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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Anders C. Håkansson, Lund University, Sweden
- Second opponent: Associate Professor Fatemeh Chalabianloo, University of Bergen, Norway
- Third member and chair of the evaluation committee: Researcher Philipp Paul Lobmaier, University of Oslo
Chair of the Defence
Professor Emeritus Helge Waal, University of Oslo
Principal Supervisor
Professor Lars Lien, Høgskolen i Innlandet
Summary
Nepal has experienced a surge in use of oral and injectable opioids over the last three decades. Harm reduction approaches like Opioid agonist treatment (OAT) have been the main response for successfully addressing the issue of Human Immunodeficiency Virus (HIV) transmission but falls short in providing comprehensive care for people who use/ inject drugs.
A cross-sectional study design was used to interview 231 service users in OAT programs from five sites across three metropolitan cities in Nepal. Participants were recruited from hospital and community settings, and face-to-face interviews were undertaken. This thesis examined the burden of psychological distress, comorbid mental disorders including suicidality, internalized stigma, and quality of life among OAT service users using standardized questionnaires in local language.
About one in four had experienced severe psychological distress within the preceding month with those with history of injecting having higher psychological distress and poorer quality of life. About a quarter of service users were diagnosed with lifetime suicidality and major depressive disorder. Lifetime suicidality was associated with antisocial personality disorder and psychotic disorder, and lifetime major depressive disorder was associated with a history of any mental disorders. Both lifetime suicidality and major depression were independently associated with the presence of severe psychological distress in the last month. More than half of the service users also reported high internalized stigma, which was associated with lower quality of life across all domains.
Additionally, those with high internalized stigma were more likely to have comorbid medical conditions and lifetime experience of anxiety, depression, and alcohol use disorders. There is a need for OAT programs to screen for common mental disorders, ensure mechanisms to decrease stigma and have comprehensive approaches to enhance the quality of life of service users.
Additional information
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