Claudia Rafful

Suicidality, ethnicity and immigration in the USA

BACKGROUND Suicide is the 11th leading cause of death in the USA. Suicide rates vary across ethnic groups. Whether suicide behavior differs by ethnic groups in the USA in the same way as observed for suicide death is a matter of current discussion. The aim of this report was to compare the lifetime prevalence of suicide ideation and attempt among four main ethnic groups (Asians, Blacks, Hispanics, and Whites) in the USA. METHOD Suicide ideation and attempts were assessed using the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). Discrete time survival analysis was used to examine risk for lifetime suicidality by ethnicity and immigration among 15 180 participants in the Collaborative Psychiatric Epidemiological Surveys (CPES), a group of cross-sectional surveys. RESULTS Suicide ideation was most common among Non-Hispanic Whites (16.10%), least common among Asians (9.02%) and intermediate among Hispanics (11.35%) and Non-Hispanic Blacks (11.82%). Suicide attempts were equally common among Non-Hispanic Whites (4.69%), Hispanics (5.11%) and Non-Hispanic Blacks (4.15%) and less common among Asians (2.55%). These differences in the crude prevalence rates of suicide ideation decreased but persisted after control for psychiatric disorders, but disappeared for suicide attempt. Within ethnic groups, risk for suicidality was low among immigrants prior to migration compared to the US born, but equalized over time after migration. CONCLUSIONS Ethnic differences in suicidal behaviors are explained partly by differences in psychiatric disorders and low risk prior to arrival in the USA. These differences are likely to decrease as the US-born proportion of Hispanics and Asians increases.

Predictors of quit attempts and successful quit attempts in a nationally representative sample of smokers

Although most current smokers report that they would like to quit, most quit attempts fail suggesting that predictors of quitting attempts may differ from those of successful attempts. We examined sociodemographic and clinical predictors of quit attempts and successful quit attempts in a nationally representative sample of US adults. Data was collected in 2001-2002 (Wave 1) and 2004-2005 (Wave 2). Almost 40% of individuals who had not previously attempted to quit, tried to quit over the next three years; only 4.6% of those who tried had succeeded at the time of the evaluation. Hispanics, Asians, individuals with high income, and those with college education were less likely to attempt to quit, whereas those with daily nicotine use, younger age at first use and most symptoms of dependence were more likely to do so. Having an educational level below high school and older age at first nicotine use were predictors of successful quitting. Despite relatively high rates of quit attempts, rates of success are extremely low, indicating a gap between the public health need of decreasing tobacco use, and existing means to achieve it. Although there is a need to encourage people to quit tobacco, there may be an equally large need to develop more effective interventions that increase the rate of successful quit attempts.

Towards a comprehensive developmental model of cannabis use disorders

AIMS To develop a comprehensive risk-factor model of cannabis use disorders (CUD) based on Kendlers development model for major depression. DESIGN Risk factors were divided into five developmental tiers based on Kendlers model of depression (childhood, early adolescence, late adolescence, adulthood, past year). Hierarchical logistic regression models were used to examine the independent contribution of each risk factor. Separate models were built to predict the lifetime risk of cannabis use and the risk of CUD among those with a history of lifetime risk of cannabis use. SETTING Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) in the United States. PARTICIPANTS Participants consisted of wave 2 of the NESARC (n = 34 653). MEASUREMENTS Odds ratios (OR), Adjusted OR (AOR) and confidence intervals (95% CI) were used to determine the risk factors in each tier and with multiple models. FINDINGS After mutually adjusting for the effect of other risk factors, lifetime history of drug use disorder (AOR = 4.78, 95% CI = 1.53-14.91), past year alcohol use disorders (AOR = 6.55, 95% CI = 2.54-16.89) and independent (AOR = 1.57, 95% CI = 1.15-2.14) and dependent (AOR = 1.25, 95% CI = 1.01-1.55) stressful life events predicted lifetime cannabis use. Impulsivity (AOR = 2.18, 95% CI = 1.34-3.53), past year alcohol use disorders (AOR = 4.09, 95% CI = 2.29-7.31), greater number of Axis I disorders (AOR = 1.56, 95% CI = 1.01-2.40) and social deviance (AOR = 1.19, 95% CI = 1.08-1.32) independently increased the risk of the development of CUD, whereas religious service attendance (AOR = 0.50, 95% CI = 0.30-0.85) decreased this risk. In both models, the effect of earlier development tiers was mediated by more proximal ones. There were few gender differences in both models. CONCLUSIONS A modification of Kendlers risk factor model for major depression which stratifies risk factors into five groups (childhood, early adolescence, late adolescence, adulthood, past year) provides a useful foundation for a comprehensive developmental model of cannabis use and cannabis use disorders.

The effectiveness of compulsory drug treatment: A systematic review

BACKGROUND Despite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the effectiveness of compulsory drug treatment. METHODS We conducted a systematic review of studies assessing the outcomes of compulsory treatment. We conducted a search in duplicate of all relevant peer-reviewed scientific literature evaluating compulsory treatment modalities. The following academic databases were searched: PubMed, PAIS International, Proquest, PsycINFO, Web of Science, Soc Abstracts, JSTOR, EBSCO/Academic Search Complete, REDALYC, SciELO Brazil. We also searched the Internet, and article reference lists, from database inception to July 15th, 2015. Eligibility criteria are as follows: peer-reviewed scientific studies presenting original data. Primary outcome of interest was post-treatment drug use. Secondary outcome of interest was post-treatment criminal recidivism. RESULTS Of an initial 430 potential studies identified, nine quantitative studies met the inclusion criteria. Studies evaluated compulsory treatment options including drug detention facilities, short (i.e., 21-day) and long-term (i.e., 6 months) inpatient treatment, community-based treatment, group-based outpatient treatment, and prison-based treatment. Three studies (33%) reported no significant impacts of compulsory treatment compared with control interventions. Two studies (22%) found equivocal results but did not compare against a control condition. Two studies (22%) observed negative impacts of compulsory treatment on criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient treatment on criminal recidivism and drug use. CONCLUSION There is limited scientific literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.

Probability and predictors of treatment-seeking for prescription opioid use disorders: A National Study

BACKGROUND Prescription opioid use disorders are the second most common drug use disorder behind only cannabis use disorders. Despite this, very little is known about the help-seeking behavior among individuals with these disorders. METHODS The sample included respondents of the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) with a lifetime diagnosis of prescription drug use disorders (N=623). Unadjusted and adjusted hazard ratios are presented for time to first treatment-seeking by sociodemographic characteristics and comorbid psychiatric disorders. RESULTS The lifetime cumulative probability of treatment seeking was 42% and the median delay from prescription drug use disorder onset to first treatment was 3.83 years. Having an earlier onset of prescription opioid use disorder and a history of bipolar disorder, major depression disorder, specific phobia and cluster B personality disorders predicted shorter delays to treatment. CONCLUSIONS Although some comorbid psychiatric disorders increase the rate of treatment-seeking and decrease delays to first-treatment contact rates of treatment-seeking for prescription drug use disorder are low, even when compared with rates of treatment for other substance use disorders. Given the high prevalence and adverse consequences of prescription drug use disorder, there is a need to improve detection and treatment of prescription opioid use disorder.

Depression, gender, and the treatment gap in Mexico

BACKGROUND Gender is associated to lifetime risk of mood disorders, women having the highest lifetime and 12-month prevalence. In Mexico one out of five individuals with any mood disorder receives treatment during the first year. We evaluate the ages at which women and men are more vulnerable for the first onset of a major depressive episode, the longest duration and greatest number of episodes, the areas of daily functioning most affected, and which variables predict whether or not a person receives any kind of treatment. METHODS The Mexican National Comorbidity Survey, as part of the World Mental Health Surveys Initiative, is based on a stratified, multistage area probability Mexican urban household sample aged 18 to 65 (n=5782). Wald X(2) tests were performed to evaluate gender and cohort differences; logistic regression models were performed to evaluate gender and cohort as treatment predictors. RESULTS The most vulnerable group is the cohort of 45-54 year-old women. Once a first episode occurs, there are no sex differences in terms of number or length of episodes. There is a gap in service use, especially among 18-29 year-old women; the oldest women are the most impaired. LIMITATIONS Individuals from rural communities are not represented and there may have been recall bias due to the retrospective design. CONCLUSIONS Efforts should focus on factors related to the first onset episode and on early treatment programs to reduce the risk of subsequent episodes. Research and health resources should attend to the most vulnerable group, and the youngest women, who are in the reproductive age and have the largest treatment gap.

Mexican immigration to the US and alcohol and drug use opportunities: Does it make a difference in alcohol and/or drug use?

BACKGROUND Mexican immigrants in the US do not have increased risk for alcohol use or alcohol use disorders when compared to Mexicans living in Mexico, but they are at higher risk for drug use and drug use disorders. It has been suggested that both availability and social norms are associated with these findings. We aimed to study whether the opportunity for alcohol and drug use, an indirect measure of substance availability, determines differences in first substance use among people of Mexican origin in both the US and Mexico, accounting for gender and age of immigration. METHODS Data come from nationally representative surveys in the United States (2001-2003) and Mexico (2001-2002) (combined n=3432). We used discrete time proportional hazards event history models to account for time-varying and time-invariant characteristics. The reference group was Mexicans living in Mexico without migration experience. RESULTS Female immigrants were at lower risk of having opportunities to use alcohol if they immigrated after the age of 13, but at higher risk if they immigrated prior to this age. Male immigrants showed no differences in opportunity to use alcohol or alcohol use after having the opportunity. Immigration was associated with having drugs opportunities for both sexes, with larger risk among females. Migration was also associated with greater risk of using drugs after having the opportunity, but only significantly for males. CONCLUSIONS The impacts of immigration on substance use opportunities are more important for drugs than alcohol. Public health messages and educational efforts should heed this distinction.

Mexico's drug policy reform: Cutting edge success or crisis in the making?

In August 2009, Mexicos federal government took the bold step of passing a law partially decriminalizing possession of small quantities of drugs such as cannabis, cocaine, amphetamines, and heroin (Consejo Nacional contras las Adicciones, 2010). Concurrently, the law (known as the ‘ley de narcomenudeo’) also mandates that individuals found to be in possession of these drugs be diverted to addiction treatment, including methadone maintenance therapy (MMT) (Consejo Nacional contras las Adicciones, 2010). Specifically, individuals carrying illegal drugs under a threshold amount subject to the law who are stopped by police are released with a warning up to two times. However, upon a third drug-related infraction, individuals are either mandated to addiction treatment or jail (Consejo Nacional contras las Adicciones, 2010).

The latent structure and predictors of non-medical prescription drug use and prescription drug use disorders: a national study

BACKGROUND Despite growing concerns about non-medical prescription drug use and prescription drug use disorders, whether vulnerability for these conditions is drug-specific or occurs through a shared liability and common risk factors is unknown. METHODS Exploratory and confirmatory factor analysis of Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to examine the latent structure of non-medical prescription drug use and prescription drug use disorders. Multiple Indicators Multiple Causes (MIMIC) analysis was used to examine whether the effect of sociodemographic and psychiatric covariates occurred through the latent factor, directly on each drug class or both. RESULTS A one-factor model described well the structure of both non-medical prescription drug use and prescription drug use disorders. Younger age, being White, having more intense pain or one of several psychiatric disorders increased the risk of non-medical prescription drug use through the latent factor. The same covariates, except for anxiety disorders also significantly increased the risk of prescription drug use disorders through the latent factor. Older age directly increased the risk of non-medical use of sedatives, and alcohol use disorders decreased the risk of non-medical tranquilizer use. No covariates had direct effects on the risk of any prescription drug use disorders beyond their effect through the latent factor. CONCLUSION The risk for non-medical prescription drug use and prescription drug use disorders occurs through a shared liability. Treatment, prevention and policy approaches directed at these drugs as a group maybe more effective than those focused on individual classes of drugs.

High dead-space syringe use among people who inject drugs in Tijuana, Mexico

Abstract Background: High dead-space syringes (HDSS) are believed to confer an elevated risk of acquiring HIV and other blood-borne infections. Objectives: We identified prevalence and correlates of HDSS use among injection drug users (IDU) in Tijuana, Mexico, where syringe purchase and possession is legal without a prescription. Methods: Beginning in 2011, IDU who reported being 18 years or older and injected drugs within the last month were recruited into a prospective study. At baseline and semi-annually, 557 IDU underwent HIV-testing and interviewer-administered surveys. Logistic regression was used to identify correlates of using HDSS. Results: Of 557 IDU, 40% had ever used HDSS, mostly because no other syringe type was available (72%), or because they were easier to get (20%). Controlling for sex and age at first injection, use of HDSS was associated with cocaine as the first drug injected (Adjusted Odds Ratio [AOR]: 2.68; Confidence Interval 95% [CI]: 1.15–6.22), having been stopped or arrested by police (AOR: 1.84; 95% CI: 1.11–3.07), being deported from the US (AOR: 1.64; 95% CI:1.06–2.53), and believing it is illegal to carry syringes (AOR:1.78; 95% CI: 1.01–3.15). Conclusion: Use of HDSS is surprisingly common among IDU in Tijuana. Efforts are needed to expand coverage of low-dead space syringes through existing syringe exchange programs. Education is required to increase awareness of the harms associated with HDSS, and to inform IDU that syringe possession is legal across Mexico.