British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
Drug Alcohol Rev. 2018 Apr;37 Suppl 1(Suppl 1):S285-S293. doi: 10.1111/dar.12631. Epub 2017 Nov 22.
Limited attention has been given to the predictors of mental health diagnoses among people who inject drugs (PWID) in community settings. Therefore, we sought to longitudinally examine the prevalence, incidence and predictors of mental disorder diagnosis among a community-recruited cohort of PWID.
Data were derived from two prospective cohort studies of PWID (VIDUS and ACCESS) in Vancouver, Canada between December 2005 and May 2015. We used multivariable extended Cox regression to identify factors independently associated with self-reported mental disorder diagnosis during follow-up among those without a history of such diagnoses at baseline.
Among the 923 participants who did not report a mental disorder at baseline, 206 (22.3%) reported a first diagnosis of a mental disorder during follow-up for an incidence density of 4.29 [95% confidence interval (CI) 3.72-4.91] per 100 person-years. In the multivariable analysis, female sex [adjusted hazards ratio (AHR) = 1.74, 95% CI 1.29-2.33], experiencing non-fatal overdose (AHR = 2.33, 95% CI 1.38-3.94), accessing any drug or alcohol treatment (AHR = 1.68, 95% CI 1.24-2.27), accessing any community health or social services (AHR = 1.53, 95% CI 1.02-2.28) and experiencing violence (AHR = 1.60, 95% CI 1.12-2.29) were independently associated with a mental disorder diagnosis at follow-up.
We observed a high prevalence and incidence of mental disorders among our community-recruited sample of PWID. The validity and implication of these diagnoses for key substance use and public health outcomes are an urgent priority.
在社区环境中，针对注射毒品者（PWID）的心理健康诊断预测因素，关注的程度有限。因此，我们试图通过对社区招募的 PWID 队列进行纵向研究，来检查精神障碍诊断的患病率、发病率和预测因素。
数据来自于加拿大温哥华的两项针对 PWID 的前瞻性队列研究（VIDUS 和 ACCESS），研究时间为 2005 年 12 月至 2015 年 5 月。我们使用多变量扩展 Cox 回归来确定基线时没有此类诊断史的参与者在随访期间报告首次精神障碍诊断的独立相关因素。
在 923 名基线时未报告精神障碍的参与者中，有 206 名（22.3%）在随访期间报告了首次精神障碍诊断，发病率密度为每 100 人年 4.29（95%置信区间 3.72-4.91）。在多变量分析中，女性（调整后的危险比 [AHR] = 1.74，95%置信区间 1.29-2.33）、非致命性过量用药（AHR = 2.33，95%置信区间 1.38-3.94）、接受任何药物或酒精治疗（AHR = 1.68，95%置信区间 1.24-2.27）、接受任何社区卫生或社会服务（AHR = 1.53，95%置信区间 1.02-2.28）和经历暴力（AHR = 1.60，95%置信区间 1.12-2.29）与随访时的精神障碍诊断独立相关。
我们在社区招募的 PWID 样本中观察到精神障碍的高患病率和发病率。这些诊断对关键的物质使用和公共卫生结果的有效性和意义是当务之急。
