This project will explore the relationship between child maltreatment, mental disorders and opioid dependence in people that use illicit opioids, like heroin, and those prescribed opioids for chronic non-cancer pain. Systematic reviews will first estimate the prevalence rates of a history of child maltreatment and mental disorders in people with opioid dependence. Longitudinal studies will examine how child maltreatment and mental disorders affect opioid use and dependence in both people that use pharmaceutical and illicit opioids.
Ample evidence exists to support association between child maltreatment, mental disorders, opioid use and opioid dependence. Multiple studies have reported rates of child abuse, child neglect and mental disorders that are far higher in people with opioid dependence than the general population. Despite compelling evidence to support the association between child maltreatment, mental disorders and opioid dependence, there have not yet been any systematic reviews on the prevalence rates of these variables in this population. Estimates of child maltreatment and mental disorder prevalence rates in people with opioid dependence may inform appropriate service and resource allocation for people with opioid dependence.
One of the key populations of people with opioid dependence, are people prescribed opioids for chronic non-cancer pain (CNCP). The unintended consequences of opioid prescription for CNCP include the development of opioid dependence, which is associated with high rates of overdose and mortality. A frequently identified risk factor for opioid dependence includes a history of child maltreatment. However, this relationship is not clearly understood in people prescribed opioids for CNCP. Child maltreatment has been associated elevated levels of mental disorders including anxiety, PTSD, and depression. Both trauma and psychological distress can adversely affect an individual’s interpretation of pain and pain coping skills. Therefore, it is unsurprising that population surveys report elevated levels of childhood trauma and mental disorders in people with chronic pain. Examining the relationship between child maltreatment, mental disorders and opioid dependence in people prescribed opioids for CNCP, may provide a better understanding on the relationships between child trauma, mental health, pain and substance use.
Component 1: Estimate the global prevalence of child maltreatment in people with opioid dependence
Component 2: Estimate the global prevalence of mental disorders in people with opioid dependence
Component 3: Longitudinal cohort data- Examine the relationship between child maltreatment, mental disorders and opioid dependence in people prescribed opioids for chronic non-cancer pain
Component 1 & Component 2: Although conducted separately, both reviews have similar designs and methods. The reviews are being conducted according to PRISMA guidelines and searches were completed in major electronic peer-review databases. Both reviews identified studies that included information on people with opioid dependence and information on the key variables of interest: a history of child maltreatment and co-morbid mental disorders. After screening and data extraction, meta-analyses will estimate the prevalence rates of different types of child maltreatment and mental disorders in people with opioid dependence. Meta-analyses and meta-regressions will also be employed to identify the key differences in prevalence rates of child maltreatment and mental disorders in different sub-populations of people with opioid dependence.
Component 3: This study will use data from the POINT cohort, a large, community sample of prescribed opioids for CNCP. Longitudinal analyses will examine how child maltreatment and mental disorders affect the risk of opioid dependence in people prescribed opioids for CNCP.
- To inform service providers of people with opioid dependence on the level of need for trauma-informed care and adjunct mental health services
- To provide a better understanding of how and why childhood trauma and mental disorders increase the risk of opioid use disorders