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.

KEYWORDS:

• Substance-related disorders
• mood disorders
• urban populations
• harm reduction

Acknowledgments

The first author extends her gratitude for comments on earlier drafts of this manuscript to the following colleagues in the Johns Hopkins School of Public Health, Department of Mental Health– Kenneth Feder, Tamar Mendelson, Renee Johnson, Angela Lee Winn, Pia Mauro, Sarah Murray, Katherine Musliner, and Emma Stapp. The coauthors also appreciate the editorial assistance provided by Kenneth Feder.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This research was funded through a grant from the National Institute on Drug Abuse grant R01 DA016555 and the Johns Hopkins Center for AIDS Research (1P30AI094189). The first author acknowledges funding support from the Brown Community Health Scholarship.