Longitudinal changes in personal wellbeing in a cohort of people who inject drugs

Scott, Nick; Carrotte, Elise Rose; Higgs, Peter; Stoové, Mark; Aitken, Campbell; Dietze, Paul

doi:10.1371/journal.pone.0178474

Cited by 11 publications

(13 citation statements)

References 34 publications

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“…Studies in South Asia and the Middle East show high lifetime prevalence of psychiatric disorders, especially depression and anxiety, psychological distress and lower QoL among opioid users [13,[33][34][35][36][37][38][39][40]. These are consistent with numerous studies from diverse sites in Europe, Nepal, Australia, the US, Slovakia, Taiwan and Vietnam [31,32,[41][42][43][44][45]. Effectively addressing mental health issues is crucial, and the studies reveal that QoL of people with opioid dependence improves with substitution therapies and provision of interventions addressing their individual and complex needs [46,47].…”

Section: Discussionsupporting

confidence: 82%

“…In the current study, upper middle or above SES participants had better quality of life than those with lower SES, highlighting well recognized health inequalities. The Scott et al study demonstrated substantially lower personal well-being and related psychological stress and SES over time in a population of IDUs, but that housing and health services could make a difference [32]. Interestingly, while SES was associated with QoL and SPD, castes was not.…”

Section: Discussionmentioning

confidence: 92%

“…In addition, there is stigma and discrimination from the community in general, and even health and social service providers. [15,31,32]. This complexity is not new to OST services, but how to respond to build optimism, resilience, and agency in participants to improve QoL and reduce psychological distress is challenging, especially in resource poor settings.…”

Section: Discussionmentioning

confidence: 99%

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Psychological Distress and Quality of Life Among Opioid Substitution Therapy Participants with Histories of Injecting and Non-Injecting: A Cross-Sectional Study in Kathmandu, Nepal

Pant

Thapa

Howard

et al. 2022

Preprint

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Background: Opioid use is a serious public health problem in Nepal. People who use opioids can experience severe psychological distress over time along with poor quality of life. Opioid substitution therapy (OST) is central in treating opioid dependence. This study aimed to examine factors associated with quality of life and severe psychological distress among OST therapy participants in the Kathmandu valley, Nepal and compare those who had injected opioids prior to OST and those who did not inject.Methods: A cross-sectional study was conducted with 231 participants proportionately allocated across five OST sites in the Kathmandu Valley. They were administered a semi-structured questionnaire, the Nepalese versions of the Kessler 6 psychological distress scale and World Health Organization Quality of Life (WHOQOL-BREF). Univariate and multivariate analyses were used to elicit associations between severe psychological distress, quality of life, and independent variables. Results: Of the participants 92% were male and about half were injecting drug users. Severe psychological distress was found in about one in four participants, and significantly more prevalent among participants with a history of injecting practices (32.2%) compared to non-injectors (15.9%). Higher mean psychological distress scores were observed among injecting drug users.Those self-reporting a history of psychiatric illnesses were around seven times more likely to have severe psychological distress, and those with history of comorbidity around 1.6 times more likely. In the adjusted linear regression model, injecting drug users were likely to have lower physical quality of life compared to non-injectors. Age was positively associated with better social quality of life. Lower socioeconomic status and a history of self-reported mental illness and attempt to quit substance use, were found to have significantly lower quality of life on all four domains. Conclusions: This study demonstrated that OST participants with a history of injecting drug use were at higher risk of severe psychological distress and lower physical quality of life. In addition to OST, the complex and entangled needs of injecting drug users and non-injectors need to be addressed to improve quality of life and lessen psychological distress and a return to problematic substance use.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Psychological Distress and Quality of Life Among Opioid Substitution Therapy Participants with Histories of Injecting and Non-Injecting: A Cross-Sectional Study in Kathmandu, Nepal

Pant

Thapa

Howard

et al. 2022

Preprint

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“…A recent study explored trends in PWI scores among people who inject drugs in the SuperMIX cohort (a source of recruitment for our study) over a seven‐year follow‐up period. 43 Whilst scores did not significantly differ over the time period, findings suggested increased psychological distress, moving into unstable accommodation or reporting intentional overdose in the past 12 months were associated with decreases in PWI score. 43 This suggests that the PWI is sensitive to change in this cohort and destabilizing life events may obscure benefits achieved through hepatitis C treatment.…”

Section: Discussionmentioning

confidence: 83%

“… 43 Whilst scores did not significantly differ over the time period, findings suggested increased psychological distress, moving into unstable accommodation or reporting intentional overdose in the past 12 months were associated with decreases in PWI score. 43 This suggests that the PWI is sensitive to change in this cohort and destabilizing life events may obscure benefits achieved through hepatitis C treatment. Future studies should explore the degree to which viral hepatitis C cure and the knowledge of cure directly impact quality of life among people who inject drugs and explore key characteristics of sub‐groups who do show improvements in quality of life following treatment.…”

Section: Discussionmentioning

confidence: 83%

Patient‐reported outcomes of the Treatment and Prevention Study: A real‐world community‐based trial of direct‐acting antivirals for hepatitis C among people who inject drugs

Goutzamanis

Spelman

Harney

et al. 2021

Journal of Viral Hepatitis

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The impact of hepatitis C cure with direct‐acting antivirals (DAAs) on patient‐reported outcomes (PROs) in community settings remains unclear. We aimed to assess changes in PROs over time and whether treatment was associated with sustained improved PROs in a cohort of people who inject drugs. This study is a sub‐analysis of the Treatment and Prevention Study, a nurse‐led trial where people who inject drugs and their injecting partners were recruited in a community setting, in Melbourne, Australia. Three participant groups were characterized: treatment, untreated and non‐viremic (hepatitis C RNA negative at screening). PROs included assessment of health‐related quality of life using the Short Form‐8 (SF‐8) Survey and life satisfaction using Personal Wellbeing Index (PWI). PROs were measured at baseline and every 12 weeks until week 84. Generalized estimating equations were used to measure whether treatment was associated with longitudinal PRO change. A total of 215 participants were included in this analysis. PWI scores were significantly higher at week 12 for both treatment group (p = 0.0309) and non‐viremic group (p = 0.0437) compared to baseline. However, treatment was not associated with longitudinal change in PRO scores. In conclusion, we found DAA treatment did not significantly improve PRO scores compared to those not receiving treatment and without hepatitis C. The measures used in this study may not be sensitive enough to capture the hepatitis C specific improvements in quality of life that treatment affords or factors other than treatment may be influencing quality of life scores in this cohort.

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Quality-adjusted life years among people who inject drugs in a needle syringe program in Sweden

et al. 2022

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Purpose Needle syringe programs (NSP) significantly reduce risk behavior and HIV and hepatitis transmission in people who inject drugs (PWID). However, PWID are underrepresented in studies on health-related quality of life (HRQoL), representing a barrier to evaluate effects of public health and preventive measures related to injecting drug use. In this study, we investigate how well the two questionnaires EQ-5D-3L and SF-6D measure health in PWID. We also estimate HRQoL in the PWID population. Method Data on demographics, injection drug use, HIV, hepatitis status, and self-reported HRQoL were collected from 550 PWID enrolled in the Stockholm NSP at enrollment and at 6-, 12-, and 24-month follow-up. Self-rated HRQoL was measured as QALY, using EQ-5D-3L and the SF-6D. Item response theory (IRT) was used to evaluate which of the two instruments that measure health most accurately in this population. Regression analysis was used to estimate population-specific QALYs. Results The IRT analysis showed that SF-6D was better suited to measure health in PWID. More specifically, SF-6D to a larger extent discriminated between persons regardless of their health status, while EQ-5D was more suitable to detect persons with poorer health. Self-rated HRQoL showed that average QALY was lower among PWID compared to the general Swedish population. However, a general increase in self-reported health was noted over time among participants. Conclusion This study increase knowledge of what instruments are most suitable to measure health among PWID. This is of great importance when evaluating effects of public health and preventive measures in the PWID population.

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Longitudinal changes in personal wellbeing in a cohort of people who inject drugs

Cited by 11 publications

References 34 publications

Psychological Distress and Quality of Life Among Opioid Substitution Therapy Participants with Histories of Injecting and Non-Injecting: A Cross-Sectional Study in Kathmandu, Nepal

Psychological Distress and Quality of Life Among Opioid Substitution Therapy Participants with Histories of Injecting and Non-Injecting: A Cross-Sectional Study in Kathmandu, Nepal

Patient‐reported outcomes of the Treatment and Prevention Study: A real‐world community‐based trial of direct‐acting antivirals for hepatitis C among people who inject drugs

Quality-adjusted life years among people who inject drugs in a needle syringe program in Sweden

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