Associations between childhood trauma and mental disorders and adverse treatment, social, and health outcomes, among people with opioid dependence

Background: Opioid use disorder (OUD) and mental disorders are major public health issues. Among people with OUD, comorbid mental disorders are associated with poorer health outcomes, including overdose. To our knowledge, this is the first systematic review and meta-analysis to estimate the prevalence of mental disorders among people with OUD.

Methods: We searched Embase, MEDLINE, and PsycInfo to identify studies of people with OUD that reported mental disorder data from January 1990 to July 2021. Observational studies that evaluated one or more mental disorder through clinical diagnosis or validated scales were included. We extracted the prevalence of each disorder, sample characteristics, and methodological factors from each publication. We used random-effects meta-analyses to generate prevalence estimates for each mental disorder with 95% Confidence Intervals (95%CIs). Meta-regressions and stratified analyses were used to examine sample characteristics and methodological factors associated with variance in pooled estimates.

Results: Of the 36,971 publications identified, we included data from 345 studies, 36 countries, and 104,135 people with OUD. Among people with OUD, the prevalence of current depression was 36.1% (95%CI 32.4-39.7%), anxiety was 29.1% (95%CI 24.0-33.3%), attention-deficit disorder was 20.9% (95%CI 15.7-26.2%), post-traumatic stress disorder was 18.1% (95%CI 15.4-20.9%), and bipolar disorder was 8.7% (95%CI 6.7-10.7%). Lifetime prevalence of anti-social personality disorder was 33.6% (95%CI 29.1-38.0%) and borderline personality disorder was 18.2% (95%CI 13.4-23.1%). Sample characteristics and methodological factors, such as participant sex and recruitment setting, were associated with variance in pooled estimates for specific mental disorders.

Conclusion: Mental disorders are far more common among people with OUD than the general population. Our findings emphasise the need for access to mental disorder treatment among this population. Results may inform clinical guidelines, treatment services, and future research among people with OUD.