Depression, other mental health co-morbidities, common in people with OUD

A systematic review shows that up to one-third of people with opioid use disorder have co-occurring depression and one-third will have antisocial personality disorder in their lifetime.

More than a third of people with opioid use disorder (OUD) also have depression, according to a new systematic review, and nearly 3 in 10 suffer from anxiety.

The study, which is likely the first systematic review and meta-analysis to measure rates of specific mental disorders among people with OUD, was published in the journal Drug and alcohol addiction.

Previous research has shown that comorbid mental disorders were common among people with OUD, and people with both OUD and mental disorders are known to have poorer long-term health outcomes compared to their peers. However, despite the status of OUD as a major public health issue, little was known about the prevalence of specific mental disorders among people with OUD.

Thomas Santo Jr. of the National Drug and Alcohol Research Center at the University of New South Wales, in Australia, and colleagues wanted to better understand the rate of mental disorders in the OUD population, so they conducted a systematic review of studies published between 1990 and 2021 that examined various mental disorders in people with OUD.

Of the nearly 37,000 studies identified, a total of 345 studies involving 104,135 people with OUD were ultimately included in the analysis.

The pooled data showed that about 36% of people with OUD had co-occurring depression, 29% had anxiety and 21% had attention-deficit/hyperactivity disorder. Post-traumatic stress disorder (PTSD) was present in 18% of people with OUD.

Santo said Managed Healthcare Executive® that the link between mental disorders and OUD was not in itself a surprise, but he said the prevalence rate was unexpectedly high.

“For example, people with OUD experienced depression, PTSD, personality disorders and ADHD at more than ten times the rates of the general population,” he said. “Since mental disorders and OUD are strongly related, we expected that most mental disorders would be higher in people with OUD. However, the magnitude of the change was surprising.”

Over their lifetime, just over a third of people with OUD experienced antisocial personality disorder (95% CI 29.1–38.0%) and just under a fifth (18.2%) experienced borderline personality disorder.

Santo said he was also intrigued by the differences in prevalence between men and women. Depression, anxiety, PTSD, and obsessive-compulsive disorder (OCD) were more prevalent in women with OUD compared to men. ADHD and antisocial personality disorder were more common in males. Santo said these findings should be helpful to medical professionals who provide services to people with OUD.

“Incorporating trauma-informed principles or developing gender-specific interventions may improve treatment for all people with OUD and may be particularly important for women with OUD and comorbid mental disorders,” he said.

The report may also shed light on why it can be difficult to treat people with OUD. Although the study itself did not directly address treatment adherence, Santo said it is easy to see how the high prevalence of mental comorbidities compounds the problems faced by people with OUD.

“Comorbid mental disorders increase the risk of treatment dropout, contact with the criminal justice system, and hospitalization,” he said, “so improved treatment of comorbid mental disorders among people with OUD may reduce the likelihood of these negative outcomes in people with OUD”.

Santo and colleagues said these data point to the importance of providing people with OUD with access to mental health services and tailoring those services to holistically address both their addiction and their mental health disorders.

Leave a Comment

Your email address will not be published.