Elsevier

Psychiatry Research

Volume 262, April 2018, Pages 184-192
Psychiatry Research

Profile of psychiatric symptoms in methamphetamine users in China: Greater risk of psychiatric symptoms with a longer duration of use

https://doi.org/10.1016/j.psychres.2018.02.017Get rights and content

Highlights

  • Over half of the MA users were present with psychiatric symptoms covering psychosis, depression and anxiety.

  • The co-occurrence of multiple psychiatric symptoms in chronic MA users was common.

  • A dose-response relationship between duration of MA use and the risk of psychiatric symptoms was observed in chronic MA users.

  • Early intervention and effective treatment are urgently needed to address both MA dependence and associated psychiatric problems.

Abstract

Chronic methamphetamine (MA) use is associated with psychiatric symptoms. This study explored pattern of co-occurring psychiatric symptoms in MA users and their relationship to duration of MA use. A cross-sectional study was conducted among MA users at the Shenzhen Compulsory Drug Detoxification Center from April 2012 to October 2015. The Positive and Negative Syndrome Scale, Hamilton Anxiety Scale, and Beck Depression Inventory were used to assess psychiatric symptoms. Among 1277 MA users, 57.6% participants had any type of psychiatric symptoms including depressive, anxiety and psychotic symptoms. A dose-response relationship was found between duration of MA use and risk of psychiatric symptoms. The odds ratios (OR) of depressive symptoms increased with the duration of MA use (1–5 years vs. < 1 year: 1.74 [95% CI, 1.24–2.42]; ≥ 5 years vs. < 1 year: 2.07 [1.19–3.61]), so did the ORs of co-occurring anxiety and depressive symptoms (1–5 years: 1.74 [1.20–2.51]; ≥ 5 years: 3.09 [1.76–5.40]). Methamphetamine-dependent individuals were four-times more likely to experience any type of psychiatric symptoms than non-dependent users. The prevalence of psychiatric symptoms was high in chronic MA users and increased with MA use duration. Early prevention and treatment strategies targeting both MA use and associated psychiatric symptoms are needed.

Introduction

The past decade has witnessed a significant increase in the popularity of amphetamine-type stimulants (ATS), particularly methamphetamine (MA), which is an increasing concern worldwide (United Nations Office on Drugs and Crime, 2014). Methamphetamine use continues to rise in most countries in East and Southeast Asia (United Nations Office on Drugs and Crime, 2016). China has experienced changes in patterns of drug abuse in the past few years, with a rapid increase in the use of synthetic drugs, especially ATS abuse (Jia et al., 2015; Lu et al., 2007; Sun et al., 2014). The China National Narcotics Control Commission reported that the number of registered synthetic drug users has exceeded the number of heroin users, mainly attributable to a large increase in MA use. At the end of 2015, among the 2.35 million drug users who were registered in China, 57.1% reported the use of synthetic drugs. Users of ATS accounted for 73.2% of newly identified drug users in 2015 (Office of China National Narcotic Control Commission, 2016). Amphetamine-type stimulants have become the leading drug of abuse in China. Data from the updated National Drug Abuse Monitoring Annual Report indicated that over 70% of ATS users in China began their drug use within the past 5 years (China Food and Drug Administration, 2016).

Chronic MA use can lead to severe neuropsychiatric symptoms (Harro, 2015, Wang et al., 2017). Psychosis, depression, and anxiety are among the most commonly reported symptoms in MA users (Akindipe et al., 2014, Bao et al., 2013, McKetin et al., 2006). Persecutory delusions and auditory hallucinations are frequently present in psychotic MA users, increasing the high risk of violence and criminality (Srisurapanont et al., 2003). The presence of anxiety and depression is related to a low quality of life and suicidal behavior (Bolton et al., 2010, Joffe et al., 2012). These psychiatric symptoms are predictive of relapse, cause serious comorbidities, and increase the risk of morbidity and mortality (Eslami-Shahrbabaki et al., 2015, Javadian et al., 2016, Kittirattanapaiboon et al., 2010). Estimates of the prevalence of psychiatric symptoms among MA users have been established in the United States and Australia, among other countries (Glasner-Edwards et al., 2008, McKetin et al., 2006, Salo et al., 2011, Sulaiman et al., 2014). The risk of current and lifetime MA-induced psychosis among MA-dependent individuals was 13.01% and 47.95%, respectively (Sulaiman et al., 2014). High rates of psychiatric disorders(36.0%) were also observed among MA-dependent users in a South African study, including mood disorders (16.0%), psychotic disorders (13.0%), and anxiety disorders (7.0%; Akindipe et al., 2014). Our previous study found that 42% of ATS users in China had depressive symptoms (Bao et al., 2013). However, the profiles of other psychiatric symptoms, including psychosis, depression, and anxiety, have not been comprehensively examined among chronic MA users in China, and the prevalence of their co-occurrence is unclear.

The presence of psychiatric symptoms among MA users was associated with poorer treatment outcomes and greater health service utilization (Glasner-Edwards et al., 2008, Glasner-Edwards et al., 2010a, Glasner-Edwards et al., 2010b). Thus, co-occurring psychiatric symptoms in this population need to be addressed. The World Drug Report indicated that qualified professional treatment for MA dependence and associated psychiatric problems is lacking in some countries in Southeast Asia (United Nations Office on Drugs and Crime, 2015). Considering the heavy burden of ATS abuse and possible consequences of new ATS use that has emerged in recent years, it is necessary to understand the pattern of psychiatric symptoms in MA users in real-world settings to guide healthcare services with regard to prevention and treatment. Despite the well-established prevalence of psychiatric symptoms in MA users and their outcomes, evidence of possible associations between psychiatric comorbidities and the duration of MA use and other risk factors is lacking, especially epidemiological studies with large sample sizes in developing countries. Thus, the primary goal of the present study was to explore patterns of co-occurring psychiatric symptoms in MA users and their relationship to the duration of MA use and other potential risk factors.

Section snippets

Subjects and setting

A cross-sectional study was conducted at Shenzhen Compulsory Drug Detoxification Center in Guangdong province, China. A total of 1511 MA users who only or primarily used MA in the past (prior to enrollment) were recruited from April 2012 to October 2015. To be included in the study, the subjects had to meet the following inclusion criteria: (1) at least 18 years old, (2) MA was their primary drug ever used, with positive urine test for MA at the time they entered the treatment center, and (3)

Demographic and drug use characteristics

Among the 1277 eligible subjects, 704 (55.1%) began MA use within the past year, 458 (35.9%) had a duration of MA use of 1–5 years, and 115 (9.0%) had a duration of MA use of ≥ 5 years. Table 1 presents the demographic and drug use characteristics of the subjects. The mean age of the participants was 31.82 years. The participants were predominantly male (87.0%) and Han ethnicity (92.5%), 33.7% were currently unemployed, and 53.9% were unmarried. The level of education was mainly junior high

Discussion

The present study investigated the prevalence of three types of psychiatric symptoms, including anxiety, depressive, and psychotic symptoms, in Chinese subjects with different durations of MA use (i.e., < 1 year, 1–5 years. and ≥ 5 years). A high prevalence of psychiatric symptoms was found among MA users in the current sample, and the co-occurrence of multiple psychiatric symptoms was common in this population. These findings support an important effect of the duration of MA use on the

Acknowledgements

This work was supported by the Thirteenth Five-Year Program of the Chinese Ministry of Science and Technology (no. 2016YFC0800907), Twelfth Five-Year Program of the Chinese Ministry of Science and Technology (no. 2012ZX10001001) and the the State Scholarship Fund of China (no. 201706015001).

Role of funding source

The funding organizations had no role in the development of the study design or collection, analysis, and interpretation of the data; the writing of the report; or the decision to submit the article for publication.

Conflicts of interest

The authors declare no conflicts of interest.

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