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Association of Depression, Anxiety, and Suicidal Ideation With High-Risk Behaviors Among Men Who Inject Drugs in Delhi, India

Armstrong, Gregory MSc*; Jorm, Anthony F. PhD; Samson, Luke BA; Joubert, Lynette PhD§; Nuken, Amenla PhD*; Singh, Shalini MSc; Kermode, Michelle PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15th, 2013 - Volume 64 - Issue 5 - p 502–510
doi: 10.1097/QAI.0b013e3182a7ef21
Epidemiology and Prevention

Background: Sharing of needles and syringes and unprotected sex remain a common practice among people who inject drugs (PWID) in India and are important drivers of new HIV infections. Whether engagement in risk behaviors among PWID is associated with symptoms of common mental disorders in India is unknown.

Methods: We analyzed the data collected in April and May of 2012 from a community-based sample of 420 PWID in Delhi using time location sampling. Self-report symptom scales were used to measure the severity of symptoms of depression (Patient Health Questionnaire 9) and anxiety (Generalized Anxiety Disorder scale 2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts within the past 12 months.

Results: PWID with severe depressive symptoms and those with suicidal thoughts were 4 and 2 times more likely to share needles/syringes, respectively. PWID experiencing suicidal thoughts had 82% more female sexual partners and were 5 times more likely to have had unprotected sex at last sex with a paid female partner. Conversely, symptoms of anxiety were associated with a 30% decrease in the likelihood of needle/syringe sharing and a 70% decrease in the likelihood of unprotected sex at last sex with a paid female partner.

Conclusions: We found a high prevalence of symptoms of depression, anxiety, and suicidal ideation among men who inject drugs in Delhi and that depression and suicidal ideation are independently positively associated with HIV risk behaviors, whereas anxiety is associated with a reduction in such behaviors. Ameliorating mental health problems among PWID in India may aid in reducing HIV infections.

*Nossal Institute for Global Health; and

Population Mental Health Group, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia;

The Society for Service to Urban Poverty, Delhi, India; and

§Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, Victoria, Australia.

Correspondence to: Gregory Armstrong, MSc, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 4, Alan Gilbert Building, 161 Barry St, Carlton, Victoria 3010, Australia (e-mail:

Supported by Nossal Institute for Global Health (University of Melbourne, Australia).

The authors have no conflicts of interest to disclose.

Received May 07, 2013

Accepted July 23, 2013

© 2013 by Lippincott Williams & Wilkins