Abstract
Both heroin use and depression are significant health problems. Methadone maintenance treatment (MMT) can be of great benefit to heroin users. However, changes in the level of depression in heroin users during MMT are not clear. Gender and age are also important factors in the development of depression, and whether gender and age moderate changes in depression in heroin users during MMT warrants further study. This study aimed to explore: (1) the trajectory of depression in opioid users during MMT and (2) the moderating effects of gender and age on the trajectory of depression in opioid users receiving MMT. A total of 294 intravenous heroin users were recruited into this 9-month observational study. The level of depression was measured at the intake interview and at follow-up interviews every 3 months. A latent growth model was used to analyze the trajectory of the level of depression among the participants. Depression improved rapidly during the first 3 months of MMT and slowly after the first 3 months in both the female and male heroin users. There was no gender difference in the level of depression at each follow-up point. The level of depression in the female heroin users decreased faster than that in the male heroin users. In addition, the level of depression in the younger heroin users decreased faster than that in the older subjects. Depression in female and younger heroin users improved more rapidly than in male and older subjects, respectively.
Highlights
Heroin dependence has many negative effects, such as inadvertent overdose, increased risk of infection, unemployment, social cost due to criminal activities, and family disruption [1]
The first important finding was that the heroin users had a markedly high level of depression before starting maintenance treatment (MMT), the average Center for Epidemiological Studies Depression Scale (CES-D) score being higher than 15, with a previous study recommending that a total CES-D score of 15 or higher indicates the presence of clinically significant depression [22]
Heroin users may have a higher level of depression than that of the general population, with up to one-quarter of users meeting the criteria for major depression [24]
Summary
Heroin dependence has many negative effects, such as inadvertent overdose, increased risk of infection, unemployment, social cost due to criminal activities, and family disruption [1]. Around 0.7% of adults worldwide use opioids, the most common of which is heroin [2]. Heroin use disorder is an important health issue. Depression was ranked the fourth leading cause of disability worldwide by the World Health Organization and is expected to be the second leading cause in 2020 [4]. A previous study demonstrated that substance use disorder is positively associated with depression [5]. The prevalence of depression among heroin users is high, ranging between 20 and 45% [6, 7]. Heroin users with depression may be associated with greater drug use and risky behavior [6]. Depression is an important mental issue in opioid users
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