Melbourne School of Population and Global Health - Theses
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ItemA cross-sectional study of depression, anxiety and suicidal ideation and attempts among men who inject drugs in Delhi, India( 2014)Studies from high-income countries report a high prevalence of suicide and symptoms of common mental disorders among people who inject drugs (PWID), an important group for human immunodeficiency virus (HIV) prevention interventions. Research in India has largely overlooked the mental health of this high-risk group, including the risk factors for suicide and the impact of poor mental health on risky injecting and sexual practices. The aim of this study was to strengthen understanding of the common mental health problems faced by PWID in Delhi, India and the implications of these for suicide prevention and mitigation of HIV transmission risk. This study utilised data from a cross-sectional survey of 420 PWID recruited from needle and syringe programs (NSPs) in Delhi to generate a range of novel findings in relation to the four research questions: 1) What are the quality of life and socio-economic characteristics of PWID in Delhi? 2) What is the prevalence of symptoms of depression and anxiety and suicidal ideation and attempts? 3) What are the psychological and social correlates of suicidal ideation and attempts? 4) And, are symptoms of depression, anxiety and suicidal ideation associated with engagement in risky injecting and sexual practices? Descriptive findings profile the poor quality of life and psychosocial vulnerabilities of an impoverished and isolated sub-population of PWID. Their lives were characterised by health risk behaviours, broken and disrupted social relationships, extremely poor living conditions and a challenging broader community context. Additionally, a disconcertingly high prevalence of depressive and anxiety symptoms and suicidal ideation and attempts was observed. Significant risk factors differentiated suicidal PWID from non-suicidal PWID. Depressive and anxiety symptoms, in combination with social stressors including poor physical health, a long history of injecting drug use, experiences of violence, sexual abuse, housing insecurity, and strained marital and familial relationships were significant suicide risk factors and ought to be given due consideration in urgently needed suicide prevention strategies. The high prevalence of suicidality in this community is an important issue in and of itself, but it also has direct implications for HIV prevention. Needle / syringe sharing and unprotected sex were very common and suicidal thoughts were strongly associated with increased injecting and sexual risk behaviours. Strategies that address the drivers of suicidality in this sub-population could enhance HIV prevention efforts. The findings present a compelling case for the integration of mental health care into programs working with PWID in Delhi. Community-based initiatives are needed to increase access to appropriate mental health services, prevent suicide deaths, and mitigate HIV transmission risk.