Depression and Access to Mental Health Services Among Injection Drug Users and Their Intimate Partners in Almaty, Kazakhstan
Methods: The study uses baseline data from NIDA-funded Project Renaissance, a randomized controlled trial to test the efficacy of a dyadic-focused HIV prevention intervention for couples, conducted between 2009 and 2012 in Almaty, Kazakhstan. To be eligible to participate in the study, at least one member of the couple reported injection drug use in the previous 90 days. People were recruited via word of mouth through other participants, as well as through targeted recruitment in sites where injection drug users gathered. Data collection included both self-reported data and objective biological assays. Depression was measured through the BSI-18 sub-scale, which asked participants how often they had experienced depressive symptoms in the past week. Participants also reported whether or not they had received psychological counseling services in the past six months. Bivariate analyses were conducted to consider differences in depression scores and access to mental health services among men and women. Multivariate linear regression was used to control for socio-demographic characteristics and explore associations between individual, micro, and structural levels factors and depression scores.
Results: Females on average reported higher depression scores than their male partners (p<.01). Depression scores were particularly high among people who reported poor levels of health, nutrition, and fitness when compared to those who reported excellent, fair, or good health (p<.001). In the bivariate analysis, higher levels of social support from friends, family, and a significant other were associated with lower depression scores (p<.001). In the multivariate analysis, depressive scores were significantly higher among women (b=.41; SD=.08; p<.001) and among people who had ever experienced childhood sexual abuse (b=.23; SD=.08; p=.003), who had experienced sexual IPV in the past 6 months (b=.36; SD=.12; p=.003), who experienced food insecurity in the past 90 days (b=.31; SD=.08; p<.001), and who had lower levels of social support (b=-.06; SD=.03; p=.04). Access to counseling in the past 6 months was similar across genders (18.5%). Among those who had not received counseling, 51.0% of females and 35.9% of males said they needed services. Only 27.6% of those in need of services felt that such services were available.
Implications: Social support and physical health are important determinants of mental wellbeing among injection drug users in Kazakhstan. Policies that support health and mental health treatment for injection drug users are needed in this region. Services that promote supportive relationships and knowledge about health may be useful in addressing mental health needs. Additional research is needed to explore barriers to mental health services access and appropriate treatment approaches for drug users and their sexual partners in Central Asia.