A systematic review shows that up to one-third of people with opioid use disorder have co-occurring depression and one-third will experience antisocial personality disorder in their lifetime.
According to a new systematic review, more than a third of people with opioid use disorder (OUD) also have depression, and nearly 3 in 10 people have anxiety.
The study, which is likely the first systematic review and meta-analysis to quantify rates of specific mental disorders in people with TOU, was published in the journal Addiction to drugs and alcohol.
Previous research has shown that comorbidities of mental disorders are common among people with TOU, and people with both TOU and mental disorders are known to have poorer long-term health outcomes compared to their peers. Yet, despite the status of TOU as a major public health problem, little was known about the prevalence of specific mental disorders in people with TOU.
Thomas Santo Jr. of the National Center for Drug and Alcohol Research at the University of New South Wales, Australia, and his colleagues wanted to better understand rates of mental disorders among the OUD population. So they conducted a systematic review of studies published between 1990 and 2021 that looked at various mental disorders in people with OUD.
Of nearly 37,000 identified studies, a total of 345 studies involving 104,135 people with TOU were ultimately included in the review.
The pooled data showed that around 36% of people with TOU 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 TOU.
Santo said Managed Healthcare Executive® that the association between mental disorders and OUD was not in itself a surprise, but he said the degree of prevalence was surprisingly high.
“For example, people with OUD suffered from depression, PTSD, personality disorders and ADHD at rates more than ten times higher than the general population,” he said. “Since mental disorders and OUD are strongly linked, we expected that most mental disorders would be higher in people with OUD. However, the magnitude of the difference was surprising.
Over their lifetime, just over one-third of people with TOU have had antisocial personality disorder (95% CI: 29.1-38.0%), and just under one fifth (18.2%) had borderline personality disorder.
Santo said he was also intrigued by the prevalence gaps between men and women. Depression, anxiety, PTSD, and obsessive-compulsive disorder (OCD) were more common in women with TOU than in men. ADHD and antisocial personality disorder were more common in men. Santo said these findings should be useful to healthcare professionals providing services to people with OUD.
“The incorporation of trauma-informed principles or the development of gender-specific interventions can improve treatment for all people with TOU, and may be particularly important for women with TOU and comorbid mental disorders,” he said. -he declares.
The report may also shed light on why it may be difficult to treat people with OUD. Although the study itself didn’t directly address treatment adherence, Santo said it’s easy to see how the high prevalence of mental comorbidities compounds the problems experienced by people with TOU.
“Comorbid mental disorders increase the risk of discontinuation of treatment, contact with the criminal justice system and hospitalization,” he said, “thus, better treatment of comorbid mental disorders in people with ‘OUD may reduce the likelihood of these side effects in people with OUD’.
Santo and colleagues said these data show 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 conditions. .