|BRIEF RESEARCH ARTICLE
|Year : 2022 | Volume
| Issue : 1 | Page : 57-60
Physical and mental health status of women whose spouses inject drugs – A cross-sectional, multisite study
Ravindra Rao1, Preethy Kathiresan2, Kunal Kishore3, Parveen Kumar4, Charanjit Sharma5, Jatinder Kumar Mishra6
1 Additional Professor, National Drug Dependence Treatment Centre, AIIMS, New Delhi, India
2 Senior Resident, National Drug Dependence Treatment Centre, AIIMS, New Delhi, India
3 Chief of Party -Global Fund, Save the Children, Nepal
4 Additional Project Director, New Delhi, India
5 Programme Manager, Drug Use and Harm Reduction, Alliance India, New Delhi, India
6 Joint Director Delhi State AIDS Control Society, New Delhi, India
|Date of Submission||16-Dec-2020|
|Date of Decision||10-Sep-2021|
|Date of Acceptance||15-Dec-2021|
|Date of Web Publication||5-Apr-2022|
No, 4096, Department of Psychiatry, 4th Floor, Teaching Block, AIIMS, Ansari Nagar, New Delhi-29
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Substance use disorder impacts the lives of significant others, more especially the wives of individuals using substances. However, the physical and mental health issues among wives of people who inject drugs (PWID) are less studied. The current cross-sectional, multisite study assessed the physical and mental health of wives of 433 PWID across six sites in Delhi. The mean age of the participants was 32.7 years (standard deviation: 9.7). More than 50% of the participants reported menstrual problems, most commonly dysmenorrhea. Around 55.9% had adverse pregnancy outcomes (abortion, miscarriage, or stillbirth). Around one out of four participants reported at least one specific sexually transmitted infection symptom. Around 11% were diagnosed with tuberculosis and 35% with a major medical illness in their lifetime. More than 90% of the participants had depressive and anxiety symptoms. The study showed that there is a huge burden of physical and mental health issues among the wives of PWID.
Keywords: Injecting drug use, menstrual health, mental health, reproductive health, sexually transmitted infections, wives
|How to cite this article:|
Rao R, Kathiresan P, Kishore K, Kumar P, Sharma C, Mishra JK. Physical and mental health status of women whose spouses inject drugs – A cross-sectional, multisite study. Indian J Public Health 2022;66:57-60
|How to cite this URL:|
Rao R, Kathiresan P, Kishore K, Kumar P, Sharma C, Mishra JK. Physical and mental health status of women whose spouses inject drugs – A cross-sectional, multisite study. Indian J Public Health [serial online] 2022 [cited 2022 May 18];66:57-60. Available from: https://www.ijph.in/text.asp?2022/66/1/57/342585
There are around 8 lakh people who inject drugs (PWID) in India. Most PWID inject opioids as the primary drug. As PWID have a higher risk of contracting and transmitting human immunodeficiency virus (HIV) to others, most studies have focused on assessing the prevalence of HIV and HIV-related risk factors among spouses of PWID. Studies on the physical health status of spouses of PWID, apart from HIV, have been limited.
Multiple studies have found that alcohol leads to poorer physical and mental health in the users' families. Studies assessing the impact of opioid use on the health of their family members are few. Families of people with opioid dependence, especially those who inject opioids, have a higher caregiver burden compared to families of those who do not inject opioids. The high caregiver burden, coupled with high rates of unemployment among PWID leading to the financial crisis, and stigma and discrimination by the society, can lead to a higher level of stress among spouses of PWID. Stress affects the mental as well as physical health of an individual. However, literature on the physical and mental health of spouses of PWID is limited.
There is a sizeable population of spouses of PWID in India, as almost 43% of the PWID in India are married. Given a large number of spouses of PWID in India, it would be important to assess their physical and mental health status. The present study aimed to assess the physical and mental health status of wives of PWID, with a focus on their (1) menstrual and reproductive health, (2) sexually transmitted infection (STI), (3) major medical illnesses, including tuberculosis (TB), and (4) mental illnesses.
The current study was a cross-sectional study conducted among wives of male PWID registered at harm reduction intervention sites, which are run by non-governmental organizations and supported by the Delhi State AIDS Control Society. Of the 13 sites in Delhi, six sites were selected (one site from each district) to ensure geographical representativeness. Considering the time available for data collection, it was planned to include at least 80 participants from each site. All sites contributed 80 participants, except for one site, which contributed only 33 participants. Finally, 433 participants could be included in the study.
From the list of active clients at these sites, we initially approached adult, married, and male PWID by purposive sampling method. After getting consent from the PWID, his wife was selected for the study if she fulfilled the following criteria – stayed with PWID in last 6 months, at least 18 years of age, had no major physical or psychological problem hampering interview, and gave consent to take part in the study. A structured questionnaire was used to collect details on sociodemographics, menstrual health, reproductive health, STIs, major medical illness, as well as stigma and discrimination. Mental health was assessed using generalized anxiety disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales.
After receiving training on data collection tools and study methodology, female psychologists interviewed the participants, ensuring privacy. The study was conducted between December 2019 and February 2020 after getting ethics approval. Data were collected using REDCap electronic data capture tools and analyzed using SPSS version 21 (IBM Corp 2012, Armonk, NY, USA). We summarized categorical data as frequency (percentage) and continuous data as mean (standard deviation [SD]) or median (interquartile range).
The mean age of participants was 32.7 years (SD: 9.7). About 66% (n = 286) were illiterate. Only 4.6% (n = 20) were educated beyond class 10. About 72.1% (n = 312) were housewives. About 49% (n = 212) belonged to lower socioeconomic status. About 72.7% (n = 315) belonged to nuclear family.
Among participants who had at least one menstrual cycle in past 3 months (n = 319), 73.9% (n = 236) experienced menstrual problems – 58.9% (n = 188) dysmenorrhea, 18.8% (n = 60) hypomenorrhea, 9% (n = 29) hypermenorrhea, 8.8% (n = 28) oligomenorrhea, and 2.8% (n = 9) polymenorrhea. However, only 5.5% (n = 13) took treatment.
Most (94%, n = 407) participants had been pregnant ever in their lifetime. The mean number of pregnancies was 4.1 (SD: 2.4) and the mean number of live births was 3.3 (SD: 1.6). Around 55.8% (n = 239) of the participants had adverse pregnancy outcome ever, with spontaneous abortions (n = 148, 61.9%) being most common, followed by induced abortions (n = 69, 28.9%), and stillbirth (n = 45, 18.8%). Around 9.9% (n = 43) of the participants had experienced infertility ever, but only 30.2% (n = 13) of them had taken treatment. Around 16.4% (n = 71) had dyspareunia in the past 3 months, with 11.3% (n = 8) taking treatment.
As can be seen from [Table 1], most participants (n = 361, 83.4%) had experienced any STI symptom ever. Around 25.9% (n = 112) experienced at least one specific symptom of STI (genital ulcers, inguinal buboes, or genital skin rashes). About 85.1% (n = 372) of the participants reported experiencing any STI symptom ever, either by self or husband, but only 9.1% (n = 34) had received treatment together.
|Table 1: Prevalence of symptoms of sexually transmitted infections among female spouses of persons who inject drugs|
Click here to view
Only 44.6% (n = 193) had ever been tested for HIV. Among them, eight (4.3%) participants tested positive for HIV and six participants had started antiretroviral treatment.
About 36% (n = 156) of the participants had ever been tested for TB. Of these, 30.8% (n = 48) had been diagnosed with TB and 47 participants had received treatment. Two had TB at the time of interview. About 26.1% (n = 113) reported at least one symptom suggestive of pulmonary TB at the time of assessment.
About 35.3% (n = 153) of the participants were diagnosed with major medical illnesses (except TB) ever. The common illnesses reported were anemia (66%, n = 101), hypertension (46.4%, n = 71), hypothyroidism (13.7%, n = 21), and diabetes mellitus (13.1%, n = 20). Most participants – 63.4% (n = 64) with anemia, 97.2% (n = 69) with hypertension, 90.5% (n = 19) with hypothyroidism, and 100% with diabetes mellitus were on treatment at the time of the interview.
As seen from [Table 2], most participants (90.8%, n = 393) had depressive symptoms based on the PHQ-9 scale, with 34.4% (n = 149) in the “moderately severe/severe” category. About 92.3% (n = 402) had anxiety symptoms based on the GAD-7 scale, with 36.3% in the “severe” category.
|Table 2: Scores on scales to assess depression and anxiety through Patient Health Questionnaire-9 generalized anxiety disorder-7 scale, respectively|
Click here to view
About 59.3% (n = 257) of the participants reported avoiding mixing with others and 59.8% (n = 259) reported that others have reduced visiting their family because of husband's drug use. About 70.4% (n = 305) reported having been treated unfairly by others, including neighbors (36.4%, n = 111), relatives (33.1%, n = 101), and friends (15.4%, n = 47).
There are few studies that have assessed the physical and mental health of wives of PWID. Our study used a fairly large sample from different sites providing harm reduction services to PWID in the city of Delhi and used a structured questionnaire to collect data.
A study analyzing nationwide data on 170,632 Indian women in the reproductive age group found that 10.9% had menstrual problems in the past 3 months. The prevalence of menstrual problems among wives of PWID in our study was 2–5 times higher than the general population. Reproductive health in our study population was also worse compared to the general population. The mean number of pregnancies in our study was 3.3, compared to the total fertility rate of 2.2 for India. A study of 4000 female partners of PWID in India found that 28.2% had miscarriages and 17.8% had induced abortions, comparable to the values from the current study. Thus, the rates of pregnancies, live births, and abortions in this population are much higher than the general population. Even though most participants in our study reported STI symptoms ever, only 9% had received treatment together. This shows the gross undertreatment of STI in this population. It is important to screen PWID and their spouse for STI and offer treatment to both.
The TB prevalence in 2015 in India was 0.32%. There was a higher TB prevalence among the study participants, with 11% diagnosed with TB ever. As TB prevalence is higher among PWID, and wives of PWID share the same living space, they are at a higher risk of acquiring TB. Hence, there is a need to extend the active case detection of TB in this population. The study also found an enormous burden of mental illness among the participants, with over 90% having depressive and anxiety symptoms. A previous study also found a higher incidence of anxiety (55%) and depression (43%) among women due to family members' drug use. Our study also found an enormous burden of stigma and discrimination, with around 70% of the participants feeling that they were treated unfairly by others, similar to other studies.
The study also has important limitations. We selected the sites as well as the participants purposively for data collection because of feasibility issues, which may limit the generalizability of the findings. The data were based on self-report and no actual testing for STI or HIV or general physical health conditions was done. Despite these limitations, the study shows that the prevalence of physical and mental health adversities among wives of PWID is very high.
| Conclusion|| |
There is a high burden of physical and mental health disorders among wives of PWID. It is important to address these vulnerabilities while designing HIV prevention interventions for this population.
The following are acknowledged for their support for the study: Ashim Chawla, New CE of Alliance, India; Rewati Chawla, Lead Programmes, Frontline AIDS; Ira Madan, Alliance India; Bhagwati Khandpal, Alliance India; Ms Rabya Khatoon; and Ms Bushra Hashim; Delhi State AIDS Control Society.
Financial support and sponsorship
The study was funded by Frontline AIDS, UK. The funding agency did not have any role in designing study methodology, or data analysis.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ambekar A, Chadda RK, Khandelwal SK, Rao R, Mishra AK, Agrawal A. Magnitude of Substance use in India. New Delhi: Ministry of Social Justice and Empowerment, Government of India; 2019.
Solomon SS, Mehta SH, Latimore A, Srikrishnan AK, Celentano DD. The impact of HIV and high-risk behaviours on the wives of married men who have sex with men and injection drug users: Implications for HIV prevention. J Int AIDS Soc 2010;13 Suppl 2:S7.
Casswell S, You RQ, Huckle T. Alcohol's harm to others: Reduced wellbeing and health status for those with heavy drinkers in their lives. Addiction 2011;106:1087-94.
Nebhinani N, Anil BN, Mattoo SK, Basu D. Family burden in injecting versus noninjecting opioid users. Ind Psychiatry J 2013;22:138-42.
] [Full text]
NACO. National Integrated Biological and Behavioural Surveillance (IBBS), India 2014-15. New Delhi: National AIDS Control Organisation; 2015.
Nitika, Lohani P. Prevalence and determinants of menstrual disorders and napkin usage among women in India using DLHS-4 data. J Family Med Prim Care 2019;8:2106-11.
International Institute of Population Sciences (IIPS), ICF. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS; 2017.
Murthy P. Women and Drug Use in India: Substance, Women and High – Risk Assessment Study. Delhi: United Nations Office on Drugs and Crime – Regional Office for South Asia; 2008.
Central TB Division. India TB Report 2018. Revised National TB Control Programme. Annual Status Report. Delhi: Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare; 2019.
Shankardass MK, Ranganathan S, Benegal V, Mittal S, Mani VS, Singh UN. Burden on Women due to Drug Abuse by Family Members. Delhi: Ministry of Social Justice and Empowerment and United Nations International Drug Control Programme – Regional Office for South Asia; 2001.
[Table 1], [Table 2]