Long-Term Associations with Childhood Trauma and Mental Disorders Among People With Opioid Dependence

Author: Thomas Santo Natasa Gisev Gabrielle Campbell Elliot Nelson Louisa Degenhardt

Theme: Epidemiology & Public Health Research Year: 2022

Background: Childhood trauma and mental disorders increase risk of opioid dependence. We
examined if childhood trauma and mental disorders were associated with outcomes related to
opioid agonist treatment (OAT), crime, and mortality among people with opioid dependence.
Method: The sample included 1,482 people receiving OAT. We linked comprehensive survey on
childhood trauma and mental disorders to over one decade of administrative OAT, crime, and
mortality data. Exposure variables of interest were four latent classes of childhood trauma and five
different mental disorders. We used discrete-time analysis with odds ratios (ORs) to examine time
from opioid dependence onset to OAT entry. We used Poisson regressions with Incident Rate Ratios
(IRRs) to analyse time in OAT and criminal offending. Logistic regression was used to examine
mortality risk. All analyses used 95% Confidence Intervals (95%CIs).
Results: Participants with extensive childhood trauma experiences and anti-social personality
disorder (ASPD) were less likely to enter OAT in any given year after opioid dependence onset,
however, those with depression were more likely to enter OAT after opioid dependence onset. Panic
disorder, posttraumatic stress disorder (PTSD), and borderline personality disorder were associated
with less time in OAT. Multiple childhood trauma experiences, ASPD, and borderline personality
disorder increased risk of criminal offending. There were no significant associations between
exposure variables and mortality.
Conclusion: Our findings suggest that childhood trauma and mental disorders, except for
depression, increase risk of adverse treatment and social outcomes among people with opioid
dependence. Interventions that aim to reduce harm among people with opioid dependence may
consider the effect of childhood trauma and mental disorders on OAT engagement and crime.
Disclosure of Interest Statement: Mr Santo reported receiving the Australian Government Research
Training Program Fee Offset scholarship and Australian Federal Government Department of Health
Grants National Centre Core Funding during the conduct of the study. Dr Campbell reported
receiving grants from Indivior and NHMRC Early Career Fellowship during the conduct of the study.
Dr Degenhardt reported receiving grants from NHMRC Fellowship, project funding and grants from
the National Institutes of Health Project funding, grants from Indivior Untied to evaluate new opioid
medications in Australia, and grants from Seqirus United to evaluate new opioid medications in
Australia outside the submitted work. No other disclosures were reported. This work was supported
by the National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, the Australian
Government Department of Health under the Drug and Alcohol Programme, and the Australian
National Health and Medical Research Council. The Comorbidity and Trauma Study was funded by
NIH R01 DA17305.

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