Major depressive disorder and access to health services among people who use illicit drugs in Vancouver, Canada

Abstract

BackgroundPeople who use illicit drugs (PWUD) are commonly diagnosed with major depressive disorder (MDD). However, little is known about whether PWUD living with MDD experience additional barriers to accessing health services compared to those without MDD. We sought to identify whether MDD symptoms were associated with perceived barriers to accessing health services among people who use illicit drugs (PWUD) in Vancouver, Canada.MethodsData were collected through prospective cohorts of PWUD in Vancouver, Canada between 2005 and 2016. Using multiple logistic regression, we examined the relationship between MDD symptoms, defined as a Centre for Epidemiologic Studies Depression (CES-D) scale total score of ≥16, and barriers to access health services. We also used descriptive statistics to examine common barriers among participants who reported any barriers.ResultsAmong a total of 1529 PWUD, including 521 (34.1%) females, 415 (27.1%) reported barriers to accessing health services, and 956 (62.5%) reported MDD symptoms at baseline. In multiple logistic regression analyses, after adjusting for a range of potential confounders, MDD symptoms (adjusted odds ratio [AOR] = 1.40; 95% confidence interval [CI]: 1.03–1.92) were positively and significantly associated with barriers to accessing health services. Among those who reported MDD symptoms and barriers to access, commonly reported barriers included: long wait lists/times (38.1%); and treated poorly by health care professionals (30.0%).ConclusionThese findings show that the likelihood of experiencing barriers to accessing health services was higher among PWUD with MDD symptoms compared to their counterparts. Policies and interventions tailored to address these barriers are urgently needed for this subpopulation of PWUD.

Psychiatric morbidity and cervical cancer screening: a retrospective population-based case–cohort study

“…Depressive disorders are common psychiatric comorbidities, 23,24 and they have been independently associated with reduced use of health care services. [25][26][27][28] However, inconsistent use of diagnostic codes for major depressive disorder can result in misclassification; 29 therefore, we did not include suspected major depressive disorder in the exposure. In a sensitivity analysis, we excluded women with suspected major depressive disorder (ICD-9 code F296.2-296.36, ICD-10 code F33.x) to determine whether suspected major depressive disorder affected observed screening rates and associations.…”

Engagement in primary health care among marginalized people who use drugs in Ottawa, Canada

“…For example, people who receive disability payments, social services, and housing support likely have high mental health comorbidity [8,34]. Despite greater reported barriers to care [7], PWUD with concomitant mental health disorders may be more likely to access medical treatment and counseling services than those with substance use disorder alone, given evidence that integration of substance use disorder services lags behind that of mental health services in primary care settings [35]. Furthermore, while unstable housing is a known barrier to accessing primary care [36], those with stable housing and who have navigated the process of applying for disability are more likely to liaise with connected or co-located health care services, including mental health and addiction services [37], with such service integration being a key policy driver for improved care [38][39][40][41].…”

“…Common comorbidities among PWUD include mental health conditions, HIV and hepatitis C [2,5,6]. Despite this high burden of illness, the large majority of people who use drugs have unmet health needs [7][8][9]. In turn, PWUD have disproportionately greater use of acute care services, including emergency department visits and hospital admissions for issues including mental health and substance use diagnoses, and also infectious complications such as soft tissue infections and pneumonia [2,10,11].…”

Medición de la comorbilidad depresiva en drogodependientes: Validez y eficacia diagnóstica del Inventario de Depresión de Beck (BDI-II) en dominicanos con múltiple consumo de sustancias

“…Entre las consecuencias negativas derivables de la depresión se encontraría la drogodependencia o el consumo abusivo de sustancia. Si bien los mecanismos neurobiológicos y cognitivos que explican esta comorbilidad aún están siendo estudiados, existe mucha evidencia de la fuerte asociación entre la depresión y diversas problemáticas de consumo de drogas (Beaulieu, et al, 2018;Crnić, Todorović, Marković, Kastratović, y Timotijević, 2016;Gajewski, Turecki, y Robison, 2016;García-García, Luque, Santos Ruiz, y Tabernero, 2017;Gómez-Coronado, et al, 2018;Hammond, Lai, Wright, y Treisman, 2016;Khalid y Kausar, 2016;Hodgson, et al, 2017;Lai, Cleary, Sitharthan, y Hunt, 2015;Lister, Ledgerwood, Lundahl, y Greenwald, 2015;Rao, 2006). Una de las principales hipótesis que se han propuesto para la explicación de esta comorbilidad entre depresión y abuso de sustancia, es la hipótesis de automedicación (self-medication hypothesis; Gómez-Coronado, et al, 2018).…”