Abstract
Objective: Cocaine use and mental health disorders have both been separately identified as risk factors for blood borne virus infection. However, the contribution of specific underlying aspects of mental health to risks is not well documented. The aim of this study was to examine the association between psychological distress and risk behaviors for HIV and Hepatitis C infection among cocaine users. Methods: Individuals who either smoked or injected cocaine were recruited in community-based and addiction treatment programs located in downtown Montreal. Participants were asked to complete an interviewer-administered questionnaire assessing psychological distress based on the Kessler scale (K10). Three-month risk behaviors outcomes included drug injection material sharing (needle, dilution water, cooker, filters, backloading, frontloading or wash), and smoking equipment sharing. Socio-demographic data, severity of cocaine dependence and other substances use information were also collected. Statistical analyses were conducted using logistic regression. Results: Severe psychological distress was reported by 202 (34.3%) out of 589 participants (86.2% male; 76.6% ≥ 30y.o.). The prevalence of sharing was: 14.8% for needles, 24.9% for other injection equipment (378 injectors) and 68.3% for smoking material (508 smokers). Multivariate analysis showed that injectors with severe psychological distress were more likely to report needle sharing (Adjusted Odds Ratio (AOR): 2.1, 95% CI: 1.1-3.8). No significant association was found between K10 score and sharing of other paraphernalia. Conclusion: Severe psychological distress increases the risk of needle sharing, a major risk factor for HIV and HCV infection, but not sharing of other paraphernalia. These results suggest differential psychological mechanisms according to sharing practices. They also support the importance of screening for psychological distress in order to implement adequate preventive interventions aimed at cocaine users.
Highlights
The current study documented the association between psychological distress and different categories of paraphernalia sharing in a population of cocaine users
The major finding of our study is that severe psychological distress increases the risk of sharing needles but not sharing of other paraphernalia
Two studies have previously demonstrated an association between severe psychological distress and injection material sharing among an undifferentiated sample of PWID [35,36]
Summary
Underlying mechanism linking psychiatric disorders to risky behaviors, are not fully understood. It is not entirely clear if specific psychiatric symptoms, social consequences of psychiatric disorder, their cognitive correlates or their general impact on functioning and well-being mediate these associations. A few studies have suggested that psychological distress could be associated with injection equipment sharing among PWID [35,36]. Few studies have addressed the relation between psychological distress and risks of HIV and HCV transmission related to the different types of material sharing, measured as separate entities, among cocaine users. We conducted a cross-sectional study to examine the association between psychological distress and sharing of different types of injection and smoking equipment among cocaine users
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