Injection Drug Use among Homeless Adults with Mental Illness: A Gender-Based Analysis

Transcription

1 Injection Drug Use among Homeless Adults with Mental Illness: A Gender-Based Analysis Faith Eiboff ¹, Julian M Somers², Akm Moniruzzaman² ¹University of British Columbia, School of Population & Public Health, Vancouver, BC ²Simon Fraser University, Faculty of Health Sciences, Burnaby, BC

2 Background Women are disproportionately vulnerable to the serious health and social harms associated with injection drug use (IDU). IDUs are highly marginalised and stigmatised with multiple needs, yet are hard to reach with mainstream healthcare services. Paucity of research examining IDU among homeless adults with mental illness. Moreover, little is currently known about the prevalence, characteristics and implications of IDU by gender.

3 Study Objectives To characterise injection drug use among a population of homeless adults with mental illness, focusing on gender, and examining associations between IDU and health, mental health, and use of health care services. 1) Document the prevalence and characteristics of IDU 2) Examine associations of IDU with mental and physical health problems; and 3) Test whether IDU is associated with the increased use of health and social services

4 Vancouver At Home Study A research demonstration project investigating interventions for people who are homeless and living with mental illness. A total of 497 participants were recruited between October 2009 and June Eligibility criteria: the presence of a mental disorder current absolute or precarious housing legal adult status ( 19 years of age)

5 Vancouver At Home Study Participants completed a baseline questionnaire eliciting information on a detailed set of clinical, health and social measures: Socio-demographic information Housing and homelessness history Mental health status Physical health status Substance use and risk behaviours Health care, social services, justice service utilisation Analyses draw exclusively from the baseline assessment.

6 Methods Univariate and multivariable statistical techniques. Analyses were conducted independently for women and men. Relevant variables significant at p 0.05 in univariate analyses were force entered into multivariable logistic regression models. Effect sizes are expressed in adjusted odds ratios (AORs).

7 Results At any time in the past month, did you inject drugs? Vancouver At Home Study 133 (27.4%) Participants n = (72.6%)

8 Results At any time in the past month, did you inject drugs? Vancouver At Home Study Participants 133 (27.4%) 352 (72.6%) n = 485 Vancouver At Home Study Participants n = % Prevalence

9 Results At any time in the past month, did you inject drugs? Vancouver At Home Study Participants 133 (27.4%) 352 (72.6%) n = 485 Vancouver At Home Study Participants n = (24.8%) 17.7% Prevalence 53 (15.1%) p = 0.012

10 Results At any time in the past month, did you inject drugs? Vancouver At Home Study Participants 133 (27.4%) 352 (72.6%) n = 485 Vancouver At Home Study Participants n = (24.8%) 17.7% Prevalence 53 (15.1%) p = (6-8%) Lifetime Prevalence (16-26%) (33 49) (Susser et al., 1997) (85 101)

11 Univariate Analyses Non-IDU (n=100) vs. IDU (n=33) Non-IDU (n=299) vs. IDU (n=53) 33.3 vs. 51.5% Have children (under 18) 18.9 vs. 28.8% 17.0 vs. 36.4% Aboriginal Ancestry 11.7 vs.17.0% 35 vs. 27 Median Age of First Homeless 28 vs vs. 48.4% Lifetime Homeless: 60+ months 30.5 vs. 52.8% 43.0 vs. 72.7% Major Depressive Episode 35.5 vs. 41.5% 34.4 vs. 54.5% Post-traumatic Stress Disorder 19.1 vs. 30.2% 51.0 vs. 93.9% Current Substance Dependence 49.8 vs. 94.3% 31.0 vs. 93.9% Polysubstance Useᵃ 25.1 vs. 90.6% 18.0 vs. 57.6% Daily Illicit Drug Useᵃ 21.1 vs. 43.4% 6.1 vs. 34.5% Involvement in Sex Workᵃ 3.4 vs vs. 30 Median days with drug problemᵃ 13 vs vs. 59.4% Head Injuries 68.4 vs. 80.8% 54.1 vs. 62.5% Visited Emergency Roomᵇ 56.5 vs. 67.9% 34.0 vs. 54.5% Needed healthcare, but did not receive itᵇ 44.4 vs. 44.2% ᵃ denotes activities in the past month; ᵇ denotes activities in the past six months

12 Univariate Analyses Non-IDU (n=100) vs. IDU (n=33) Non-IDU (n=299) vs. IDU (n=53) 33.3 vs. 51.5% Have children (under 18) 18.9 vs. 28.8% 17.0 vs. 36.4% Aboriginal Ancestry 11.7 vs.17.0% 35 vs. 27 Median Age of First Homeless 28 vs vs. 48.4% Lifetime Homeless: 60+ months 30.5 vs. 52.8% 43.0 vs. 72.7% Major Depressive Episode 35.5 vs. 41.5% 34.4 vs. 54.5% Post-traumatic Stress Disorder 19.1 vs. 30.2% 51.0 vs. 93.9% Current Substance Dependence 49.8 vs. 94.3% 31.0 vs. 93.9% Polysubstance Useᵃ 25.1 vs. 90.6% 18.0 vs. 57.6% Daily Illicit Drug Useᵃ 21.1 vs. 43.4% 6.1 vs. 34.5% Involvement in Sex Workᵃ 3.4 vs vs. 30 Median days with drug problemᵃ 13 vs vs. 59.4% Head Injuries 68.4 vs. 80.8% 54.1 vs. 62.5% Visited Emergency Roomᵇ 56.5 vs. 67.9% 34.0 vs. 54.5% Needed healthcare, but did not receive itᵇ 44.4 vs. 44.2% ᵃ denotes activities in the past month; ᵇ denotes activities in the past six months

13 Univariate Analyses Non-IDU (n=100) vs. IDU (n=33) Non-IDU (n=299) vs. IDU (n=53) 33.3 vs. 51.5% Have children (under 18) 18.9 vs. 28.8% 17.0 vs. 36.4% Aboriginal Ancestry 11.7 vs.17.0% 35 vs. 27 Median Age of First Homeless 28 vs vs. 48.4% Lifetime Homeless: 60+ months 30.5 vs. 52.8% 43.0 vs. 72.7% Major Depressive Episode 35.5 vs. 41.5% 34.4 vs. 54.5% Post-traumatic Stress Disorder 19.1 vs. 30.2% 51.0 vs. 93.9% Current Substance Dependence 49.8 vs. 94.3% 31.0 vs. 93.9% Polysubstance Useᵃ 25.1 vs. 90.6% 18.0 vs. 57.6% Daily Illicit Drug Useᵃ 21.1 vs. 43.4% 6.1 vs. 34.5% Involvement in Sex Workᵃ 3.4 vs vs. 30 Median days with drug problemᵃ 13 vs vs. 59.4% Head Injuries 68.4 vs. 80.8% 54.1 vs. 62.5% Visited Emergency Roomᵇ 56.5 vs. 67.9% 34.0 vs. 54.5% Needed healthcare, but did not receive itᵇ 44.4 vs. 44.2% ᵃ denotes activities in the past month; ᵇ denotes activities in the past six months

14 Univariate Analyses Non-IDU (n=100) vs. IDU (n=33) Non-IDU (n=299) vs. IDU (n=53) Mental Health Status 51.0 vs. 93.9% Current Substance Dependence 49.8 vs. 94.3% 43.0 vs. 72.7% Major Depressive Episode 35.5 vs. 41.5% 34.4 vs. 54.5% Post-traumatic Stress Disorder 19.1 vs. 30.2% 18.0 vs. 31.3% Mood Disorder w/psychotic Feature 14.0 vs. 22.6% 50.0 vs. 36.4% Pyschotic Disorder 57.2 vs. 41.5% 59.0 vs. 84.8% Mental Illness: Less Severe Form 44.1 vs. 69.8% 72.0 vs. 66.7% Mental Illness: Severe Form 75.3 vs. 66.0% Physical Health Status 1.0 vs. 12.5% Tuberculosis 2.1 vs. 1.9% 16.8 vs. 81.3% Hepatitis C Virus 19.4 vs. 80.9% 2.1 vs. 12.1% Hepatitis B Virus 5.3 vs. 6.5% 4.0 vs. 21.9% HIV/AIDS 7.2 vs. 17.0% 16.2 vs. 78.8% Infectious Disease (HIV/HCV/HBV) 23.7 vs. 77.4% 55.2 vs. 59.4% Head Injuries 68.4 vs. 80.8%

15 Univariate Analyses Non-IDU (n=100) vs. IDU (n=33) Non-IDU (n=299) vs. IDU (n=53) Health Service Use 73.0 vs. 75.8% Seen by a health or social service providerᵇ 77.0 vs. 90.6% 34.0 vs. 54.5% Needed healthcare, but did not receive itᵇ 44.4 vs. 44.2% 2.0 vs. 9.1% Visited Addictions Counselorᵃ 3.3 vs. 5.7% 30.0 vs. 6.1% Visited Psychiatristᵃ 29.4 vs. 20.8% 54.1 vs. 62.5% Visited Emergency Roomᵇ 56.5 vs. 67.9% 55.6 vs. 84.8% Ever received treatment/counseling 51.7 vs. 88.7% harm reduction servicesᵇ ᵃ denotes activities in the past month; ᵇ denotes activities in the past six months

16 Multivariable Analyses Non-IDU (n=100) vs. IDU (n=33) Non-IDU (n=299) vs. IDU (n=53) Controlling for Severity of Homelessness Controlling for Involvement in Sex Work ( ) AOR 24.87** Infectious Disease (HIV/HBV/HCV) AOR 9.07** 3.83* Mental Illness Less Severe Cluster: Major Depression/PTSD/Panic Disorder 1.96* 0.18* Visit Psychiatristᵃ Seen by a health or social service providerᵃ Ever received treatment/counseling/ harm reduction servicesᵇ ** * p < 0.10 ** p < ᵃ denotes activities in the past month; ᵇ denotes activities in the past six months

17 Multivariable Analyses Non-IDU (n=100) vs. IDU (n=33) Non-IDU (n=299) vs. IDU (n=53) Controlling for Severity of Homelessness Controlling for Involvement in Sex Work ( ) AOR 24.87** Infectious Disease (HIV/HBV/HCV) AOR 9.07** 3.83* Mental Illness Less Severe Cluster: Major Depression/PTSD/Panic Disorder 1.96* 0.18* Visit Psychiatristᵃ Seen by a health or social service providerᵃ Ever received treatment/counseling/ harm reduction servicesᵇ ** * p < 0.10 ** p < ᵃ denotes activities in the past month; ᵇ denotes activities in the past six months

18 Multivariable Analyses Non-IDU (n=100) vs. IDU (n=33) Non-IDU (n=299) vs. IDU (n=53) Controlling for Severity of Homelessness Controlling for Involvement in Sex Work ( ) AOR 24.87** Infectious Disease (HIV/HBV/HCV) AOR 9.07** 3.83* Mental Illness Less Severe Cluster: Major Depression/PTSD/Panic Disorder 1.96* 0.18* Visit Psychiatristᵃ Seen by a health or social service providerᵃ Ever received treatment/counseling/ harm reduction servicesᵇ ** * p < 0.10 ** p < ᵃ denotes activities in the past month; ᵇ denotes activities in the past six months

19 Multivariable Analyses Non-IDU (n=100) vs. IDU (n=33) Non-IDU (n=299) vs. IDU (n=53) Controlling for Severity of Homelessness Controlling for Involvement in Sex Work ( ) AOR 24.87** Infectious Disease (HIV/HBV/HCV) AOR 9.07** 3.83* Mental Illness Less Severe Cluster: Major Depression/PTSD/Panic Disorder 1.96* 0.18* Visit Psychiatristᵃ Seen by a health or social service providerᵃ Ever received treatment/counseling/ harm reduction servicesᵇ ** * p < 0.10 ** p < ᵃ denotes activities in the past month; ᵇ denotes activities in the past six months

20 Multivariable Analyses Non-IDU (n=100) vs. IDU (n=33) Non-IDU (n=299) vs. IDU (n=53) Controlling for Severity of Homelessness Controlling for Involvement in Sex Work ( ) AOR 24.87** Infectious Disease (HIV/HBV/HCV) AOR 9.07** 3.83* Mental Illness Less Severe Cluster: Major Depression/PTSD/Panic Disorder 1.96* 0.18* Visit Psychiatristᵃ Seen by a health or social service providerᵃ Ever received treatment/counseling/ harm reduction servicesᵇ ** * p < 0.10 ** p < ᵃ denotes activities in the past month; ᵇ denotes activities in the past six months

21 Multivariable Analyses Non-IDU (n=100) vs. IDU (n=33) Non-IDU (n=299) vs. IDU (n=53) Controlling for Severity of Homelessness Controlling for Involvement in Sex Work ( ) AOR 24.87** Infectious Disease (HIV/HBV/HCV) AOR 9.07** 3.83* Mental Illness Less Severe Cluster: Major Depression/PTSD/Panic Disorder 1.96* 0.18* Visit Psychiatristᵃ Seen by a health or social service providerᵃ Ever received treatment/counseling/ harm reduction servicesᵇ ** * p < 0.10 ** p < ᵃ denotes activities in the past month; ᵇ denotes activities in the past six months

22 Discussion

23 Discussion 3.83

24 Discussion %

25 Discussion %

26 Discussion 59.4% %

27 Discussion 59.4% % Daily drug use problems: 30 (median) days in past month

28 Discussion IDU women present with a complex clinical profile which would benefit from comprehensive care. Yet, are less likely to obtain psychiatric care or other forms of treatment, counseling or harm reduction services.

29 Discussion Of immediate concern: Findings reveal a significantly higher prevalence of active IDU among homeless women with mental illness compared to homeless men Findings support previous research suggesting an epidemic of PTSD among IDU women in Vancouver IDU and involvement in the sex trade are strong predictors of premature mortality among women in Vancouver Currently an absence of gender-specific health and harm reduction services available to IDU women in Vancouver

30 Implications Results indicate gender-related differences have important implications for health, safety and the development of health and social responses. Trauma-related treatment and prevention for IDU women should be prioritised as an important public health issue.

31 Acknowledgements The Vancouver At Home study is funded by a research grant from Health Canada and the Mental Health Commission of Canada. The authors gratefully acknowledge the Vancouver At Home study participants and field research team. Here At Home, an NFB Web documentary about mental illness and homelessness: Ici, Chez soi, un documentaire Web de l ONF sur la maladie mentale et l itinérance: Contact: Faith Eiboff ( faithe@interchange.ubc.ca) Reference: Susser, E., Betne, P. Valencia, E., Goldfinger, S.M. & Lehman, A.F. (1997). Injection drug use among homeless adults with severe mental illness. American Journal of Public Health, 87(5),