Risk Indicators of Depressive Symptomatology among Injection Drug Users and Increased HIV Risk Behaviour

Article excerpt

Objectives: In 2009, the annual incidence of positive human immunodeficiency virus (HIV) test reports for people in the Saskatoon Health Region (SHR) was 31.3 per 100 000, when the national average was only 9.3 per 100 000. The first objective was to determine the prevalence of depressive symptomatology among injection drug users (IDUs) in the SHR. The second objective was to determine the unadjusted and adjusted risk indicators associated with depressive symptomatology among IDUs. The third objective was to determine if depressive symptomatology was associated with HIV risk behaviours.

Methods: From September 2009 to April 2010, 603 current IDUs were surveyed with validated instruments; this sample represents 76.6% of known IDUs in the SHR.

Results: Among the respondents, 81.4% reported depressive symptomatology, whereas 57.7% reported more severe depressive symptomatology. After multivariate analysis, the 4 covariates that had an independent association with depressive symptomatology included sexual assault as an adult, sexual assault as a child, attending a residential school, and having an annual income of less than $10 000 Depressive symptomatology was initially associated with 7 HIV risk behaviours. After multivariate analysis, depressive symptomatology was associated with giving sex to get money, giving drugs to get sex, and with more frequently sharing injecting equipment.

Conclusions: This study found that depressive symptomatology was strongly associated with injection drug use.

Can J Psychiatry. 2011;56(6):358-366.

Clinical Implications

* There is a need to integrate substance abuse prevention and cessation efforts with postvictimization services.

* Broad public policy initiatives, such as increased social services payments and subsidized housing, to prevent poverty within IDUs would help reduce depressive symptomatology.

* Offering more services where IDUs live, with mental health providers who treat both depression and drug abuse as a means to reduce HIV risk behaviour, may aid in reducing HIV incidence.

Limitations

* Our study was cross-sectional and therefore unable to determine causation.

* Although validated instruments were used, all of the information generated was based on self-report data.

* Even though our sample represented 76.6% of the known IDUs in the SHR, no attempt was made to collect information from the remaining 23.4% to determine if they were different from the study sample. Selection bias could have possibly influenced results.

Key Words: intravenous substance abuse, risk factors, depression

Abbreviations

AIDS acquired immune deficiency syndrome

BDI-II Beck Depression Inventory-II

CES-D Center for Epidemiologic Studies Depression Scale

HIV human immunodeficiency virus

IDU injection drug user

RBA Risk Behaviours Assessment

SCID-III-R Structured Clinical Interview for DSM-III-Revised

SES socioeconomic status

SHR Saskatoon Health Region

The number of new positive HIV test reports in the SHR in the province of Saskatchewan is rapidly on the rise. In 2004, there were 16 positive test reports confirmed, which increased annually to 39 in 2005, 53 in 2006, 57 in 2007, 77 in 2008, and 94 in 2009. In 2009, the annual incidence of positive HIV test reports for people in the SHR was 31.3 per 100 000, when the national average was only 9.3 per 100 000.1

Detailed information on HIV risk indicators for the SHR is unavailable, but it is available for the province of Saskatchewan, where the SHR had 54% of all new infections in 2008.2 The majority (76.9%) of positive HIV test reports in the province were associated with injection drug use, compared with 18.9% nationally.1,2

Depression among IDUs is associated with increased risk behaviours, and there are numerous papers that support this.3 For example, Perdue et al3 found that depression was associated with an increased likelihood of injecting with a syringe that had been used by another IDU. …