Psychiatric and Substance Use Comorbidities among People who Inject Drugs in India: A Cross-Sectional, Community-Based Study

Abstract

Background: People who Inject Drugs (PWID) show higher rates of comorbid psychiatric illnesses than the general population. We aimed to assess the rates of different psychiatric disorders and substance dependence among PWID in the state of Delhi, India. Methods: We conducted a community-based, cross-sectional study interviewing 104 adult male participants receiving various harm reduction and HIV prevention services. A semi-structured questionnaire assessed socio-demographics, drug use and injecting patterns, and opioid overdose experience. Mini-International Neuropsychiatric Interview Version 7.0.2 (for screening and diagnosing major psychiatric disorders), World Health Organization-Alcohol, Smoking, and Substance Involvement Screening Test for the pattern of other psychoactive substance use were used. Results: The mean age of participants was 27.9 years. The predominant opioid injected in the last 1 year was heroin. About 52% of participants had at least one psychiatric illness during their lifetime. Antisocial personality disorder (25%) was the most common psychiatric illness followed by suicidality (23.1%). About 23.1% had more than one psychiatric comorbidity other than substance use disorder. Being unskilled (χ2 = 11.39; P = 0.03), having early mean age of tobacco onset (t = −2.416; P = 0.02), longer duration of tobacco (t = 2.033; P = 0.04), alcohol (t = 2.204; P = 0.03) use, less abstinent attempts for opioid use (χ2 = 5.003; P = 0.03), longer duration of injecting drug use (t-test = 2.437; P = 0.02), higher vein-related complications (χ2 = 9.27; P = 0.02), high HIV positivity rate (χ2 = 8.54; P = 0.01), and high rates of nonfatal opioid overdose over lifetime (χ2 = 4.87; P = 0.03) were significantly associated with having lifetime psychiatric illness. Conclusion: Our study found high rates of psychiatric illnesses and the use of other psychoactive substances among PWID from India. There is an urgent need to incorporate mental health services into the existing HIV prevention services directed at PWID in India.