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Schuler M, Gerlich C, Leven L, Renz S, Pamperin I, Vorsatz N, Vogel H. [The Blaufeuer measure for employees with mental stress and simultaneous workplace problems-Is the target group being reached?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024:10.1007/s00103-024-03907-4. [PMID: 38896151 DOI: 10.1007/s00103-024-03907-4] [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: 01/10/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Employees with mental burden and simultaneous workplace problems have an increased risk of chronification and disability pension. To support this group of people, the German Pension Insurance (Deutsche Rentenversicherung Bund) developed the Systemic Integration Management for People with Mental Impairments (SEMpsych) project as part of the rehapro federal program. The Blaufeuer counselling service was implemented in three model regions (Berlin, Cologne, and Nuremberg). The measure usually comprises up to 12 counselling sessions in 12 months. This article describes the characteristics of the participants and examines whether they belong to the intended target group. METHOD During September 2020 and June 2022, the participants completed a questionnaire between the first and second counselling sessions. Socio-demographic-, clinical- and work-related variables were assessed. The data were analysed using descriptive statistics and 95% confidence intervals. RESULTS Data from n = 482 participants (66.4% female; MAge = 45.2 years (±10.2 years); 64.1% working full-time; 49.8% currently on sick leave) were included. The participants have high psychological impairments (e.g. PHQ-9: M = 14.6 (±5.4)) and low subjective work ability (e.g. WAS: M = 3.2 (±2.6)). Most participants report overload at work and problems with superiors. DISCUSSION Participants exhibit mental burden values that correspond to those of patients at the beginning of outpatient psychotherapy or the first contact in an inpatient psychiatric clinic. Blaufeuer addresses a highly stressed group of people who have not yet received adequate treatment. Further studies on process and outcome evaluation will follow.
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Affiliation(s)
- Michael Schuler
- Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg (Bayern), Deutschland.
- Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum (Nordrhein-Westfalen), Deutschland.
- Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum (Nordrhein-Westfalen), Deutschland.
| | - Christian Gerlich
- Arbeitsgruppe Rehabilitationswissenschaften im Zentrum Psychische Gesundheit, Universitätsklinikum Würzburg, Würzburg (Bayern), Deutschland
| | - Lorenz Leven
- Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg (Bayern), Deutschland
| | - Silvan Renz
- Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg (Bayern), Deutschland
| | - Ina Pamperin
- Deutsche Rentenversicherung Bund, Berlin, Deutschland
| | | | - Heiner Vogel
- Arbeitsgruppe Rehabilitationswissenschaften im Zentrum Psychische Gesundheit, Universitätsklinikum Würzburg, Würzburg (Bayern), Deutschland
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Nojomi M, Rezapour M, Azar NS, Darabi M, Asadi-Aliabadi M. Patterns of Health-related Quality of Life in Men Who Inject Drugs: A Survey in Southeast Iran. J Prev Med Public Health 2024; 57:148-156. [PMID: 38576200 PMCID: PMC10999300 DOI: 10.3961/jpmph.23.379] [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: 08/29/2023] [Revised: 11/25/2023] [Accepted: 12/29/2023] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES Understanding patterns of quality of life in people who inject drugs (PWID) can help healthcare providers plan and manage their health problems in a more focused manner. Therefore, the current study aimed to identify patterns of health-related quality of life in PWID in southeast Iran. METHODS This cross-sectional study was conducted in southeast Iran on men who had injected drugs at least once during the last year. We used convenience sampling in 2 drop-in centers and venue-based sampling at 85 venues. Demographic characteristics, high-risk behaviors, and health-related quality of life were evaluated using the 5-level EQ-5D version (EQ-5D-5L) questionnaire. Latent profile analysis was used to identify patterns of quality of life. RESULTS This study enrolled 398 PWID, who had a mean age of 34.1±11.4 years. About 47.9% reported a prison history in the last 10 years, 59.2% had injected drugs in the last month, and 31.6% had a history of sharing syringes. About 46.3% reported having 2 or more sexual partners in the last 6 months, and 14.7% had a history of sex with men. Out of the 5 EQ-5D-5L profiles, the fifth profile had the most people (36.6%). Most variations in quality of life were related to pain and discomfort. CONCLUSIONS We showed that the pain and discomfort dimension of EQ-5D-5L had more variation in PWID. This finding will be useful for allocating appropriate interventions and resources to promote health-related quality of life in this population.
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Affiliation(s)
- Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
- Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maysam Rezapour
- Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Neda Soleimanvandi Azar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Darabi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehran Asadi-Aliabadi
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
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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: 0] [Impact Index Per Article: 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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Ponnuchamy L, Kumar SS, Majhi G, Venkataraman P. Quality of life, social support, and pathways of care among persons with psychiatric disorders-A cross-sectional study. Ind Psychiatry J 2023; 32:S32-S41. [PMID: 38370934 PMCID: PMC10871395 DOI: 10.4103/ipj.ipj_192_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/14/2023] [Accepted: 06/23/2023] [Indexed: 02/20/2024] Open
Abstract
Background Patients with psychiatric disorders have varied psychosocial realities embedded in the community context. Help-seeking behavior is extremely crucial in determining the prognosis and outcome of interventions. Objectives (1) To assess the levels of quality of life, perceived social support, and decision to first seek help. (2) To assess the association of socio-demographic variables with these domains. Materials and Methods A cross-sectional descriptive survey with 100 psychiatric patients in a tertiary care setting employed three scales, namely WHOQOL-BREF, PSSS, and WHO Pathways Encounter form. Results Patients had higher levels of quality of life and perceived social support. The majority of patients chose health professionals over faith healers at the onset of symptoms, had higher reliance on family members, and continued with hospital visits till the third follow-up. Sex, occupation, and marital status were associated with perceived social support, and duration of illness was associated with help-seeking behavior. Conclusions Community-based interventions must include holistic services and reduce the gap between onset and first contact, leading to higher quality of life and perceived social support.
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Affiliation(s)
- Lingam Ponnuchamy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sachin S Kumar
- Psychiatric Counsellor, Central Prison, Parapana Agrahara, Bengaluru, Karnataka, India
| | - Gobinda Majhi
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Prabhu Venkataraman
- Department of Medical Research, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India
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Pant SB, Thapa SB, Howard J, Ojha SP, Lien L. Psychological distress and quality of life among Opioid Agonist Treatment service users with a history of injecting and non-injecting drug use: A cross-sectional study in Kathmandu, Nepal. PLoS One 2023; 18:e0281437. [PMID: 36745666 PMCID: PMC9901755 DOI: 10.1371/journal.pone.0281437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Opioid use disorder is a serious public health problem in Nepal. People who use opioids often experience psychological distress and poor quality of life. Opioid agonist Treatment (OAT) is central in managing opioid dependence. This study aimed to examine factors associated with quality of life and serious psychological distress among OAT service users in the Kathmandu Valley, Nepal and compare those who had injected opioids prior to OAT and those who had not. METHODS A cross-sectional study with 231 was conducted using a semi-structured questionnaire, the Nepalese versions of the Kessler 6 psychological distress scale and World Health Organization Quality of Life scale (WHOQOL-BREF). Bivariate and multivariate analyses were undertaken to examine factors associated with quality of life and serious psychological distress. RESULTS Most participants were males (92%) and about half had injected opioids before initiating OAT. Serious psychological distress in the past four weeks was significantly more prevalent among participants with a history of injecting (32.2%) than those who did not inject (15.9%). In the adjusted linear regression model, those who had history of injecting were likely to have lower physical quality of life compared to non-injectors. Those self-reporting a past history of mental illness were more than seven times and those with medical comorbidity twice more likely to have serious psychological distress over last four weeks. Lower socioeconomic status and a history of self-reported mental illness in the past were found to be significantly associated with lower quality of life on all four domains. CONCLUSION Those who had history of injecting were younger, had frequent quit attempts, higher medical comorbidity, lower socioeconomic status and remained longer in OAT services. Alongside OAT, the complex and entangled needs of service users, especially those with a history of injecting drugs, need to be addressed to improve quality of life and lessen psychological distress.
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Affiliation(s)
- Sagun Ballav Pant
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Institute of Medicine, Tribhuvan University, Kirtipur, Nepal
- * E-mail: ,
| | - Suraj Bahadur Thapa
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Institute of Medicine, Tribhuvan University, Kirtipur, Nepal
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - John Howard
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Saroj Prasad Ojha
- Department of Psychiatry, Institute of Medicine, Tribhuvan University, Kirtipur, Nepal
| | - Lars Lien
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Armoon B, Bayat AH, Bayani A, Mohammadi R, Ahounbar E, Fakhri Y. Quality of life and its associated factors among patients with substance use disorders: A systematic review and meta-analysis. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2069612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amir-Hossien Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Azadeh Bayani
- School of Allied Medical Sciences, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Yadollah Fakhri
- Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Saing CH, Chhoun P, Chann N, Uk P, Mun P, Tuot S, Yi S. Sex Under the Influence of Drugs Among People Who Use Drugs in Cambodia: Findings From a National Survey. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1461-1470. [PMID: 35194721 PMCID: PMC8917026 DOI: 10.1007/s10508-021-02243-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/01/2021] [Accepted: 11/20/2021] [Indexed: 05/20/2023]
Abstract
Studies in drug use settings rarely use sex under the influence of drugs as an indicator of sexual risk behaviors. This study explored the prevalence of sex under the influence of drugs and its correlates among people who use drugs (PWUD) in Cambodia. We included 1147 PWUD from 12 provinces in this study. A multiple logistic regression analysis was conducted to identify factors associated with sex under the influence of drugs. Of the total, 39.7% reported having had sex under the influence of drugs in the past three months. After adjustment, sex under the influence of drugs was significantly associated with living in urban areas (AOR 2.97, 95% CI 1.68-5.27), having two to three (AOR 2.48, 95% CI 1.76-3.49) and four or more sexual partners (AOR 6.46, 95% CI 4.24-9.85), engaging in transactional sex (AOR 1.69, 95% CI 1.19-2.39), using methamphetamine (AOR 2.97, 95% CI 2.06-4.31), using drugs for three years or longer (AOR 1.67, 95% CI 1.15-2.41), having been to a drug rehabilitation center (AOR 1.77, 95% CI 1.18-2.41), having a network of ten or more PWUD (AOR 1.82, 95% CI 1.25-2.66), and having high psychological distress (AOR 1.66, 95% CI 1.25-2.22). This study documents the high prevalence of sex under the influence of drugs and its risk factors among male and female PWUD in Cambodia. These findings point to the need for integrating HIV and harm-reduction programs using innovative approaches to address the overlapping risks in this key population.
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Affiliation(s)
- Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Ponha Uk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
- Center for Global Health Research, Touro University California, Vallejo, CA, USA.
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Likindikoki SL, Meyrowitsch DW, Mizinduko MM, Ishungisa AM, Tersbøl BP, Leyna GH, Moen K, Makyao N, Lange T, Leshabari MT, Mmbaga EJ. Socio-cognitive factors influencing access to HIV prevention services among people who inject drugs in Dar es Salaam, Tanzania: An integrated bio-behavioural survey. PLoS One 2022; 17:e0261500. [PMID: 35089928 PMCID: PMC8797198 DOI: 10.1371/journal.pone.0261500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/03/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction People who inject drugs (PWID) in Sub-Saharan Africa have limited access to comprehensive HIV services. While it is important to inform programming, knowledge about factors influencing access to comprehensive HIV services is scarce. We assessed the proportions of PWID with access to HIV prevention services and associated socio-cognitive factors in Tanzania. Methods A cross-sectional survey was conducted among PWID between October and December 2017 in Dar es Salaam, Tanzania. Data on access to HIV prevention services, demographics and selected socio-cognitive factors were collected through structured face-to-face interviews. Weighted descriptive and forward selection multivariable logistics regression analyses were done to assess independent associations between HIV prevention services and predictors of interest. The results were two tailed and a p-value of less than 0.05 was considered statistically significant. Results The study included 611 PWID (males: 94.4%) with a median age of 34 years (Interquartile Range (IQR), 29–38). A large majority of participants reported to have access to condoms (87.8%), sterile needles/syringes (72.8%) and ever tested for HIV (66.0%). About half (52.0%) reported to have used condoms in the past one month and about a third (28.5%) accessed a peer educator. The odds of testing for HIV decreased among participants who perceived their HIV risk to be high (aOR = 0.29; 95%CI: 0.17–0.49) and those experienced sexual violence (aOR = 0.60; 95%CI 0.37–0.98). However, the odds of testing for HIV increased among participants with secondary level of education (aOR = 2.16; 95%CI: 1.06–5.55), and those who reported having correct comprehensive HIV knowledge (CCHK) (aOR = 1.63; 95%CI 1.12–2.41). The odds of access to condoms increased among females (aOR = 2.23; 95%CI: 1.04–5.02) but decreased among participants with secondary level of education (aOR = 0.41; 95%CI: 0.19–0.84), an income of >TZS 200,000 (aOR = 0.39; 95%CI: 0.23–0.66) and those who perceived their HIV risk to be high (aOR = 0.13; 95%CI: 0.03–0.36). The odds of access to peer educators was higher among participants with primary (aOR = 1.61; 95%CI: 1.01–2.26), and secondary (aOR = 2.71; 95%CI: 1.39–5.33) levels of education. The odds of access to sterile needle and syringe decreased among participants who perceived their HIV risk to be high (aOR = 0.11;95%CI 0.05–0.22), and low-medium (aOR = 0.25;95%CI 0.11–0.52) but increased among those with primary level of education (aOR = 1.72;95%CI 1.06–2.78). Conclusion Access to condom, HIV testing, sterile needles and syringes were relatively high among PWID. However, condom use and access to peer educators was relatively low. HIV knowledge and risk perception, gender, education, and sexual violence influenced access to HIV prevention services. There is an urgent need to address the identified socio-cognitive factors and scale up all aspects of HIV prevention services to fast-track attainment of the 2025 UNAIDS goals and ending the HIV epidemic.
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Affiliation(s)
- Samuel L. Likindikoki
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- * E-mail:
| | - Dan W. Meyrowitsch
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Mucho M. Mizinduko
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alexander M. Ishungisa
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Britt P. Tersbøl
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Germana H. Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Neema Makyao
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Children and Elderly, Dodoma, Tanzania
| | - Theis Lange
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Melkizedeck T. Leshabari
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia J. Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Alcohol use among adolescents in India: a systematic review. Glob Ment Health (Camb) 2022; 9:1-25. [PMID: 36618747 PMCID: PMC9806994 DOI: 10.1017/gmh.2021.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Alcohol use is typically established during adolescence and initiation of use at a young age poses risks for short- and long-term health and social outcomes. However, there is limited understanding of the onset, progression and impact of alcohol use among adolescents in India. The aim of this review is to synthesise the evidence about prevalence, patterns and correlates of alcohol use and alcohol use disorders in adolescents from India. METHODS Systematic review was conducted using relevant online databases, grey literature and unpublished data/outcomes from subject experts. Inclusion and exclusion criteria were developed and applied to screening rounds. Titles and abstracts were screened by two independent reviewers for eligibility, and then full texts were assessed for inclusion. Narrative synthesis of the eligible studies was conducted. RESULTS Fifty-five peer-reviewed papers and one report were eligible for inclusion in this review. Prevalence of ever or lifetime alcohol consumption ranged from 3.9% to 69.8%; and prevalence of alcohol consumption at least once in the past year ranged from 10.6% to 32.9%. The mean age for initiation of drinking ranged from 14.4 to 18.3 years. Some correlates associated with alcohol consumption included being male, older age, academic difficulties, parental use of alcohol or tobacco, non-contact sexual abuse and perpetuation of violence. CONCLUSION The evidence base for alcohol use among adolescents in India needs a deeper exploration. Despite gaps in the evidence base, this synthesis provides a reasonable understanding of alcohol use among adolescents in India and can provide direction to policymakers.
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Efficacy of a Positive Psychological Intervention in Improving Mental Health Status Among Methadone Maintenance Treatment Users in Guangzhou, China—a Randomized Controlled Trial. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-019-00206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Injection drug use, depression, and HIV screening in rural primary care settings: A retrospective cross-sectional study. INTERNATIONAL JOURNAL OF CARE COORDINATION 2021. [DOI: 10.1177/2053434521999903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Antiretroviral therapy (ART) has reduced HIV viral replication and transmission of disease. However, continuing incidence of new HIV infections has been attributed to undiagnosed HIV infections among injection drug users. This purpose of this retrospective cross-sectional study was to determine whether depression moderates the relationship between injection drug use and HIV screening among people with substance use in the screening, brief intervention, and referral to treatment in Alabama (AL-SBIRT) program. Methods Electronic health record data were obtained from three consenting medical facilities (n = 103). Multivariable logistic regression analysis was conducted to determine the moderating effect of depression on the relationship between injection drug use and HIV screening. Results Bivariate analyses revealed that HIV screening was more common among individuals not engaged in injection drug use, 75% and 57% respectively. Participants who had never been screened had worse depressive symptoms on the PHQ-2 (M = 3.00, SE = 0.42) than individuals who had been screened for HIV (M = 1.45, SE = 0.17). After controlling for demographic variables, tobacco use, alcohol consumption, and drug abuse, results indicated a moderating effect of depression on the relationship between injection drug use and receipt of HIV screening (aOR = 0.85 [95% CI = 0.84, 0.86). Discussion Findings suggest that high risk subgroups such as injection drug users with severe depression may not be using HIV prevention services, leading to possible delays in HIV diagnosis. Integration of behavioral interventions and HIV prevention services may reduce risk factors among depressed injection drug users. Such interventions may improve retention for injection drug users who experience worse depressive symptoms post HIV diagnosis.
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Saing CH, Prem K, Uk P, Chann N, Chhoun P, Mun P, Tuot S, Yi S. Prevalence and social determinants of psychological distress among people who use drugs in Cambodia. Int J Ment Health Syst 2020; 14:77. [PMID: 33292352 PMCID: PMC7640420 DOI: 10.1186/s13033-020-00411-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/29/2020] [Indexed: 01/04/2023] Open
Abstract
Background People who use drugs are at a disproportionately higher risk of mental disorders due to prolonged exposure to psychosocial challenges. However, studies on mental health among people who use drugs in resource-constrained countries are scarce. This study sheds light on the prevalence and correlates of psychological distress among people who use drugs in Cambodia. Methods We conducted this cross-sectional study in the capital city and 11 provinces in 2017. The Respondent Driven Sampling method was adapted to recruit 1677 people who used drugs for face-to-face interviews using a structured questionnaire. Psychological distress was measured using the General Health Questionnaire (GHQ-12). A total score of GHQ-12 > 2 indicated high psychological distress. We performed a multiple logistic regression analysis to identify factors associated with psychological distress. Results We included 1598 participants in the analyses, with a mean age of 28.6 years (SD = 7.8). Of the total, 42% had high psychological distress – 50% in women and 37% in men. The adjusted odds of having high psychological distress were significantly higher among participants who were 25–34 years old and 35 years and above, had been to a drug rehabilitation center, had been insulted by family members, and had been sexually harassed/abused by someone when they were growing up. The odds of having high psychological distress were significantly lower among participants who were male, lived in their own dwelling, reported injecting as the mode of the first drug use, and had someone taking care of them when they got sick. Conclusions This study documents a high prevalence of psychological distress among people who use drugs in Cambodia. Intervention programs that attempt to address mental health problems among people who use drugs in resource-limited settings should be gender- and age-sensitive and target more marginalized subpopulations. Mental health services can be integrated into HIV and harm-reduction programs for people who use drugs.
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Affiliation(s)
- Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ponha Uk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore. .,KHANA Center for Population Health Research, Phnom Penh, Cambodia. .,Center for Global Health Research, Touro University California, Vallejo, CA, USA. .,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.
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Saadati H, Tavakoli Ghouchani H, Asghari D, Gholizadeh N, Rahimi J, Valizadeh R. Comparison of the quality of life and general health in opium and non-opium users referred to the addiction treatment centers. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1838635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Hassan Saadati
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Tavakoli Ghouchani
- Addiction and Behavioral Sciences Research Center Health North Khorasan University of Medical Sciences, Bojnurd, Department of Health Education and Promotion, School of Health North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Dordane Asghari
- Measurement And Measurement Field (Psychometric Field), Addiction And Behavioral Sciences Research Center (Researcher), Bojnurd, Iran
| | - Nazanin Gholizadeh
- General Psychology, Addiction and Behavioral Sciences Research Center(Researcher), Bojnurd, Iran
| | - Jamileh Rahimi
- Department of Epidemiology and Biostatistics, School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Rohollah Valizadeh
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Kermode M, Choudhurimayum RS, Rajkumar LS, Haregu T, Armstrong G. Retention and outcomes for clients attending a methadone clinic in a resource-constrained setting: a mixed methods prospective cohort study in Imphal, Northeast India. Harm Reduct J 2020; 17:68. [PMID: 32993646 PMCID: PMC7523306 DOI: 10.1186/s12954-020-00413-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 09/10/2020] [Indexed: 11/22/2022] Open
Abstract
Background Opioid substitution therapy (OST) with buprenorphine has been widely available in India since 2007, but the introduction of methadone occurred much later in 2012, and availability remains limited. Illicit injecting drug use is a long-standing public health problem in Manipur, a state in Northeast India characterised by major resource constraints and political unrest. We investigated retention and outcomes for clients attending a methadone-based OST program in Manipur with the aim of strengthening the evidence base for development of relevant policies and programs. Methods All clients enrolling in the methadone clinic over a 1 year period were invited to be part of a prospective cohort study, which followed up and surveyed both retained and defaulting clients for 12 months post-enrollment to assess retention as well as social, behavioural and mental health outcomes. Additionally, we conducted semi-structured qualitative interviews to supplement quantitative information and identify factors contributing to retention and drop-out. Results Of the 74 clients enrolled, 21 had dropped out and three had died (all defaulters) by 12 months post-enrollment, leaving 67.6% still in the program. Using an intention-to-treat analysis, meaningful and statistically significant gains were observed for all social, behavioural and mental health variables. Between baseline and 12 months there were reductions in needle sharing, drug use, property crime, anxiety, depression and suicidal thoughts; and improvements in physical health, mental health, quality of family relationships, employment and hopefulness. Factors contributing to retention and drop-out were identified, including the centrality of family, and general lack of awareness of and misunderstanding about methadone. Conclusion Even in parts of India where resources are constrained, methadone is an effective treatment for opioid dependence. Scaling up the availability of methadone elsewhere in Manipur and in other areas of India experiencing problematic opioid dependence is indicated.
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Affiliation(s)
- Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia.
| | | | - Lenin Singh Rajkumar
- Department of Psychiatry, Regional Institute of Medical Science, Imphal, Manipur, India
| | - Tilahun Haregu
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia
| | - Greg Armstrong
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia
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Picos AP, González RP, de la Iglesia Gutiérrez M. Exploring causes and consequences of sex workers' psychological health: Implications for health care policy. A study conducted in Spain. Health Care Women Int 2018; 39:844-858. [PMID: 29565214 DOI: 10.1080/07399332.2018.1452928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Nowotny KM, Perdue T, Cepeda A, Valdez A. Mental health of heroin users with differing injection drug use histories: A non-treatment sample of Mexican American young adult men. Drug Alcohol Depend 2017; 181:124-131. [PMID: 29054031 PMCID: PMC5683936 DOI: 10.1016/j.drugalcdep.2017.08.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/26/2017] [Accepted: 08/30/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND While the comorbidity of mental health and injecting heroin has been documented, current research is limited by describing the mental health of people who inject drugs without a comparison group and by the lack of research on nontreatment samples in the United States, particularly among Hispanics. The purpose of this study was to examine the association of injecting history (never, former, occasional, and daily) and multiple outcomes of global and mental health using a sample of U.S.-based Latinos not currently in treatment. METHODS Data are from a sample of street-recruited Mexican American young adult men (n=275) in San Antonio, TX. Multiple logistic regression and structural equation modeling were used. RESULTS Overall 54% of men reported lifetime injecting drug use (20.7% former users, 11.1% occasional users, and 21.9% daily users). We found varying prevalence rates of global and mental health status among different histories of injecting. After covariate adjustment, daily injecting remained strongly associated with all four outcomes: perceived poor health status (AOR=4.39; p≤0.001), psychological distress (AOR=2.78; p≤0.05), depression (AOR=4.37; p≤0.001), and suicidal ideation (OR=4.75; p≤0.001). Acculturation, gang membership, and incarceration history also emerged as important factors. CONCLUSION This study provides new information about the relationship between mental health and injecting heroin use. FINDINGS Support the need to consider mental health states among people who inject drugs, and to examine varying histories of injecting with socially and culturally relevant factors.
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Affiliation(s)
- Kathryn M. Nowotny
- University of Miami Department of Sociology, 5202 University Dr., Merrick Bldg Rm 120D, Coral Gables, FL 33146
| | - Tasha Perdue
- University of Southern California Suzanne Dworak-Peck School of Social Work, 669 W 34 St, Los Angeles, CA 909989
| | - Alice Cepeda
- University of Southern California Suzanne Dworak-Peck School of Social Work, 669 W 34 St, Los Angeles, CA 909989
| | - Avelardo Valdez
- University of Southern California Suzanne Dworak-Peck School of Social Work, 669 W 34 St, Los Angeles, CA 909989
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Goldstone D, Bantjes J. Mental health care providers' perceptions of the barriers to suicide prevention amongst people with substance use disorders in South Africa: a qualitative study. Int J Ment Health Syst 2017; 11:46. [PMID: 28811835 PMCID: PMC5553916 DOI: 10.1186/s13033-017-0153-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/03/2017] [Indexed: 12/05/2022] Open
Abstract
Background Substance use is a well-established, and potentially modifiable, risk factor for suicide. Suicide prevention interventions are typically framed within the biomedical paradigm and focus on addressing individual risk factors, improving access to psychiatric care, and improving the skills of medical personnel to recognise at-risk individuals. Few studies have focused on contextual factors that hinder suicide prevention in people with substance use disorders, particularly in low-resource settings. The aim of this qualitative study was to explore mental health care providers’ perceptions of barriers to suicide prevention in people with substance use disorders in South Africa. Methods Semi-structured interviews were conducted with 18 mental health care providers who worked with suicidal people with substance use disorders in Cape Town, South Africa. Data were analysed using thematic analysis and Atlas.ti software was used to code the data inductively. Results Two superordinate themes were identified: structural issues in service provision and broad contextual issues that pose barriers to suicide prevention. Participants thought that inadequate resources and insufficient training hindered them from preventing suicide. Fragmented service provision was perceived to lead to patients not receiving the psychiatric, psychological, and social care that they needed. Contextual problems such as poverty and inequality, the breakdown of family, and stigma made participants think that preventing suicide in people with substance use disorders was almost impossible. Conclusions These findings suggest that structural, social, and economic issues serve as barriers to suicide prevention. This challenges individual risk-factor models of suicide prevention and highlights the need to consider a broad range of contextual and socio-cultural factors when planning suicide prevention interventions. Findings suggest that the responsibility for suicide prevention may need to be distributed between multiple stakeholders, necessitating intersectoral collaboration, more integrated health services, cautious use of task shifting, and addressing contextual factors in order to effectively prevent suicide in people with substance use disorders.
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Affiliation(s)
- Daniel Goldstone
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Scott N, Carrotte ER, Higgs P, Stoové MA, Aitken CK, Dietze PM. Longitudinal changes in personal wellbeing in a cohort of people who inject drugs. PLoS One 2017; 12:e0178474. [PMID: 28562646 PMCID: PMC5451053 DOI: 10.1371/journal.pone.0178474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 05/13/2017] [Indexed: 11/22/2022] Open
Abstract
Aims To determine whether the self-reported personal wellbeing of a cohort of people who inject drugs (PWID) changes over time, and to identify longitudinal correlates of change. Methods We used Personal Wellbeing Index (PWI) scores reported between April 2008 and February 2015 by 757 PWID (66% male) enrolled in the Melbourne Injecting Drug Use Cohort Study (2,862 interviews; up to seven follow-up waves). A mixed-effects model was used to identify correlations between changes in temporal variables and changes in individual PWI scores while controlling for demographic variables. Results The cohort’s mean PWI score did not significantly differ over time (between 54.4/100 and 56.7/100 across the first four interview waves), and was 25–28% lower than general Australian population scores (76.0/100). However, there were large variations in individuals’ PWI scores between interviews. Increased psychological distress, moving into unstable accommodation, reporting intentional overdose in the past 12 months and being the victim of assault in the past six months were associated with declines in PWI scores. Conclusions Participants experienced substantially lower levels of personal wellbeing than the general Australian population, influenced by experiences of psychological distress, assault, overdose and harms related to low socioeconomic status. The results of this study suggest a need to ensure referral to appropriate housing and health support services for PWID.
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Affiliation(s)
- Nick Scott
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail:
| | | | - Peter Higgs
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Melbourne, Australia
- Department of Public Health, La Trobe University, Bundoora, Australia
| | - Mark A. Stoové
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Campbell K. Aitken
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul M. Dietze
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Scott N, Carrotte ER, Higgs P, Cogger S, Stoové MA, Aitken CK, Dietze PM. Longitudinal changes in psychological distress in a cohort of people who inject drugs in Melbourne, Australia. Drug Alcohol Depend 2016; 168:140-146. [PMID: 27664551 DOI: 10.1016/j.drugalcdep.2016.08.638] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous research into psychological distress among people who inject drugs (PWID) is predominantly cross-sectional; we determined longitudinal predictors of change in psychological distress among a cohort of PWID. METHOD We examined Kessler Psychological Distress Scale (K10) scores from 564 PWID (66% male) enrolled in the Melbourne Injecting Drug User Cohort Study. Gender-stratified linear models with fixed effects for each participant were used to examine correlates of change in individual K10 scores. Further linear regressions of adjusted K10 scores were used to measure correlations between demographic variables. RESULTS Participants reported higher K10 scores (higher psychological distress) than the general Australian population (mean K10 scores 23.4 (95%CI 22.6-24.2) and 14.5 (95%CI 14.3-14.7) respectively). The cohort's mean K10 score did not significantly differ over time, but individual variations were common. Women reported higher K10 scores than men (mean baseline K10 scores 25.2 (95%CI 23.9-26.6) and 22.4 (95%CI 21.5-23.3) respectively), however no significant differences remained after controlling for temporal factors. Key predictors of increases in K10 scores were being the victim of an assault in the past six months (P<0.001 for women and men) and intentionally overdosing in the past 12 months (P=.010 for women and P<0.001 for men). CONCLUSIONS PWID experience higher levels of psychological distress than the general population. Temporal rather than individual factors may account for the higher levels of psychological distress reported among women. Interventions to reduce rates of assault and/or intentional overdose should be explored to reduce high levels of psychological distress among PWID.
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Affiliation(s)
- Nick Scott
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Elise R Carrotte
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Peter Higgs
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; National Drug Research Institute, Faculty of Health Sciences, Curtin University, Melbourne Office, 6/19-35 Gertrude St, Fitzroy, Victoria 3065, Australia; Department of Public Health, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Shelley Cogger
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Mark A Stoové
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Campbell K Aitken
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Paul M Dietze
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
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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: 16] [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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The imperative to integrate suicide prevention within community-based harm reduction programs for people who inject drugs: Informed by the situation in Delhi, India. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 28:133-5. [DOI: 10.1016/j.drugpo.2015.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/06/2015] [Accepted: 08/13/2015] [Indexed: 11/20/2022]
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Li J, Gu J, Lau JTF, Chen H, Mo PKH, Tang M. Prevalence of depressive symptoms and associated factors among people who inject drugs in China. Drug Alcohol Depend 2015; 151:228-35. [PMID: 25920800 DOI: 10.1016/j.drugalcdep.2015.03.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND People who inject drugs (PWID) have a high prevalence of mental health problems (e.g., depression) which compromise the effects of HIV prevention. We investigated the prevalence of depression and associated factors among PWID in Dazhou, China. METHODS Anonymous face-to-face interviews were administered to eligible participants by well-trained doctors. The Center of Epidemiological Studies Depression Scale (CES-D) was used to measure depression, using hierarchical linear regression models. RESULTS Among the 257 participants, 7.0%, 11.3%, and 75.1% were probable cases of mild (16 ≤ CES-D < 21), moderate (21 ≤ CES-D < 25), and severe (CES-D ≥ 25) depression, respectively. Hopefulness (standardized β = -0.34, p < 0.001) and emotional family support (β = -0.21, p < 0.001) were negatively associated, whereas severity of drug dependence (β = 0.12, p = 0.034) and unmet service needs (β = 0.20, p < 0.001) were positively associated, respectively, with CES-D scores. The adjusted analysis showed that resilience was negatively associated with CES-D, but it was not selected by the stepwise model containing hopefulness and emotional family support. Protective factors (i.e., hopefulness and emotional family support) and risk factors (i.e., severity of drug dependence and unmet service needs) remained significant in the same regression model. CONCLUSION Protective and risk factors were independently associated with depressive symptoms. Integrated interventions covering basic and psychosocial needs for PWID are warranted. Such interventions should strengthen emotional family support and cultivate positive factors such as hopefulness.
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Affiliation(s)
- Jinghua Li
- Division of Behavioral Health and Health Promotion, Faculty of Medicine, The School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Joseph T F Lau
- Division of Behavioral Health and Health Promotion, Faculty of Medicine, The School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China; Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, China.
| | - Hongyao Chen
- Dazhou Center for Disease Control and Prevention, Sichuan, China
| | - Phoenix K H Mo
- Division of Behavioral Health and Health Promotion, Faculty of Medicine, The School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Mei Tang
- Dazhou Center for Disease Control and Prevention, Sichuan, China
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Armstrong G, Medhi GK, Mahanta J, Paranjape RS, Kermode M. Undiagnosed HIV among people who inject drugs in Manipur, India. AIDS Care 2014; 27:288-92. [PMID: 25345544 DOI: 10.1080/09540121.2014.972322] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Manipur is a geographically isolated state of India characterised by a high HIV prevalence among people who inject drugs (PWID). A low-to-moderate lifetime rate of HIV testing has been documented amongst PWID in Manipur. Little is known about the extent of undiagnosed HIV in this setting and whether uptake of HIV testing (and knowledge of a positive diagnosis) leads HIV-positive PWID to change their risk behaviours. The cross-sectional data (n = 821) analysed for this paper were collected in 2009 for the Integrated Behavioural and Biological Assessment (IBBA) using interviewer-administered questionnaires and the collection of de-linked blood and urine samples. Almost one-third (30.7%) of the participants tested HIV positive. The majority knew where to obtain a confidential HIV test (80.7%), however, half of the HIV-positive participants had either never had an HIV test (37.7%), or had undertaken a test without collecting the result (12.7%). Almost one-quarter (23.4%) of the HIV-positive participants and 17.4% of the HIV-negative participants had shared a needle/syringe with at least one other injector during the preceding month. Encouragingly, HIV-positive participants were significantly more likely than HIV-negative participants to use condoms with their regular sexual partners, however, there was still a high proportion of HIV-positive participants who did not use a condom at last sex with their regular (47.2%) or casual (48.0%) partners. Having taken an HIV test and collected the result was associated with a reduction in HIV-risk behaviours among HIV-positive participants, but not among HIV-negative participants. In conclusion, we found that a substantial proportion of the HIV-positive PWID in Manipur were not aware of their positive status, and risky injecting and sexual practices were commonplace. However, HIV-positive PWID appear to reduce their high-risk behaviours when they become aware of their HIV status highlighting the importance of taking HIV testing coverage to scale.
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Affiliation(s)
- Gregory Armstrong
- a Nossal Institute for Global Health, Melbourne School of Population and Global Health , University of Melbourne , Carlton , VIC , Australia
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Suicidal ideation and attempts among men who inject drugs in Delhi, India: psychological and social risk factors. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1367-77. [PMID: 24907898 DOI: 10.1007/s00127-014-0899-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 05/25/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Suicide is major public health problem in India. The objective of the analyses presented in this paper is to examine depressive and anxiety symptoms and socio-demographic indicators as correlates of suicidal ideation and attempts among people who inject drugs (PWID), a high-risk group for suicide. METHOD We analysed data collected in April-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 (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts within the past 12 months. RESULTS Depressive and anxiety symptoms were associated with suicidal ideation, as were a range of social stressors including poor physical health, length of injecting drug use, housing insecurity, and experiences of violence and sexual abuse. However, depressive and anxiety symptoms were not associated with suicide attempts. Factors associated with suicide attempts among ideators were housing insecurity and relational dynamics including a poor relationship with family and, interestingly, being married. CONCLUSION Suicide prevention interventions among this population should address not only individual mental health and addiction support needs but also the overwhelmingly poor psychosocial circumstances of this group.
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Armstrong G, Jorm AF, Samson L, Joubert L, Singh S, Kermode M. Male-to-male sex among men who inject drugs in Delhi, India: overlapping HIV risk behaviours. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26:404-11. [PMID: 25440911 DOI: 10.1016/j.drugpo.2014.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/12/2014] [Accepted: 08/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND HIV among people who inject drugs (PWID) is a major public health challenge in India. This paper examines PWID in Delhi who also have male-to-male sex with a focus on overlapping HIV risk behaviours and the psychosocial correlates of a history of male-to-male anal sex. METHODS We analysed data collected in April-May of 2012 from a community-based sample of 420 male PWID in Delhi obtained using time location sampling. RESULTS One third (37%) of the men reported a history of anal sex with men, among whom just 16% used a condom at last anal sex. Almost all (93%) participants who had a history of anal sex with men also had sex with women. Chi-square tests revealed that a history of anal sex with men was associated with a higher number of female sexual partners and sharing of needles and syringes. Additionally, unprotected sex at last sex with a male partner was significantly associated with unprotected sex at last sex with regular and paid female partners. Multivariate binary logistic regression revealed that the psychosocial correlates of a history of anal sex with other men were: being aged 18-24 (OR = 2.4, p = 0.014), illiteracy (OR = 1.9, p = 0.033), having never been married (OR = 2.6, p = 0.007), a main source of income of crime/begging (OR = 3.1, p = 0.019), a duration of injecting drug use greater than 20 years (OR = 3.4, p = 0.035) and suicidal ideation (OR = 1.7, p = 0.048). CONCLUSION Male-to-male sex was associated with psychosocial vulnerability, including a longer history of injecting drug use, suicidal ideation and socio-economic disadvantage. Given the extent of overlapping HIV risk behaviours, HIV programs for PWID would benefit from a strong focus on prevention of sexual HIV transmission, especially among male injectors who also have sex with other men.
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Affiliation(s)
- Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
| | - Anthony F Jorm
- Population Mental Health Group, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Luke Samson
- The Society for Service to Urban Poverty (SHARAN), Delhi, India
| | - Lynette Joubert
- Department of Social Work, School of Health Sciences, University of Melbourne, Victoria, Australia
| | - Shalini Singh
- The Society for Service to Urban Poverty (SHARAN), Delhi, India
| | - Michelle Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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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: 3.9] [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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Shittu RO, Alabi MK, Odeigah LO, Sanni MA, Issa BA, Olanrewaju AT, Sule AG, Aderibigbe SA. Suicidal Ideation among Depressed People Living with HIV/AIDS in Nigeria, West Africa. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojmp.2014.33027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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