Inventory (BDI-13) and a
demographic history form to 929 heroin users who had been receiving MMT at nine methadone treatment
clinics in three Chinese cities for an average of 9 months and to 238 heroin users who had enrolled in a MMT
program at the centers but had not yet begun MMT. Results Seventy-nine percent (188/238) of the untreated individuals reported depressive symptoms
compared to 68% (628/929) of the individuals receiving MMT (χ2=11.69, p<0.001). The median (interquartile
range) BDI score in the untreated group was 10.4 (7.9-11.4) compared to 8.0 (5.7-11.6) in the MMT group
(Z=2.75, p=0.006). In the MMT group, there was a negative correlation between the severity of reported
depressive symptoms and the duration of participation in the MMT program (rs=-0.24, Z=2.88, p=0.004).
Multivariate linear regression analysis showed that after adjusting for all demographic variables the treated
group still had less severe depressive symptoms than the untreated group. After adjusting for the effect of
MMT treatment, depressive symptoms were more severe in heroin users who self-reported poor family
relationships (standardized regression coefficient β=0.118, t=6.56, p<0.001) and in those who were
divorced (β=0.120, t=3.73, p<0.001). Conclusions Moderate to severe depressive symptoms are common in heroin users. MMT is associated
with lower levels of depressive symptoms in heroin users, but prospective randomized controlled trials
are needed to determine whether or not MMT actually improves depressive symptoms in heroin users.
Poor relationships with family members are also associated with depressive symptoms in heroin users; this
suggests that treatment of heroin addiction needs to incorporate methods for helping heroin users repair
the severed social relationships that their addiction has caused.
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Affiliation(s)
- Yafei Wu
- Weinan Vocational and Technical College, Shanxi, China
| | - Shiyan Yan
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Yanping Bao
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhi Lian
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhi Qu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhimin Liu
- China Academy of Chinese Medical Sciences, Beijing, China ; Weinan Vocational and Technical College, Shanxi, China
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30
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Tran BX, Nguyen LH, Nong VM, Nguyen CT, Phan HTT, Latkin CA. Behavioral and quality-of-life outcomes in different service models for methadone maintenance treatment in Vietnam. Harm Reduct J 2016; 13:4. [PMID: 26837193 PMCID: PMC4736621 DOI: 10.1186/s12954-016-0091-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrating HIV/AIDS and methadone maintenance treatment (MMT) services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics. However, efficiency of different integrative service models is unknown. This study assessed behavioral and health-related quality-of-life (HRQOL) outcomes of MMT in four service delivery models and explored factors associated with these outcomes of interest. METHODS A cross-sectional survey was conducted in two HIV epicenters in Vietnam: Hanoi and Nam Dinh Province. All patients in five selected MMT clinics were invited to participate, and 1016 were interviewed (80-90% response rate). RESULTS Respondents had a mean age of 35.8, taken MMT for average 16.5 months and 3.3% on MMT for 36-60 months. The MMT integrated with rural district health center (DHC) has the highest prevalence of concurrent drug use (11.3%). The percentage of condom use (last sexual intercourse) with primary and casual partners was lowest in the MMT at urban DHCs. Patients at the rural DHC reported very high proportions of pain/discomfort (37.8%), anxiety/depression (43.1%), and mobility (13.3%). In regression models, poorer HRQOL outcomes were found in MMT models in the rural areas or without general health care, and among those patients who were HIV positive, reported concurrent drug use, and had higher numbers of previous drug rehabilitation episodes. Mobility and anxiety/depression are factors that increased the likelihood of concurrent drug use among MMT patients. CONCLUSIONS Outcomes of MMT were diverse across different integrative service models. Policies on rapid expansion of the MMT program in Vietnam should also emphasize on the integration with comprehensive health care services including psychological supports for patients.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Long Hoang Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Vuong Minh Nong
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Chen VCH, Wu MH, Lin TY, Ho YF, Wang HY, Gossop M. Comparison of socio-demographic characteristics, substance, and depression among male heroin users attending therapeutic community and methadone maintenance treatment program in Nantou, Taiwan. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:41. [PMID: 26507876 PMCID: PMC4624703 DOI: 10.1186/s13011-015-0037-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/19/2015] [Indexed: 11/18/2022]
Abstract
Background Little is known about differences between the characteristics and psychopathological symptoms of heroin users attending TC or MMT in Asia. This study aimed to compare characteristics and prevalence of depressive disorders among male heroin users in TC and MMT program in Nantou, Taiwan. Methods The study sample (n = 705) comprised male heroin users with heroin dependence recruited from the MMT program and TC program at a psychiatric center in Nantou, Taiwan between 2006 and 2014. Socio-demographic and heroin-related characteristics were obtained from self-report questionnaires. DSM-IV diagnoses of heroin dependence, major depressive disorder, and dysthymic disorder were evaluated by trained interviewers. T-test and chi-square test and multivariate logistic regression were performed to measure the differences on variables between samples of TC and MMT. Results Compared to MMT, TC participants had poorer family support, higher rate of unmarried, higher rate of unemployment, earlier onset of heroin use, longer length of heroin use, and lower daily dosage of heron. MMT heroin users had higher 1-month prevalence of major depressive disorder than TC participants. We found the distribution of current major depression disorder differed between heroin users choosing different treatment models even controlling for other demographic factors, substance related factors and psychosocial factors. The underlying explanations require further investigation. Conclusions This study found differences in the characteristics and prevalence of psychopathology. Further study to explore the effect of these differences on the outcome between MMT and TC is warranted.
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Affiliation(s)
- Vincent Chin-Hung Chen
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, 613, Chiayi County, Taiwan. .,Chang Gung University, 333, Tao-Yuan, Taiwan.
| | - Meng-Huan Wu
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Tsang-Yaw Lin
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Yi-Feng Ho
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Hsin-Yi Wang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Michael Gossop
- King's College London, Institute of Psychiatry, London, SE5 8AF, UK.
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Tran BX, Nguyen LH, Phan HTT, Nguyen LK, Latkin CA. Preference of methadone maintenance patients for the integrative and decentralized service delivery models in Vietnam. Harm Reduct J 2015; 12:29. [PMID: 26377824 PMCID: PMC4574353 DOI: 10.1186/s12954-015-0063-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrating and decentralizing services are essential to increase the accessibility and provide comprehensive care for methadone patients. Moreover, they assure the sustainability of a HIV/AIDS prevention program by reducing the implementation cost. This study aimed to measure the preference of patients enrolling in a MMT program for integrated and decentralized MMT clinics and then further examine related factors. METHODS A cross-sectional study was conducted among 510 patients receiving methadone at 3 clinics in Hanoi. Structured questionnaires were used to collect data about the preference for integrated and decentralized MMT services. Covariates including socio-economic status; health-related quality of life (using EQ-5D-5 L instrument) and HIV status; history of drug use along with MMT treatment; and exposure to the discrimination within family and community were also investigated. Multivariate logistic regression with polynomial fractions was used to identify the determinants of preference for integrative and decentralized models. RESULTS Of 510 patients enrolled, 66.7 and 60.8 % preferred integrated and decentralized models, respectively. The main reason for preferring the integrative model was the convenience of use of various services (53.2 %), while more privacy (43.5 %) was the primary reason to select stand-alone model. People preferred the decentralized model primarily because of travel cost reduction (95.0 %), while the main reason for not selecting the model was increased privacy (7.7 %). After adjusting for covariates, factors influencing the preference for integrative model were poor socioeconomic status, anxiety/depression, history of drug rehabilitation, and ever disclosed health status; while exposure to community discrimination inversely associated with this preference. In addition, people who were self-employed, had a longer duration of MMT, and use current MMT with comprehensive HIV services were less likely to select decentralized model. CONCLUSION In conclusion, the study confirmed the high preference of MMT patients for the integrative and decentralized MMT service delivery models. The convenience of healthcare services utilization and reduction of geographical barriers were the main reasons to use those models within drug use populations in Vietnam. Countering community stigma and encouraging communication between patients and their societies needed to be considered when implementing those models.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Long Hoang Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | | | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Newville H, Berg KM, Gonzalez JS. The interaction of active substance use, depression, and antiretroviral adherence in methadone maintenance. Int J Behav Med 2015; 22:214-22. [PMID: 25081100 DOI: 10.1007/s12529-014-9429-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Adherence to highly active antiretroviral therapy (HAART) remains crucial in successfully treating HIV. While active substance use and depression are both associated with each other and with HAART nonadherence, little is known about their interaction. An understanding of the interaction of substance use and depressive symptoms on HAART adherence can inform adherence-enhancing interventions as well as interventions that target substance use and depression. PURPOSE We tested an interaction between substance use and depression on HAART adherence among methadone maintenance patients. METHOD We assessed substance use, depressive symptoms, and HAART adherence among 100 HIV-infected individuals receiving methadone maintenance in The Bronx, New York. Regressions were performed on adherence using an interaction term comprised of substance use and depressive symptoms. MODPROBE was used to assess significant interactions. RESULTS Any use of illicit substances was associated with HAART nonadherence (p = 0.043). Cannabis was the single substance of abuse most strongly associated with nonadherence (p = 0.003). Depressive symptoms approached significance in bivariate analysis (p = 0.066). In regression analysis, a significant interaction was found between illicit substance use and depressive symptoms [OR (95% CI) 1.23 (1.06-1.44), p = 0.007], where illicit substance use was associated with nonadherence in individuals with lower depressive symptoms, but not among those with depressive symptoms at higher levels. No individual substances interacted with depressive symptoms on adherence. CONCLUSION Though substance use and depressive symptoms interacted on HAART adherence, they did not have a synergistic effect. Continued substance use (51% of the sample) suggests an unmet need for treatment, even in methadone maintenance. Further examinations of the interplay of substance use and depression on HAART adherence are warranted.
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Affiliation(s)
- Howard Newville
- Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke's, New York, NY, USA,
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Chronic pain and depression among primary care patients treated with buprenorphine. J Gen Intern Med 2015; 30:935-41. [PMID: 25678375 PMCID: PMC4471032 DOI: 10.1007/s11606-015-3212-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 01/08/2015] [Accepted: 01/21/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pain and depression are each prevalent among opioid dependent patients receiving maintenance buprenorphine, but their interaction has not been studied in primary care patients. OBJECTIVE We set out to examine the relationship between chronic pain, depression, and ongoing substance use, among persons maintained on buprenorphine in primary care settings. DESIGN Between September 2012 and December 2013, we interviewed buprenorphine patients at three practice sites. PARTICIPANTS Opioid dependent persons at two private internal medicine offices and a federally qualified health center participated in the study. MAIN MEASURES Pain was measured in terms of chronicity, with chronic pain being defined as pain lasting at least 6 months; and in terms of severity, as measured by self-reported pain in the past week, measured on a 0-100 scale. We defined mild chronic pain as pain severity between 0 and 39 and lasting at least 6 months, and moderate/severe chronic pain as severity ≥ 40 and lasting at least 6 months. To assess depression, we used the Center for Epidemiologic Studies Depression (CESD) ten-item symptom scale and the two-item Patient Health Questionnaire (PHQ-2). KEY RESULTS Among 328 participants, 169 reported no chronic pain, 56 reported mild chronic pain, and 103 reported moderate/severe chronic pain. Participants with moderate/severe chronic pain commonly used non-opioid pain medications (56.3%) and antidepressants (44.7%), yet also used marijuana, alcohol, or cocaine (40.8%) to help relieve pain. Mean CESD scores were 7.1 (±6.8), 8.3 (±6.0), and 13.6 (±7.6) in the no chronic, mild, and moderate/severe pain groups, respectively. Controlling for covariates, higher CESD scores were associated with a higher likelihood of moderate/severe chronic pain relative to both no chronic pain (OR = 1.09, p < 0.001) and mild chronic pain (OR = 1.06, p = 0.04). CONCLUSION Many buprenorphine patients are receiving over-the-counter or prescribed pain medications, as well as antidepressants, and yet continue to have significant and disabling pain and depressive symptoms. There is a clear need to address the pain-depression nexus in novel ways.
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Lee CH, Wang TJ, Tang HP, Liu YH, Bell J. Familial expressed emotion among heroin addicts in methadone maintenance treatment: does it matter? Addict Behav 2015; 45:39-44. [PMID: 25638535 DOI: 10.1016/j.addbeh.2015.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 11/13/2014] [Accepted: 01/12/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Expressed emotion (EE) is the quality of the atmosphere between a relative and a family member with mental illness. Substantial research has focused on the relationship between the level of EE and the outcomes of mental illness. However, no prior study has explored the role of EE relative to heroin addicts. AIM The aims of this study were to investigate the influence of EE on patient outcome in methadone maintenance treatment (MMT) and the relationship between the EE of heroin addicts and other demographic and psychological variables. METHODS A total of 117 heroin addicts who entered MMT were enrolled. Each subject underwent a comprehensive interview to record demographic data and drug use history. The Family Emotional Involvement Scale (FEICS), Beck Depression Inventory (BDI), and Beck Anxiety Depression Inventory (BAI) were used at baseline. All subjects were followed for 12 months. The results of monthly urine tests and the treatment retention were recorded for further analysis. RESULTS Perceived criticism was correlated with depression (r=0.20, P<0.01). The overall retention rate in 12-month MMT was 54.70%. Lower perceived criticism (OR=1.84, 95% CI=1.20-3.60, P<0.01) and lower depression (OR=1.24, 95% CI=0.65-1.80, P=0.02) predicted longer retention in MMT. CONCLUSION EE, especially perceived criticism, has its influences on outcomes among heroin addicts in MMT. This suggested the potential benefits of family therapy among high EE heroin addicts in MMT. Furthermore, the mechanism how EE affects the outcome of MMT needs to be further investigated.
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Affiliation(s)
- Chun-Hung Lee
- Jianan Psychiatric Centre, MOHW, Taiwan; Addiction Unit, Institute of Psychiatry, King's College London, UK.
| | | | | | - Yu-Hsin Liu
- Florence Nightingale School of Nursing & Midwifery, King's College London, UK
| | - James Bell
- Addiction Unit, Institute of Psychiatry, King's College London, UK
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de Dios MA, Anderson BJ, Caviness CM, Stein M. Intimate partner violence among individuals in methadone maintenance treatment. Subst Abus 2015; 35:190-3. [PMID: 24821357 DOI: 10.1080/08897077.2013.835764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is a highly prevalent and concerning problem among methadone maintenance populations, and previous studies have shown a relationship between a history of IPV and increased substance use and affective disturbances. METHODS The current study examined (1) the association between recent IPV victimization and alcohol and cocaine use and (2) the relationship between recent IPV victimization and depression in a sample of smokers (N = 203) in methadone maintenance treatment (MMT). Participants in this study completed a battery of assessments that included standard questionnaires of trauma, alcohol and substance use, and depression. Parallel logistic and linear regression models were used to estimate the adjusted association of IPV victimization and depressive symptoms and evaluate the adjusted association of victimization with recent substance use. RESULTS Participants recently victimized by partners were shown to have significantly higher mean Center for Epidemiologic Studies Depression Scale (CES-D) scores (b = 0.54, 95% confidence interval [CI]: [0.07; 1.02], P <.05) and were found to have a 6 times greater likelihood of cocaine use (odds ratio [OR] = 6.65, 95% CI: [1.61; 27.46], P <.01) after controlling for age, gender, education, opiate use, and ethnicity. CONCLUSIONS These findings support the notion that IPV victimization can potentially increase depression and other substance use among MMT patients, which can have a deleterious impact on treatment.
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Affiliation(s)
- Marcel A de Dios
- a Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences , University of Texas MD Anderson Cancer Center , Houston , Texas , USA
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Hsiao CY, Chen KC, Lee LT, Tsai HC, Chang WH, Lee IH, Chen PS, Lu RB, Yang YK. The reductions in monetary cost and gains in productivity with methadone maintenance treatment: one year follow-up. Psychiatry Res 2015; 225:673-9. [PMID: 25500321 DOI: 10.1016/j.psychres.2014.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 09/25/2014] [Accepted: 11/15/2014] [Indexed: 11/20/2022]
Abstract
While methadone maintenance treatment (MMT) is beneficial for heroin dependence, there is little information regarding the reductions in monetary cost and gains in productivity following MMT. The aim of this study was to evaluate the changes in the monetary cost of heroin addiction and productivity after one year of MMT. Twenty-nine participants from an MMT clinic were included. The monetary cost, productivity, quality of life (QOL) and mental health status were assessed at both baseline and one year follow-up. The average annual total cost was approximately US$26,485 (1.43 GDP per capita in 2010) at baseline, and decreased by 59.3% to US$10,784 (0.58 GDP) at follow-up. The mean number of months of unemployment dropped from 6.03 to 2.79, the mean income increased to exceed the basic salary, but only reached 45.3% of the national average monthly earnings. The participants׳ mental health improved, but their QOL scores did not increase significantly. After one year of MMT, the monetary cost of heroin addiction fell, both the productivity and mental health of the participants׳ improved, but limited gains were seen with regard to their QOL.
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Affiliation(s)
- Chih Yin Hsiao
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Lan-Ting Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Hsin Chun Tsai
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Wei Hung Chang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - I Hui Lee
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Ru-Band Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.
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J.R. Stewart B, Sindicich N, Turnbull D, M. Andrews J, A. Mikocka-Walus A. Changes in Australian injecting drug users’ mental health problems and service uptake from 2006-2012. ADVANCES IN DUAL DIAGNOSIS 2014. [DOI: 10.1108/add-07-2014-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to assess changes in rates of mental health problems and service utilisation for Australian regular injecting drug users (IDUs) from 2006 to 2012.
Design/methodology/approach
– Data were taken from Illicit Drug Reporting System national surveys with 914 regular IDUs in 2006 and 883 in 2012. Changes in rates of self-reported mental health problems and service use were assessed.
Findings
– Rates of self-reported mental health problems increased from 38.3 per cent in 2006 to 43.7 per cent in 2012 – mainly due to increases in anxiety rates. Conversely, there was a decrease in mental health service use from 70.2 to 58.4 per cent by 2012. However, there was a proportional increase in the use of psychologists. These trends remained after controlling for socio-demographic and medical differences between the 2006/2012 samples. K10 scores for 2012 participants validated the use of the self-report measures.
Practical implications
– Reductions in stigma, improvements in mental health literacy, and modest increases in anxiety may explain increases in self-report of mental health problems. Stagnant service utilisation rates in an expanding population willing to self-report may explain decreasing service use. The introduction of key mental health reforms also may have contributed, particularly with the increase in psychologist access. This paper highlights the need for improved population monitoring of mental health in disadvantaged groups such as IDUs.
Originality/value
– This paper is the first to assess changes in mental health outcomes over time in Australian IDUs. This examination covered a critical era in the mental health landscape, with significant increases in public awareness campaigns and major mental health reforms.
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Madsen LW, Fabricius T, Hjerrild S, Hansen TM, Mössner BK, Birkemose I, Skamling M, Christensen PB. Depressive symptoms are frequent among drug users, but not associated with hepatitis C infection. ACTA ACUST UNITED AC 2014; 46:566-72. [PMID: 24934987 DOI: 10.3109/00365548.2014.918274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To compare the prevalence and severity of depressive symptoms among drug users with and without hepatitis C virus (HCV) infection. METHODS This was a cross-sectional survey study carried out at the 2 major drug treatment centres on the island of Funen, Denmark. Participants were drug users presenting to the 2 treatment centres. Individuals with chronic hepatitis B virus or HIV infection were excluded. Participants completed the Major Depression Inventory (MDI) questionnaire when presenting at the centres. Patients with MDI scores indicating severe depression (total MDI score ≥ 35) were referred for treatment evaluation. Hepatitis C status was classified by the presence of anti-HCV as a marker of HCV exposure and HCV-RNA as a marker of ongoing infection. RESULTS Two hundred and sixty-eight patients were included, of whom 235 (88%) had complete serological testing; 100 (43%, 95% confidence interval (CI) 36-49%) had chronic hepatitis C. The median MDI score was 22 (interquartile range 12-33); 32% (95% CI 26-39%) had a score compatible with depression and 14% (95% CI 10-19%) were rated as severe depression. Depression was not associated with hepatitis C (HCV-infected 29%, non-infected 35%; p = 0.25). Forty-one percent (11/27) of the evaluated participants started antidepressant treatment. CONCLUSIONS Our study demonstrated a high prevalence of depressive symptoms among drug users, but this was not more frequent among HCV-infected patients. The high overall prevalence of depression underlines the relevance of screening for depression in patients who are drug users.
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Affiliation(s)
- Lone W Madsen
- From the Department of Infectious Diseases, Odense University Hospital , Denmark
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Are the dental health needs of adults with illegal drug dependence being met by current service provision in the United Kingdom?: a literature review. J Addict Nurs 2014; 23:191-9. [PMID: 24335736 DOI: 10.1097/jan.0b013e31826f4bf2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This literature review outlines the current issues and debates relating to the dental health of adults with drug dependence. The dental health of adults with illegal drug dependence (IDD) continues to be under debate throughout dental practice, and the most appropriate model of care suitable to meet the high complex needs of this client group remains uncertain. The study aims to review and critically analyze available research relating to the oral health effects of illegal drug misuse and the dental health needs and status of adults with drug dependence. Second, it aims to identify and critically evaluate current models of dental service/care delivery, including relevant best practice guidance and potential barriers to dental access for adults with IDD. The available literature pertaining to dental health and adults with drug dependence are systematically reviewed and critically analyzed and evaluated in order to execute a rigorous investigation. The oral effects along with general medical complications associated with IDD are increasingly being recognized. There are substantive negative effects of IDD on oral health, particularly for those with opioid dependence; therefore, these clients have high complex dental needs and low use of dental services. Adults with drug dependence comprise a group with special dental needs and therefore need greater access to dental care than most people due to their high level of need. A high awareness of the implications for oral health care for adults with drug dependence is essential. Dental professionals have a key role in supporting the rehabilitation of these patients from potentially severe or fatal addictions. There is a distinct lack of national policy and guidance relating specifically to adults with drug dependence, and therefore, problems persist. Key findings and recommendations are presented to enhance the development of dental services for adults with IDD.
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Tsui JI, Anderson BJ, Strong DR, Stein MD. Craving predicts opioid use in opioid-dependent patients initiating buprenorphine treatment: a longitudinal study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 40:163-9. [PMID: 24521036 DOI: 10.3109/00952990.2013.848875] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Few studies have assessed associations between craving and subsequent opioid use. We prospectively evaluated the relative utility of two craving questionnaires to predict opioid use among opioid-dependent patients in outpatient treatment. METHOD Opioid-dependent patients (n = 147) initiating buprenorphine treatment were assessed every two weeks for 3 months. Craving was measured using the: (1) Desires for Drug Questionnaire (DDQ) and (2) Penn Alcohol-Craving Scale adapted for opioid craving (PCS). Multi-level logistic regression models estimated the effects of craving on the likelihood of opioid use. Craving assessed at time t was entered as a time-varying predictor of opioid use at time t + 1. RESULTS Craving scores plateaued at approximately 2 weeks after initiation of buprenorphine. In adjusted regression models, a 1-point increase in PCS scores (on a 7-point scale) was associated with a significant increase in the odds of opioid use at the subsequent assessment (OR = 1.27, 95% CI 1.08; 1.49, p < 0.01). The odds of opioid use at the subsequent follow-up assessment increased significantly as DDQ desire and intention scores increased (OR = 1.25, 95%CI 1.03; 1.51, p < 0.05), but was not significantly associated with DDQ negative reinforcement (OR = 1.01, 95%CI 0.88; 1.17, p > 0.05) or DDQ control (OR = 0.97, 95%CI 0.85; 1.11, p > 0.05) scores. CONCLUSION Self-reported craving for opioids was modestly associated with subsequent relapse to opioid use among a cohort of patients treated with buprenorphine. Assessment of craving may provide clinical utility in predicting relapse among treated opioid-dependent patients.
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Affiliation(s)
- Judith I Tsui
- Boston University School of Medicine/Boston Medical Center , Boston MA , USA
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Association of depression, anxiety, and suicidal ideation with high-risk behaviors among men who inject drugs in Delhi, India. J Acquir Immune Defic Syndr 2014; 64:502-10. [PMID: 23933769 DOI: 10.1097/qai.0b013e3182a7ef21] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sharing of needles and syringes and unprotected sex remain a common practice among people who inject drugs (PWID) in India and are important drivers of new HIV infections. Whether engagement in risk behaviors among PWID is associated with symptoms of common mental disorders in India is unknown. METHODS We analyzed the data collected in April and May of 2012 from a community-based sample of 420 PWID in Delhi using time location sampling. Self-report symptom scales were used to measure the severity of symptoms of depression (Patient Health Questionnaire 9) and anxiety (Generalized Anxiety Disorder scale 2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts within the past 12 months. RESULTS PWID with severe depressive symptoms and those with suicidal thoughts were 4 and 2 times more likely to share needles/syringes, respectively. PWID experiencing suicidal thoughts had 82% more female sexual partners and were 5 times more likely to have had unprotected sex at last sex with a paid female partner. Conversely, symptoms of anxiety were associated with a 30% decrease in the likelihood of needle/syringe sharing and a 70% decrease in the likelihood of unprotected sex at last sex with a paid female partner. CONCLUSIONS We found a high prevalence of symptoms of depression, anxiety, and suicidal ideation among men who inject drugs in Delhi and that depression and suicidal ideation are independently positively associated with HIV risk behaviors, whereas anxiety is associated with a reduction in such behaviors. Ameliorating mental health problems among PWID in India may aid in reducing HIV infections.
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Moving toward personalized medicine in the methadone maintenance treatment program: a pilot study on the evaluation of treatment responses in Taiwan. BIOMED RESEARCH INTERNATIONAL 2013; 2013:741403. [PMID: 24455721 PMCID: PMC3876825 DOI: 10.1155/2013/741403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/25/2013] [Indexed: 12/26/2022]
Abstract
This pilot study simultaneously evaluated the effects of various factors, including genetic variations of CYP2B6, CYP2C19, and ABCB1, demographic characteristics, disease states, methadone-drug interactions (MDIs), and poly-substance use, on the treatment responses among non-HIV patients in the methadone maintenance treatment program (MMTP) in Taiwan. A total of 178 patients were recruited from two major hospitals that provided MMTP services in southern Taiwan, and information regarding concomitant medications and diseases was acquired from the National Health Insurance (NHI) program. The results demonstrated that the methadone maintenance dose, CYP2B6 785G allele, and ABCB1 2677T allele have positive effects on the methadone plasma concentration. In contrast, patients with HCV coinfection, alcohol problems, and psychiatric diseases may have a negative response to treatment. Thus, a comprehensive evaluation of treatment responses in the MMTP should include not only genetic polymorphisms in methadone metabolism and transporter proteins, but also concomitant diseases, MDIs, and poly-substance use. The results also suggest that personalized medicine may be indispensable for a better outcome of the MMTP.
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Nyamathi A, Albarrán CR, Branson C, Marfisee M, Khalilifard F, Leake B. Correlates of depressive symptoms among alcohol-using methadone maintained adults. Am J Addict 2013; 21 Suppl 1:S49-55. [PMID: 23786510 DOI: 10.1111/j.1521-0391.2012.00300.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Alcohol-using clients are considered at great risk for hepatitis and ongoing liver damage. This study explores the correlates of depression among a sample of methadone maintained treatment (MMT) adults in the Los Angeles area, and is part of a larger study on hepatitis health promotion among MMT clients who use alcohol. OBJECTIVES We sought to determine correlates of depressive symptoms among moderate and heavy alcohol-using adults enrolled in methadone maintenance. METHODS A cross-sectional correlation study was conducted of baseline data from a randomized control trial of adults (N= 189) receiving MMT in Los Angeles. Depressive symptoms were measured with the 10-item short-form CES-D. RESULTS Multiple regression analysis revealed that pain and social support were key correlates of depressive symptoms. More pain was associated with higher levels of depressive symptoms (p= .001), while more social support was related to lower depressive symptom severity (p= .001). Having been in sufficiently poor health that a blood transfusion, clotting factors, or an organ transplant was necessary was associated with greater depressive symptomatology, as was having injected drugs in the past month (p= .024). CONCLUSIONS The findings from this investigation can aid clinicians in selecting clients to monitor for early signs of depression and encourage early treatment for opioid users with comorbidities. SCIENTIFIC SIGNIFICANCE The use of an interdisciplinary team to care for MMT clients, routinely screen for depressive symptoms, and emphasize adequate pain control is indicated.
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Affiliation(s)
- Adeline Nyamathi
- School of Nursing, University of California-Los Angeles, CA 90095, USA.
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Wang Z, Du J, Zhao M, Page K, Xiao Z, Mandel JS. Hepatitis C virus infection is independently associated with depression among methadone maintenance treatment heroin users in China. Asia Pac Psychiatry 2013; 5:191-6. [PMID: 23857926 PMCID: PMC4513657 DOI: 10.1111/j.1758-5872.2012.00209.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 04/15/2012] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Depression and hepatitis C virus (HCV) infection are two common conditions among heroin users in methadone maintenance treatment (MMT). However, the comorbid relationship between depression and HCV infection among MMT patients is not well understood. METHODS One hundred and fifteen MMT patients were recruited from the Yangpu MMT Clinic in Shanghai. Demographic characteristics, drug use and HCV-related information were collected using a structured interview. The Beck Depression Inventory (BDI-II) and the Perceived Stress Scale (PSS) were administered to evaluate participants' symptoms of depression and stress severity. HCV antibody (anti-HCV) test results were collected from patients' MMT clinical medical records. RESULTS 58.2% of participants were anti-HCV positive, and 41.3% scored moderate-to-severe for symptoms of depression (BDI-II scores >19). The prevalence of depressive symptoms (BDI-II score >19) was greater in HCV positive than HCV negative participants (51.6% versus 27.7%, respectively; P = 0.02). There was no significant difference in the perceived stress level by anti-HCV status; overall, the perceived stress level score was 15.9 ± 5.7. In logistic regression analysis, positive anti-HCV status (OR = 3.75, 95% CI = 1.42-9.90), and greater perceived stress (OR = 1.23, 95% CI = 1.11-1.36) were independently associated with depression, after controlling for gender, age, duration of drug use and the awareness of HCV infection. DISCUSSION Depression and HCV infection are common and co-occurring among MMT patients in Shanghai. HCV infection itself appears to be associated with depressive symptoms regardless of whether the individual is aware of his HCV infection status. This finding indicates that it is important to consider the impact of depressive symptoms on injection risk behaviors and HCV transmission when planning intervention programs in MMT clinics.
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Affiliation(s)
- Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Tavakkoli M, Ferrando SJ, Rabkin J, Marks K, Talal AH. Depression and fatigue in chronic hepatitis C patients with and without HIV co-infection. PSYCHOSOMATICS 2013; 54:466-71. [PMID: 23756122 DOI: 10.1016/j.psym.2013.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 02/11/2013] [Accepted: 02/12/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Depression and fatigue are common in chronic hepatitis C (CHC). OBJECTIVE We report clinical predictors of these conditions in patients seen in a university clinic. METHODS A total of 167 CHC patients completed the Patient Health Questionnaire-9 (PHQ-9) and Fatigue Severity Scale (FSS). Major depressive disorder (MDD) suggested by PHQ-9 was confirmed by clinical interview. FSS scores ≥41 were considered clinically significant fatigue. Logistic and multiple regression models were employed for analysis. RESULTS Thirty-three percent of patients had MDD and 52% had clinically significant fatigue. Sixty-one percent were HIV-infected, among whom both MDD and clinically significant fatigue were significantly less prevalent (OR = 0.47 and 0.46, respectively). MDD was least common in patients without a history of IV drug use (OR = 0.28), and highest in methadone users (OR = 3.57). Compared with methadone users, patients with no history of IV drug use and former IV drug users had less severe fatigue (coefficients = -31.0, -34.0, respectively). Lack of a history of hepatitis treatment was also associated with less severe fatigue (coefficient= -7.6). CONCLUSION Our study confirms high prevalence of fatigue and depression in CHC. HIV-positivity was associated with lower rates of MDD and clinically significant fatigue, arguably due to support systems for people living with HIV. Higher rates of depression in methadone users might be due to intrinsically higher rates of psychopathology in this group. Being on hepatitis treatment was associated with higher rates of fatigue, probably due to the adverse effects of interferon. Our findings emphasize the importance of routine screening and evaluation of depression and fatigue in CHC populations.
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Affiliation(s)
- Mohammad Tavakkoli
- Department of Psychiatry, NY-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
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Armstrong G, Nuken A, Samson L, Singh S, Jorm AF, Kermode M. Quality of life, depression, anxiety and suicidal ideation among men who inject drugs in Delhi, India. BMC Psychiatry 2013; 13:151. [PMID: 23711075 PMCID: PMC3680014 DOI: 10.1186/1471-244x-13-151] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 05/21/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mental disorders such as depression, anxiety and suicide represent an important public health problem in India. Elsewhere in the world a high prevalence of symptoms of common mental disorders have been found among people who inject drugs (PWID). Research in India has largely overlooked symptoms of common mental disorders among this high risk group. This paper reports on the results of a survey examining quality of life, depression, anxiety and suicidal ideation among adult males who inject drugs living in Delhi. METHODS Participants (n = 420) were recruited from needle and syringe programs using time location sampling and were interviewed using an interviewer-administered questionnaire. Self-report symptom scales were used to measure the severity of symptoms of depression (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts and attempts within the past 12 months. RESULTS The mean length of injecting career was 20.9 years indicating a sample of chronic injecting drug users, of whom only one-third (38%) were born in Delhi. The level of illiteracy was very high (62%), and just 2% had completed class 12. Scavenging / rag picking was the main form of income for 48%, and many were homeless (69%). One-third (33%) had been beaten up at least twice during the preceding 6 months, and many either never (45%) or rarely (27%) attended family events. We found a high prevalence of depressive (84%, cut-off ≥10) and anxiety (71%, cut-off score of ≥3) symptoms. Fifty-three percent thought about killing themselves in the past 12 months, and 36% had attempted to kill themselves. CONCLUSIONS Our findings revealed a socially excluded population of PWID in Delhi who have minimal education and are often homeless, leaving them vulnerable to physical violence, poverty, poor health, imprisonment and disconnection from family. The high prevalence of psychological distress found in this study has implications for programmes seeking to engage, treat and rehabilitate PWID in India.
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Affiliation(s)
- Gregory Armstrong
- Nossal Institute for Global Health, University of Melbourne, Victoria, Australia
| | - Amenla Nuken
- Nossal Institute for Global Health, University of Melbourne, Victoria, Australia
| | - Luke Samson
- The Society for Service to Urban Poverty (SHARAN), Delhi, India
| | - Shalini Singh
- The Society for Service to Urban Poverty (SHARAN), Delhi, India
| | - Anthony F Jorm
- Population Mental Health Group, Melbourne School of Population Health, University of Melbourne, Victoria, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, Victoria, Australia
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Darke S. Pathways to heroin dependence: time to re-appraise self-medication. Addiction 2013; 108:659-67. [PMID: 23075121 DOI: 10.1111/j.1360-0443.2012.04001.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 03/06/2012] [Accepted: 06/22/2012] [Indexed: 10/27/2022]
Abstract
The self-medication hypothesis emphasizes the role of distressing affect as the primary motivator for the compulsive use that leads to substance dependence. The model also postulates that there will be psychopharmacological specificity between symptom presentation and the primary drug of dependence. In this review, the self-medication hypothesis is examined in relation to the development and chronicity of heroin dependence. It is argued that if self-medication has a role in engendering and extending substance dependence, it should be apparent in the use of a drug that carries such overwhelming personal risk. The psychopathology seen among adult users is certainly consistent with the model. More importantly, however, are the extraordinarily high levels of childhood trauma and psychopathology that occur typically well before the initiation of heroin use. In contrast, the postulate of drug specificity appears less supported by the polydrug use patterns typical of heroin users, and does not appear to be a necessary corollary of the model.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
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Baharudin A, Mislan N, Ibrahim N, Sidi H, Nik Jaafar NR. Depression in male patients on methadone maintenance therapy. Asia Pac Psychiatry 2013; 5 Suppl 1:67-73. [PMID: 23857840 DOI: 10.1111/appy.12069] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Depression is one of the most common psychiatric conditions in men. The aim of the study was to determine the depressive symptoms and associated factors among men on methadone maintenance therapy (MMT). METHODS A cross-sectional study was conducted involving 108 subjects who attended the Drug Clinic at Hospital Kuala Lumpur. The instruments used include the Structured Clinical Interview for Diagnostic and Statistical Manual, Fourth Edition Axis-I Disorder, Beck Depression Inventory and the 15-item International Index of Erectile Function. RESULTS The rate of depression was 44.4%. There were significant associations between Malay ethnicity, secondary education level and concurrent illicit cannabis use with depression (P < 0.05). However, there was no significant associations between depression and erectile dysfunction (P = 0.379). DISCUSSION Even though depression is common among men on MMT, it is often missed by the treating doctors. It is important to make the treating doctors aware that depression is a serious clinical condition that has a profound impact on the individual and compliance to treatment.
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Affiliation(s)
- Azlin Baharudin
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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Stein MD, Caviness CM, Anderson BJ, Abrantes A. Sitting Time, But Not Level Of Physical Activity, Is Associated With Depression In Methadone-Maintained Smokers. Ment Health Phys Act 2013; 6:43-48. [PMID: 23894252 PMCID: PMC3719871 DOI: 10.1016/j.mhpa.2013.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PROBLEM Sedentary behavior has been linked to many physical and mental health disorders including heightened risk for depression. Methadone-maintained individuals are at increased risk for depression and have been shown to be physically active at lower rates than the general population. METHOD We assessed the relationship between sitting time, physical activity, and depression in a group of 315 methadone-maintained smokers. RESULTS Mean participant age was 39.9 years of age, 49.5% were male, and 79.4% were non-Hispanic White. The mean time reported sitting each day was 320.4 minutes and the mean CES-D depression score was 12.0. After controlling for background characteristics, physical function, and physical activity, depression was significantly and positively related to sitting time. CONCLUSION Interventions to decrease time spent sitting and increase physical activity could have important benefits for the mental health of methadone-maintained individuals. This population is often underserved and suffers disproportionately from limited physical and mental health functioning, making them an ideal population for low-cost interventions to reduce sitting time and/or increase physical activity to improve well-being.
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Affiliation(s)
- Michael D. Stein
- General Medicine Research Unit, Butler Hospital, Providence, RI, 02906
- Warren Alpert Medical School of Brown University, Providence, RI, 02912
| | | | | | - Ana Abrantes
- General Medicine Research Unit, Butler Hospital, Providence, RI, 02906
- Warren Alpert Medical School of Brown University, Providence, RI, 02912
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