People Who Inject Drugs and Have Mood Disorders—A Brief Assessment of Health Risk Behaviors

Abstract

Background People who inject drugs have a greater risk of infectious disease and mortality than other substance abusers and nondrug users. Variation in risk behavior among people who inject drugs is likely associated with comorbid mental health disorders. Objectives Examine the association between a history of mood disorder and recent risk behavior among people who inject drugs. Methods With baseline data from a behavioral HIV prevention clinical trial in a population of people who inject drugs, we used logistic regression models to compare the risk behaviors of people who report a past diagnosis of bipolar disorder (n=113) or depression (n=237) to a comparison group with no history of diagnosed mental illness (n=446). We also assessed differences between groups before and after adjusting for demographic characteristics and current depressive symptoms. Results While there were no differences between groups in frequency of drug use, people who inject drugs who report a history of mood disorders reported more injection risk behaviors, drug overdoses, sex exchanges, and multiple partners than those with no history of mental illness. Adjusting the comparison for demographic characteristics and current depressive symptoms had little impact on these findings. Variation in risk between depression and bipolar disorder groups was minimal. Conclusions/Importance People who inject drugs and have mood disorders have unique and significant social, clinical, and risk reduction needs. Despite the limited validity of self-reported mental health history, simply asking about a history of mood disorder may be effective for identifying a particularly vulnerable population of people who inject drugs.

Estimating the Effect of Depression on HIV Transmission Risk Behaviors Among People Who Inject Drugs in Vietnam: A Causal Approach

“…In contrast to condomless sex, we observed possible non-linearities in the relationship between depressive symptom severity and risk of sharing injection equipment, which have not been observed previously. Prior studies have found an increasing risk of injecting risk behavior with increasing depressive symptom severity [ 38 ] or have not differentiated between mild and severe symptoms [ 35 , 37 , 39 ]. We found monotonically increasing risk with increasing depressive symptoms in our cross-sectional analysis, and a U-shaped risk in our longitudinal analysis, where those with mild depressive symptoms had the lowest risk.…”

“…Existing studies on depression and HIV transmission risk behaviors among PWID have suffered from several methodological limitations. To our knowledge, all previous studies that include PWID populations have assessed only correlations between depression and transmission risk behaviors, without inferring causality [32][33][34][35][36][37][38][39][40]. In these studies, depression and risk behaviors have typically been evaluated for the same time period (e.g., self-report covering the last month), without the ability to infer whether depression preceded risk behaviors or vice versa [35-37, 39, 40].…”

“…To our knowledge, all previous studies that include PWID populations have assessed only correlations between depression and transmission risk behaviors, without inferring causality [ 32 – 40 ]. In these studies, depression and risk behaviors have typically been evaluated for the same time period (e.g., self-report covering the last month), without the ability to infer whether depression preceded risk behaviors or vice versa [ 35 – 37 , 39 , 40 ]. Potential confounders of the relationship between depression and risk behaviors were also measured for the same retrospectively assessed time period.…”

“…Possibly stemming from these methodological issues, existing evidence for an association between depression and transmission risk behaviors in PWID is inconsistent. While an early meta-analysis (that included studies among PWID) found little evidence for an association between depression and sexual risk behaviors [ 32 ], more recent studies in PWID and MSM populations have found higher sexual risk associated with depression [ 34 , 35 , 40 ] or a non-linear association [ 36 ] in which mild symptoms are most predictive of sexual risk. The few studies that have evaluated the association of depression with injecting risk behaviors among PWID have suggested that depressive symptoms were associated with greater injecting risk behaviors [ 35 , 37 – 39 ].…”

Efficacy and Safety of Omadacycline Versus Linezolid in Acute Bacterial Skin and Skin Structure Infections in Persons Who Inject Drugs

“…The availability of both IV and oral formulations of omadacycline may be beneficial for treatment decisions in the emergency ALT alanine transaminase, AST aspartate transaminase, PWID persons who inject drugs, TEAE treatment-emergent adverse event department for PWID, where patients often seek initial care. The prevalence of co-existing mental health comorbidities in PWID and in the general population [32], and widespread use of selective serotonin reuptake inhibitors, require alternatives to oxazolidinone antimicrobials in PWID and non-PWID populations.…”