Mental disorders and suicidality among Opioid Agonist Treatment service users in Nepal: A cross sectional study

Background: High lifetime prevalence of major mental disorders and suicidality are common among Opioid Agonist Treatment (OAT) service users and impact on the outcomes of OAT programs. Despite the known detrimental effects across personal, social and economic aspects of life these associations and implications remain under-studied in resource poor settings. The aim of this study was to identify common mental disorders among OAT service users in Kathmandu valley and to explore factors associated with lifetime suicidality and major depressive disorder.Methods: A cross-sectional study was conducted among 231 participants from five OAT centers in the Kathmandu valley. Participants were administered a semi-structured questionnaire, the Nepalese version of the Kessler 6 Psychological Distress Scale (K6), and the Mini International Neuropsychiatric Interview (M.I.N.I.) 7.0.2. Bivariate and multivariate analyses were employed to identify associations between lifetime suicidality and lifetime major depressive disorder with socio-demographic variables, other mental disorders, and substance use related variables.Results: Among OAT service users, 16.5% reported a history of mental disorder and one in four had a Kessler-6 psychological distress score >= 13 within the last four weeks. Using M.I.N.I lifetime suicidality was observed in 26.0% and lifetime major depressive disorder in 24.2%. Lifetime suicidality were significantly higher among participants with lifetime psychotic disorder (AOR = 5.94; 95% CI:1.66, 21.34, p = 0.006), lifetime antisocial personality disorder (AOR = 2.60; 95% CI:1.0, 6.71, p = 0.049) and having a Kessler-6 score >= 13 (AOR = 2.45; 95% CI:1.13, 5.29, p = 0.023). Lifetime major depressive disorder was independently associated with a Kessler-6 score >= 13 (AOR = 5.38; 95% CI:2.49, 11.62, p < 0.001).Conclusion: This study revealed a high prevalence of mental disorders and lifetime suicidality among OAT service users. Reviewing initial screening and assessment protocols for OAT, and routine use of brief screening tools to ensure better identification of those at risk is warranted, including suicidality risk assessment.