Prevalence and social determinants of psychological distress among people who use drugs in Cambodia

(2020) 14:77 Saing et al. Int J Ment Health Syst https://doi.org/10.1186/s13033-020-00411-5 International Journal of Mental Health Systems Open Access RESEARCH Prevalence and social determinants of psychological distress among people who use drugs in Cambodia Chan Hang Saing1, Kiesha Prem1,2, Ponha Uk1, Navy Chann3, Pheak Chhoun4, Phalkun Mun3, Sovannary Tuot4 and Siyan Yi1,4,5,6* Abstract Background: People who use drugs are at a disproportionately higher risk of mental disorders due to prolonged exposure to psychosocial challenges. However, studies on mental health among people who use drugs in resourceconstrained countries are scarce. This study sheds light on the prevalence and correlates of psychological distress among people who use drugs in Cambodia. Methods: We conducted this cross-sectional study in the capital city and 11 provinces in 2017. The Respondent Driven Sampling method was adapted to recruit 1677 people who used drugs for face-to-face interviews using a structured questionnaire. Psychological distress was measured using the General Health Questionnaire (GHQ-12). A total score of GHQ-12 > 2 indicated high psychological distress. We performed a multiple logistic regression analysis to identify factors associated with psychological distress. Results: We included 1598 participants in the analyses, with a mean age of 28.6 years (SD = 7.8). Of the total, 42% had high psychological distress – 50% in women and 37% in men. The adjusted odds of having high psychological distress were significantly higher among participants who were 25–34 years old and 35 years and above, had been to a drug rehabilitation center, had been insulted by family members, and had been sexually harassed/abused by someone when they were growing up. The odds of having high psychological distress were significantly lower among participants who were male, lived in their own dwelling, reported injecting as the mode of the first drug use, and had someone taking care of them when they got sick. Conclusions: This study documents a high prevalence of psychological distress among people who use drugs in Cambodia. Intervention programs that attempt to address mental health problems among people who use drugs in resource-limited settings should be gender- and age-sensitive and target more marginalized subpopulations. Mental health services can be integrated into HIV and harm-reduction programs for people who use drugs. Keywords: Substance use, Mental health, Adverse childhood experiences, Resource-limited setting, Asia *Correspondence: 1 Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10‑01, Singapore 117549, Singapore Full list of author information is available at the end of the article Background In 2017, the global estimate of the number of people who use drugs, including people who inject drugs, aged 15–64 were 271 million [1], equivalent to about 5% of the world population of the same age. Of them, about 35 million (13%) suffered from drug-use disorders, which resulted in approximately 166,613 deaths and a loss of 27 million © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativeco mmons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/ zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Saing et al. Int J Ment Health Syst (2020) 14:77 Disability-Adjusted Life Years (DALYs) [1, 2]. Therefore, drug use is recognized as one of the major global public health concerns. However, the availability of and access to treatment services among people with drug use disorders remain limited globally. Only one in seven people who use drugs receive the treatment each year [1]. Existing studies show that the comorbidity between drug-use disorders and mental health problems is common among people who use drugs. Moreover, people who use drugs without drug-use disorders are also at increased risk of mental health problems [3–10]. Substance use disorders have been found to occur in tandem with anxiety disorders including generalized anxiety disorder, panic disorder, and post-traumatic stress disorder [11–14]; mental disorders including depression and bipolar disorder [8, 11–13]; attention deficit hyperactivity disorder [12, 14]; and antisocial personality disorder [15]. The relationship between mental health and risky drug use, particularly intravenous drug use and unsafe sexual practices, has been well documented in previous studies. People who use drugs with poor mental health, such as severe depressive symptoms, are more likely to adopt unsafe injection practices such as sharing needles and syringes [16–18]. Previous studies have also reported that people who use drugs with mental health problems were more likely to have more sexual partners and engage in frequent condomless sexual intercourse than those without mental health problems [19, 20]. These risky behaviors are associated with a higher risk of acquiring human immunodeficiency virus (HIV) [21]. Mental health problems of people who use drugs are a significant public health concern as it co-occurs with drug use disorders and mediates other viral infections such as HIV and hepatitis C virus (HCV) [22–24]. Therefore, addressing risk factors associated with mental health problems among people who use drugs would reduce the disease burden of drug use disorders and HIV and HCV infections among people who use drugs. Previous studies have documented drug use behaviors and experiences such as duration [25], frequency [21], overdose [26–28], and drug rehabilitation [21, 25] as associated risk factors of psychological distress. Exposure to violence, such as stigma and discrimination and sexual assault, and lack of social support, such as family intimacy and adaptability, have also been predictors of psychological distress among people who use drugs [26, 29–34]. In Cambodia, the latest estimated number of people who use drugs aged 18 years and above in 2017 was notably large at around 22,374 people [16]. Previous studies show that psychological distress is common among Cambodia (...truncated)