Factors Associated with Symptoms of Depression among Injection Drug Users Receiving Antiretroviral Treatment in Indonesia

Li, Yi; Hershow, Ronald C.; Irwanto, Irwanto; Praptoraharjo, Ignatius; Setiawan, I Made Agus; Levy, Judith A.

doi:10.4172/2155-6113.1000303

Cited by 17 publications

(19 citation statements)

References 62 publications

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“…Depressive symptoms were measured using the Revised Center for Epidemiologic Studies Depression (CESD-R) scale [ 56 ]. The CESD-R is validated and used widely across settings, including among samples of people who inject drugs in Indonesia [ 44 , 57 ]. The scale measures symptoms of depression in the previous 2 weeks, as defined by the American Psychiatric Association Diagnostic and Statistical Manual, fifth edition.…”

Section: Methodsmentioning

confidence: 99%

“…Depression is another common health disparity that disproportionately affects people who inject drugs in Indonesia. The prevalence of severe depressive symptoms among a sample of people who inject drugs recruited from Jakarta and Denpasar was nearly five times higher (33%) than prevalence found in a general Indonesian population sample (7%) [ 43 , 44 ]. Depression has been associated with recent substance use among Indonesian people who use drugs and have HIV [ 44 ], but is understudied among women.…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of severe depressive symptoms among a sample of people who inject drugs recruited from Jakarta and Denpasar was nearly five times higher (33%) than prevalence found in a general Indonesian population sample (7%) [ 43 , 44 ]. Depression has been associated with recent substance use among Indonesian people who use drugs and have HIV [ 44 ], but is understudied among women. In international research, depression has been shown to play a role in increasing women’s substance use and in inhibiting their ability to discern and navigate risky situations [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Syndemic and Synergistic Effects of Intimate Partner Violence, Crystal Methamphetamine, and Depression on HIV Sexual Risk Behaviors among Women Who Inject Drugs in Indonesia

et al. 2019

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Women who inject drugs are disproportionately affected by co-occurring intimate partner violence (IPV), poor mental health, and substance use. Less is known about the potentially synergistic effects of these factors on women’s HIV risk behavior, and no known studies in Asia examine these relationships. This study assessed the additive and interactive effects of exposure to syndemic IPV, depressive symptoms and non-injection crystal methamphetamine (crystal meth) on HIV sexual risk behaviors in the largest cross-sectional sample of women who inject drugs in Indonesia. Seven hundred thirty-one women aged ≥ 18 years, injecting drugs in the preceding 12 months, and residing in Greater Jakarta or Bandung, West Java, were recruited using respondent-driven sampling (RDS). Twenty-six percent of women experienced concurrent IPV, crystal meth use and depressive symptoms. In multivariate logistic regressions controlling for sociodemographic confounders, all three factors were significantly positively associated with sexual risk outcomes. In adjusted marginal effects models, concurrent experience of IPV, crystal meth use and depressive symptoms was associated with increases in the prevalence of HIV risk outcomes: STI symptomatology (from 12% to 60%), inconsistent condom use (from 3% to 22%), and engagement in survival sex work (from 6% to 25%). Statistically significant interaction was detected on both multiplicative and additive scales. Specifically, an interaction was observed on the multiplicative scale between depressive symptoms and crystal meth on STI symptomatology (OR = 2.61; 95% CI = 1.24, 5.48; p = 0.011). There was also evidence of additive interaction, with most observed joint effects being greater than additive. Specifically, significant positive interaction was observed between IPV and crystal meth on inconsistent condom use (AP = 0.38, p < 0.05); depressive symptoms and crystal meth on STI symptomatology (RERI = 2.04, p < 0.001; AP = 0.61, p < 0.001) and survival sex (RERI = 1.20, p < 0.01; AP = 0.53, p < 0.01); and IPV and depressive symptoms on STI symptomatology (RERI = 3.01, p < 0.01; AP = 0.52, p < 0.001; S = 2.70, p < 0.01) and survival sex (RERI = 1.21, p < 0.05; AP = 0.40, p < 0.05). This study provides new empirical evidence showing that the syndemic conditions of IPV, depressive symptoms and crystal meth consumption interact synergistically to increase women’s HIV risk. Interventions that consider the full scope of syndemic vulnerabilities, rather than addressing individual conditions separately, may be essential.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Syndemic and Synergistic Effects of Intimate Partner Violence, Crystal Methamphetamine, and Depression on HIV Sexual Risk Behaviors among Women Who Inject Drugs in Indonesia

et al. 2019

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“…Demographic characteristics shape living and working conditions of daily life and have been found to affect the prevalence of depression in HIV-positive populations [ 8 , 9 , 11 , 35 ]. In this study, younger age, lower education, unemployment, and not being married were hypothesized to be associated with a higher likelihood of depressive symptoms among PWID.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies on depression among HIV-positive PWID have occurred in the US [ 21 – 23 ] and Switzerland [ 11 ] where HIV is not concentrated among PWID and unmet needs for mental health services are not as great. Prior studies in more comparable settings in Indonesia and China focused on PWID not known to be HIV-positive [ 8 ] or enrolled participants who were engaged in HIV care and no longer active drug users [ 9 ]. To date, studies in Vietnam have assessed the prevalence of depressive symptoms in HIV-positive populations, with estimates ranging from 19% to 40% [ 24 – 28 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of depressive symptoms among HIV-positive men who inject drugs in Vietnam

Levintow

Pence

et al. 2018

PLoS ONE

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BackgroundHIV infection is common among people who inject drugs (PWID), and HIV-positive PWID may be particularly vulnerable to depression. This study measured the prevalence of depressive symptoms and the factors associated with severe symptoms among 455 HIV-positive PWID in Thai Nguyen, Vietnam.MethodsWe used cross-sectional data from PWID in a randomized controlled trial of an intervention to reduce high-risk injecting and sexual behaviors in Thai Nguyen from 2009–2013. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). We used logistic regression to assess demographic, clinical, and psychosocial predictors of severe depressive symptoms (CES-D≥23) with prevalence odds ratios (POR) and 95% confidence intervals (CI).ResultsThe prevalence of severe depressive symptoms (CES-D≥23) was 44%. 25% of participants had mild to moderate depressive symptoms (16≤CES-D<23), and 31% experienced no depressive symptoms (CES-D<16). Not being married, self-rated poor health, greater frequency of injection drug use, history of overdose, no alcohol use, and daily cigarette smoking were positively associated with severe depressive symptoms in unadjusted models and remained predictive in a multivariable model. The strongest predictors of depressive symptoms were self-reported poor health (POR = 2.94, 95% CI: 1.82, 4.76), no current alcohol use (POR = 2.35, 95% CI: 1.47, 3.77), and not currently married or cohabitating (POR = 2.21, 95% CI = 1.40, 3.47).ConclusionSevere depressive symptoms were common among HIV-positive PWID in Thai Nguyen and were strongly associated with demographic, clinical, and psychosocial factors. Interventions that promote social support from family and reduce drug dependence may particularly benefit PWID experiencing severe depressive symptoms. Greater recognition and treatment of depressive symptoms has the potential to enhance quality of life and improve HIV clinical outcomes for PWID.

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

et al. 2020

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The burden of depression and HIV is high among people who inject drugs (PWID), yet the effect of depression on transmission risk behaviors is not well understood in this population. Using causal inference methods, we analyzed data from 455 PWID living with HIV in Vietnam 2009-2013. Study visits every 6 months over 2 years measured depressive symptoms in the past week and injecting and sexual behaviors in the prior 3 months. Severe depressive symptoms (vs. mild/no symptoms) increased injection equipment sharing (risk difference [RD] = 3.9 percentage points, 95% CI −1.7, 9.6) but not condomless sex (RD = −1.8, 95% CI −6.4, 2.8) as reported 6 months later. The cross-sectional association with injection equipment sharing at the same visit (RD = 6.2, 95% CI 1.4, 11.0) was stronger than the longitudinal effect. Interventions on depression among PWID may decrease sharing of injection equipment and the corresponding risk of HIV transmission. Clinical trial registration ClinicalTrials.gov NCT01689545.

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Factors Associated with Symptoms of Depression among Injection Drug Users Receiving Antiretroviral Treatment in Indonesia

Cited by 17 publications

References 62 publications

Syndemic and Synergistic Effects of Intimate Partner Violence, Crystal Methamphetamine, and Depression on HIV Sexual Risk Behaviors among Women Who Inject Drugs in Indonesia

Syndemic and Synergistic Effects of Intimate Partner Violence, Crystal Methamphetamine, and Depression on HIV Sexual Risk Behaviors among Women Who Inject Drugs in Indonesia

Prevalence and predictors of depressive symptoms among HIV-positive men who inject drugs in Vietnam

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

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