Prevalence of psychiatric disorders and associations with drug use among clients of a needle and syr

1
Prevalence of psychiatric disorders and
associations with drug use among clients of a
needle and syringe program and primary health
centre

• David Wain1, Campbell Aitken1, Harriet Devlin1,
  Dan I. Lubman2, Leanne Hides2, Tania Gibbie3,
  Lisa Wong2, Sandra Gregson4, Margaret Hellard1.
• 1. Centre for Epidemiology and Population Health
  Research,
• Macfarlane Burnet Institute
• 2. ORYGEN Research Centre, Department of
  Psychiatry, University of Melbourne
• 3. Infectious Diseases Unit, The Alfred Hospital,
  Victoria
• 4. Healthworks Primary Health Centre, Western
  Region Health Centre

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Background

• Most studies measuring the prevalence of
  psychiatric disorders have measured people in
  treatment
• Very few measure IDUs in the community
• no way of knowing if people in treatment are
  representative of IDUs in general
• This study aims to measure current IDUs not in
  treatment
• Current defined as having used in the last 3
  months

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Why is this important?

• significantly worse psychiatric symptoms and
  treatment compliance
• greater propensity for suicidal and self-harming
  behaviours
• poorer physical health habits
• fewer social supports or financial resources
• more frequent involvement with public hospitals
  and the criminal justice system
• increased risk for blood borne virus infection

4
Aims

• To measure the prevalence of psychiatric
  disorders among clients of a needle and syringe
  program (NSP) and primary health centre (PHC)
• To assess the importance of the type and
  frequency of drug use in the three months prior
  to interview as risk factors for non-substance
  induced psychiatric disorder.

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Study design

• A cross-sectional prevalence study using a
  convenience sample of injecting drug users
  visiting a NSP and PHC in Melbourne.

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Participants

• Healthworks is a co-located PHC and NSP for IDUs
  in Footscray
• Between February and July 2004, 445 clients of
  the NSP and PHC clinic were asked to participate
  in a one hour, face to face interview
• 115 clients agreed to participate and 105
  completed the interview
• Participants were eligible for the study if they
  were current IDUs (injected in the 3 months prior
  to interview), able to provide informed consent,
  and over the age of 16 years.

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Measurements

• The MINI International Neuropsychiatric Interview
  was administered
• MINI is a short structured interview that screens
  for all psychiatric disorders except for
  personality disorders
• The Kessler Psychological Distress Scale (K10), a
  10 item measure of psychological distress was
  also completed
• Alcohol, Smoking and Substance Involvement
  Screening Test v2.1 (ASSIST) also administered
• ASSIST v2.1 asks about lifetime and the
  frequency of use of nine drug categories in the
  last three months. .

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Analysis

• All data analysed with STATA 7
• Prevalence rates of psychiatric disorders with
  95 confidence intervals were calculated
• Multiple logistic regression models were created
  to identify significant variables.
• Variables included were type of drug use,
  frequency of drug use, current age, age at first
  injection, number of years injecting and previous
  experience of trauma
• A variable was considered significant if its
  p-value was less than 0.05.

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Socio demographics

• Most participants male (76 vs 29) and single
  (58.1)
• mean age is 33.6 years (SD 8.83, 18-67 years)
• Nearly half (48.5) lived in rental
  accommodation, 18.4 lived with family, and 3.9
  of participants were homeless
• 85 were unemployed, 13.6 in full or part time
  work
• Half (50) had completed at least ten years of
  education and 44.7 had at least year 12.
• 55 reported spending some time in jail
• Most identified as Australian 1.9 were
  indigenous, 3.9 New Zealanders, 2.9 of Asian or
  Italian/Greek descent respectively, and 1.9 were
  Irish/English.

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Prevalence of psychiatric disorders (MINI)

• Current disorder (Axis I) 68.6
• gt 1 current disorder (Axis I /or Axis II)
  57.1
• Mood Disorder 48.6
• Anxiety Disorder 53.3
• Post Traumatic Stress 23.8
• Psychotic disorder 11.4

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Prevalence of psychiatric disorders

• high prevalence of psychiatric disorders
• common for participants to have more than one
  condition
• depression and anxiety the most common disorders
• This is consistent with other studies of IDUs in
  non treatment settings

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Results of K10

• K10 is a 10 question screening tool
• Gives a measure of general psychological distress
• Does not specify the cause of distress
• Is not a diagnostic tool, but is useful as an
  indicator that a diagnosis might be needed
• Used in the general pop. of Vic, so comparisons
  are possible

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Results of K10 compared to the population of the
state of Victoria

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Drug use

• Substance use among participants was widespread
  and frequent
• 100 ever used opioids,
• 82.9 using them weekly or more often
• A number of other drugs. were also commonly
  consumed on a weekly or more frequent basis
• No particular drug appeared to be predictive of
  any psychiatric disorder

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Substance use - ever

• Opioids 100
• Tobacco 100
• Alcohol 100
• Cannabis 100
• Amphetamines 97.1
• Sedatives 86.6
• Inhalants 34.2
• Hallucinogens 77.1
• Cocaine 64.7

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Substance use last 3 months (weekly or more)

• Opioids 82.9
• Tobacco 96.2
• Alcohol 25.7
• Cannabis 57.2
• Amphetamines 10.5
• Sedatives 31.4
• Inhalants 0
• Hallucinogens 0
• Cocaine 0

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Risk factors

• The only significant association with risk
  factors was for anxiety disorder and those who
  recently commenced injecting and had a history of
  trauma
• drug use may be motivated by a desire to
  alleviate symptoms of the primary disorder
• primary disorder may have been induced by drug
  use
• this distinction may not be important in the
  clinical or community setting.

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Association between anxiety disorder and risk
factors

• Previous trauma OR5.06 P-value.0111
• Injecting for less than
• six years OR5.04 P-value.0201
• Consuming alcohol
• Weekly or more often OR3.36 P-value.0291
• Consuming sedatives
• Weekly or more often OR2.63 P-value.056

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Mental health and medical service use history

• 92.4 had visited a doctor in the last year
• 65.7 had received some form of drug treatment in
  the last year
• 85.7 had visited a mental health service ever
• 67.6 having done so in the previous 12 months

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Of those who were currently diagnosed with a
psychiatric disorder

• 81.9 had accessed a mental health service, and
  of these
• 34.4 were not currently diagnosed with a
  psychiatric disorder
• 83.8 had been prescribed drugs for a psychiatric
  disorder at some stage.

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Mental health and medical service use history

• high level of engagement with mental health
  services
• over two thirds in the previous 12 months
• high level of awareness of mental health status
• able to access mental health services
• success is associated with this engagement, as a
  third of those who had ever accessed a mental
  health service were not classified as having a
  psychiatric disorder
• basic issues of access were not a significant
  barrier for participants, although data does not
  provide any details about their experience once
  through the door

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Conclusion

• prevalence of psychiatric disorders is high, much
  higher than for Vic as a whole
• majority of participants had more than one
  disorder
• No significant association between drug use
  factors, frequency of use and psychiatric
  disorders
• previous trauma is a factor associated with
  mental health disorders

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Conclusion (cont.)

• Utilisation of mental health services high
• A third of participants who had accessed mental
  health services in the past were not diagnosed
  with a current disorder at the time of interview
• over three quarters of those with a current
  psychiatric disorder were in contact with some
  form of mental health service
• Our data suggest that the prevalence of
  psychiatric illness is even higher in
  community-recruited IDUs than in those recruited
  from drug treatment services
• These findings reinforce the experience of many
  workers in the field, and support previous calls
  for community based IDU services to be allocated
  resources, training and support