Prevalence and correlates of psychological distress symptoms among patients with substance use disorders in drug rehabilitation centers in urban Nepal: a cross-sectional study

Prevalence and determinants of opioid use disorder among long-term opiate users in Golestan Cohort Study

BACKGROUND

Number of opiate users worldwide has doubled over the past decade, but not all of them are diagnosed with opioid use disorder. We aimed to identify the prevalence and risk factors for OUD after ten years of follow-up.

METHODS

Among 8,500 chronic opiate users at Golestan Cohort Study baseline (2004-2008), we recalled a random sample of 451 subjects in 2017. We used three questionnaires: a questionnaire about current opiate use including type and route of use, the drug use disorder section of the Composite International Diagnostic Interview lifetime version, and the validated Kessler10 questionnaire. We defined opioid use disorder and its severity based on the DSM-5 criteria and used a cutoff of 12 on Kessler10 questionnaire to define psychological distress.

RESULTS

Mean age was 61.2 ± 6.6 years (84.7% males) and 58% were diagnosed with opioid use disorder. Starting opiate use at an early age and living in underprivileged conditions were risk factors of opioid use disorder. Individuals with opioid use disorder were twice likely to have psychological distress (OR = 2.25; 95%CI: 1.44-3.52) than the users without it. In multivariate regression, former and current opiate dose and oral use of opiates were independently associated with opioid use disorder. Each ten gram per week increase in opiate dose during the study period almost tripled the odds of opioid use disorder (OR = 3.18; 95%CI: 1.79-5.63).

CONCLUSIONS

Chronic opiate use led to clinical opioid use disorder in more than half of the users, and this disorder was associated with psychological distress, increasing its physical and mental burden in high-risk groups.

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

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.

Psychosocial Life Aspects among Substance Misuse Clients who are at Rehabilitation Phase: A Narrative Review

Objective

The present study aimed at exploring the psychosocial life aspects among substance misuse clients through conducting a review of the literature related to the research topic. A scoping search in the literature revealed the significant lack of both local, regional and international studies exploring the psychosocial life aspects among substance misuse clients who are at the rehabilitation stage.

Method

A comprehensive literature search was performed using the keywords: "psychosocial, "psychological", "social", "life", "rehabilitation" and "substance misuse". The search process was performed in the following electronic databases "MEDLINE, PubMed, CINAHL, PsycINFO". Full text articles, published in English during the period between 2016 and 2021 were included in the literature.

Results

A total of 7 studies were found to be in relation with the topic addressed in this study, which is the psychosocial life aspects of substance misuse clients at rehabilitation phase. The results showed that there is a significant weakness of psychosocial life aspects among substance misuse clients, in addition to a significant lack of both educational and training program that aim at enhancing and improving the psychosocial life aspects among substance misuse clients who are at the rehabilitation phase.

Conclusion

The study concluded that there should be concise and clear measurement tools to be used in assessing the psychosocial life aspects of substance misuse clients who are the rehabilitation phase.

Difference of Anxiety Subscale and Depression Score in Methamphetamine Abuse Prior and after Abstinence Over the Course of Three Weeks in Rehabilitation Center of Medan Plus

BACKGROUND: Clinical effect of amphetamine is related to the release of central monoamine in such a long period of time which leads to enhanced stimulation of sympathetic nervous system. Abstinence is defined as a period of restraint in which no substance is used. Anxiety and depression are most common psychiatry problem related to methamphetamine usage that has to be addressed in rehabilitation effort of methamphetamine abuse. AIM: This study is to investigate the difference of anxiety subscale and depression (hospital anxiety and depression scale [HADS]) in methamphetamine abuse prior and after abstinence over the course of 3 weeks in rehabilitation center of Medan Plus. METHODS: This quasi-experimental study was conducted with pre- and post-test design. Sample used in this research was generated through consecutive sampling, part of non-probability sampling, in which 30 subjects that are individuals with methamphetamine abuse were recruited in Rehabilitation Centre of Medan Plus, North Sumatera. Measurement was conducted to assist the effect of 3 weeks abstinence on HADS core. In the other hand, assessment smoking and substance involvement screening test was also used to investigate the length of substance usage. RESULTS: Our study found a significant difference between anxiety and depression symptoms score prior and after 3 weeks abstinence in methamphetamine user (p < 0.001). CONCLUSION: Following abstinence, several clinical symptoms were seen to be resolved or decreased within the first couple of weeks, including symptoms of anxiety and depression.

Prevalence of Sexual Dysfunction in Women With Depressive Disorder at a Tertiary Hospital

Background:

Sexual dysfunction in female with depressive disorder is highly prevalent and strikingly understudied. Epidemiological and clinical studies have shown association between depression and impairments of sexual function. Despite high prevalence, there are limited studies regarding the prevalence of sexual dysfunction among female with depressive disorder in Nepal.

Aims:

This study was conducted to find out the prevalence of sexual dysfunction in female with depressive disorder in Nepal, their association with treatment status, and the level of psychological distress caused by it.

Methods:

A descriptive cross-sectional study was carried out among female with depression at Tribhuvan University Teaching Hospital, Nepal. The participants were grouped as drug naïve and under medication. Data were collected using semi-structured proforma, Beck Depression Inventory, Kessler 6+ Psychological Distress Scale, and Female Sexual Function Index. Data were tabulated and analyzed using Statistical Package for Social Sciences version 23.

Results:

The prevalence of sexual dysfunction was 58.82%, being 60.78% in drug-naïve cases and 56.86% in females suffering from depression and receiving medications. This study showed statistically significant association between sexual dysfunction and psychological distress but not with age, duration of marriage, number of children, occupational, and financial status.

Conclusions:

The study reported high prevalence of sexual dysfunction among female with depression. All domains of sexual function were affected and showed significant association with psychological distress. Therefore, assessment of sexual dysfunction in every female with depression is required to address the problem timely and efficiently.

History of psychiatry in Nepal

The history of psychiatry as a discipline in Nepal has been poorly studied. We have attempted to summarise historical landmarks to explore how it began and its evolution over time in relation to contemporary political events. Although Nepal has achieved several milestones, from establishing a psychiatric out-patient department with one psychiatrist in 1961 to having more than 500 psychiatric in-patient beds with 200 psychiatrists by 2020, the pace, commitment and dedication seem to be slower than necessary: the current national mental health policy dates back to 1996 and has not been updated since; there is no Mental Health Act; the number of psychiatric nurses and in-patient psychiatric beds has increased only slowly; and there is a dearth of professional supervision in rehabilitation centres. Thus, despite making significant progress, much more is required, at greater intensity and speed, and with wide collaboration and political commitment in order to improve the mental health of all Nepali citizens, including those living in rural areas and or in deprived conditions.

Effect of Abstinence on Psychological Distress Scores, Social Dysfunction Scores, Total General Health Questionnaire Scores-12, and Total Quality of Life Scores in Men with Methamphetamine Dependence in Therapeutic Community

AIM: We looked for differences in abstinence influence on Psychological Distress Scores, Social Dysfunction Scores, Total General Health Questionnaire – 12 (GHQ-12), and Total Quality of Life Scores on men with Methamphetamine dependence in the Therapeutic Community. METHODS: This study was conducted a numerical comparative analytical analysis paired with twice measurements with subject retrieval done using consecutive sampling. The participant of this study was 47 subjects who selected by inclusion and exclusion criteria. RESULTS: Found psychological distress score of the abuser was p ˂ 0.001, different with social dysfunction score there was no significant difference where the score was p = 0.062, the total GHQ-12 score was a significant difference where the score was p = 0.025 while in the total quality of life score (SF-36) there was a significant difference with the score of p ˂ 0.001. CONCLUSIONS: After abstinence, quarantine was found to improve attitude, behavior, cognitive, and social function such as appropriate communication and active social relationship with others compared with before abstinence quarantine.

Quality of life among people who use drugs living in poor urban communities in the Philippines

BACKGROUND

The quality of life (QOL) and mental health of people who use drugs (PWUD) in the Philippines, especially those living in poor urban communities, are highly concerning due to the situations surrounding drug use and the ongoing hard-line antidrug policy. This study aimed to investigate the QOL and mental health status of PWUD, compare them with a comparison group with no history of drug use, and identify factors associated with QOL among Filipino PWUD.

METHODS

A cross-sectional study was conducted with recruitment from a community-based rehabilitation programme and poor urban communities in Muntinlupa in 2018. QOL was measured using the WHOQOL-BREF, while psychological distress and posttraumatic stress disorder (PTSD) were measured using the Kessler Psychological Distress Scale (K-6) and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), respectively. Multivariable linear regressions with each WHOQOL-BREF domain as a dependent factor were conducted to establish three predictions: age- and gender-adjusted QOL means, factors associated with QOL among PWUD, and interaction of lifetime drug use with each covariate.

RESULTS

In total, 272 PWUD and 402 comparison participants were recruited. Most PWUD were current drug users (53%), primarily of methamphetamine (70%). Among PWUD, the prevalence of moderate to severe psychological distress was 70%, and probable PTSD was 28%-both rates higher than those among the comparison group. All four QOL domain scores (physical, psychological, social, and environmental) of PWUD were lower than those of the comparison group. Multivariable regressions showed that psychological distress, current drug use, selling drugs, experiencing discrimination, and being never-married were associated with lower QOL. Higher individual income, household resources, social activity participation, and service use for drug use problems were associated with higher QOL among PWUD. Stratified and interaction analyses revealed that the QOL of PWUD was more sensitive to changes in individual income relative to the QOL of comparison group.

CONCLUSION

A comprehensive intervention addressing psychological distress reduction, economic empowerment, and social inclusion-complementary to abstinence-oriented programmes-may improve the well-being of Filipino PWUD.

How do medical and non-medical use of z-drugs relate to psychological distress and the use of other depressant drugs?

BACKGROUND

Z-drugs are hypnotic drugs used for insomnia with considerable potential of abuse. We investigated the relationship of past-year medical and non-medical use of z-drugs with past-year: i) psychological distress; ii) medical use, non-medical use, and DSM-IV use disorder of Benzodiazepine (BZD) tranquilizers; iii) use and DSM-IV alcohol and marijuana use disorders, recreational drugs with a depressant effect on the central nervous system.

METHODS

Data came from the 2015-2017 NSDUH (n = 128,740). Participants aged 18+ were asked if they had used any Z-Drug medically or non-medically in the past year. We investigated the associations between the three-level z-drugs variable with psychological distress and BZD, alcohol, and marijuana variables in multinomial logistic regression models.

RESULTS

Past-year prevalences of z-drug use were 3.3% for medical and 0.5% for non-medical use. Medical and non-medical users of z-drugs had higher risk of psychological distress, compared to non-users. Medical and non-medical users of z-drugs had higher risk of medical use, non-medical use, and BZD use disorders. Compared to non-users of z-drugs, medical users had higher risk of marijuana and alcohol use and alcohol use disorders, while non-medical users had higher risk of marijuana use and marijuana use disorders and alcohol.

CONCLUSION

Z-drug users have elevated risk of use and dependence of BZDs and recreational drugs, possibly due to concurrent prescribing and self-medication.

Prevalence and factors associated with psychological distress among key populations in Togo, 2017

OBJECTIVES

Mental health is a largely neglected issue among in Sub-Saharan Africa, especially among key populations at risk for HIV. The aim of this study was to estimate the prevalence of psychological distress (PD) and to assess the factors associated among males who have sex with males (MSM), female sex workers (FSW) and drug users (DU) in Togo in 2017.

STUDY DESIGN

A cross-sectional bio-behavioral study was conducted in August and September 2017 using a respondent-driven sampling (RDS) method, in eight cities in Togo.

METHODS

A standardized questionnaire was used to record sociodemographic characteristics and sexual behaviors. The Alcohol Use Disorders Identification Test (AUDIT) and a subset of questions from the Tobacco Questions for Survey were used to assess alcohol and tobacco consumption respectively. PD was assessed with the Kessler Psychological Distress Scale. A blood sample was taken to test for HIV. Descriptive statistics, univariable and multivariable ordinal regression models were used for analysis.

RESULTS

A total of 2044 key populations including 449 DU, 952 FSW and 643 MSM with a median age of 25 years, interquartile range (IQR) [21-32] were recruited. The overall prevalence of mild PD among the three populations was 19.9% (95%CI = [18.3-21.8]) and was 19.2% (95%CI = [17.5-20.9]) for severe/moderate PD. HIV prevalence was 13.7% (95%CI = [12.2-15.2]). High age (≥ 25 years) [aOR = 1.24 (95% CI: 1.02-1.50)], being HIV positive [aOR = 1.80 (95% CI: 1.31-2.48)] and hazardous alcohol consumption [aOR = 1.52 (95% CI: 1.22-1.87)] were risk factors for PD. Secondary [aOR = 0.52 (95% CI: 0.42-0.64)] or higher [aOR = 0.46 (95% CI: 0.32-0.64)] education levels were protective factors associated with PD. FSW [OR = 0.55 (95% CI: 0.43-0.68)] and MSM [OR = 0.33 (95% CI: 0.24-0.44)] were less likely to report PD compared with DU.

CONCLUSION AND RECOMMENDATIONS

This is the first study conducted among a large, nationally representative sample of key populations in Togo. The prevalence of PD is high among these populations in Togo and was associated to HIV infection. The present study indicates that mental health care must be integrated within health programs in Togo with a special focus to key populations through interventions such as social support groups.

Socio-demographic and substance-related factors associated with mental distress among Wollo university students: institution-based cross-sectional study

BACKGROUND

The presence of mental distress among students affects their cognitive, emotional, physical, and interpersonal functioning. Besides, it predisposes to substance use problems and finally affects academic performance negatively. Therefore, this study was designed to estimate the magnitude and identify associated factors for the mental distress of students at Wollo University, Dessie, Ethiopia.

METHODS

This institution-based cross-sectional survey assessed mental distress among 585 undergraduate students at Wollo University from April 10 to May 10/2019 using a multi-stage stratified sampling technique. Kessler-10 item scale was used to collect data about mental distress. Variables with p-value < 0.25 in bivariate logistic regression were pooled into a multi-variable logistic regression model and p-value < 0.05 in the multi-variable model was considered significant statistically. The strength of the relationship was interpreted using the odds ratio with 95% CI. The model adequacy in multi-variable regression was approved with Hosmer and Lemeshow goodness of fit test.

RESULTS

Among 585 questionnaires distributed, 548 clear and completed questionnaires were included in the analysis with a response rate of 93.7%. The mental distress prevalence in the current study was 106 (19.3%). From this 65 (11.9%), 28 (5.1%), and 13 (2.4%) were found to be mild, moderate and severe mental distress respectively. Never attending a place of worship (AOR = 4.2, 95% CI 1.73, 10.39), family history of mental illness (AOR = 2.1, 95% CI 1.12, 3.95), current cigarette smoking (AOR = 3.2, 95% CI 1.69, 6.20), current alcohol use (AOR = 2.5, 95% CI 1.49, 4.25), and current cannabis use (AOR = 3.4, 95% CI 1.18, 9.57) were the associated factors for mental distress.

CONCLUSION

One in five students was affected by mental distress. Never attending a place of worship, family history of mental illness, current cigarette smoking, current alcohol use, and current cannabis use were the factors associated with it. Therefore, all stakeholders should be involved in overcoming this public health problem. Besides, clubs should be established in the university and have to play an active role in bringing behavioral change to substance use.

Patterns and sociodemographic characteristics of substance abuse in Al Qassim, Saudi Arabia: a retrospective study at a psychiatric rehabilitation center

BACKGROUND

The problem of substance abuse is one of the top 20 risk factors for poor health worldwide. Though widely prevalent in the Middle East, there are few studies in Saudi Arabia.

OBJECTIVE

Record the pattern of substances abuse and the sociodemographic characteristics of abusers attending the local rehabilitation center.

DESIGN

Descriptive, retrospective medical record review.

SETTING

Patients admitted to psychiatric rehabilitation center.

METHODS

The sample included all patients admitted to a rehabilitation center during the period of January 2016-December 2016. Data was collected retrospectively from patient records.

MAIN OUTCOME MEASURES

Descriptive epidemiological data and statistical comparisons.

SAMPLE SIZE

612 patients.

RESULTS

The majority of patients (73%) were 21-40 years of age. Polysubstance abuse (60%) and amphetamine (24%) abuse were most predominant in the 20-40 year olds (45%) and high school dropouts (41%). The average number of drugs being used by polysubstance abusers was 2.5 (and the maximum was 6). There was no relationship of family history of drug abuse and mental illness.

CONCLUSION

There was an increased use of polysubstances and amphetamine with a decreased abuse of prescription drugs when compared to previous studies reported in Saudi Arabia. There was a decreasing prevalence for heroin and alcohol. Substance abusers have certain epidemiological, social and drug patterns and we recommend that authorities and planners integrate their efforts to look for the reasons for substance abuse.

LIMITATIONS

Females not included and prevalence of tobacco smoking not studied.

CONFLICT OF INTEREST

None.