Psychiatric Correlates of Injection Risk Behavior Among Young People Who Inject Drugs

Introduction. People who inject drugs (PWID) and have mental health conditions, such as major depression, an anxiety disorder, or anti-social or borderline personality disorder may have elevated risk for HIV/HCV infection.  This study examined the associations between psychiatric disorders and risky injection behavior in an out-of-treatment sample of young PWID. 

Methods. Participants were 570 young adults  (18-25 years) who injected drugs in the previous 30 days, recruited through outreach and respondent-driven sampling.  Psychiatric diagnoses were based on interviews using the Psychiatric Research Instrument for Substance and Mental Disorders (PRISM).  Latent class analysis of self-reported injection risk behavior was used to identify distinct classes of injection risk behavior.  Associations between risk behavior class and psychiatric conditions were analyzed using multiple logistic regression. 

Results. Four classes of injection risk behavior were identified, including low risk, equipment sharing only, moderate syringe sharing risk, and high syringe sharing risk.  Primary major depression (ever), substance-induced major depression (ever or past year), anti-social personality disorder (among males only) and borderline personality disorder were associated with a greater likelihood of high-risk behavior.  Associations between depressive disorders and injection risk were attenuated when adjusted for borderline personality disorder.  Participants who met the criteria for borderline personality disorder were 3 times as likely as those who did not to report high-risk injection behavior (relative to low-risk behavior).  In addition, those who reported self-harm behaviors in the past year (recurrent self-mutilation or suicidal behavior, symptoms associated with borderline personality disorder) were over 7 times as likely as those who did not to report high-risk injection behavior.

Conclusions.  Borderline personality disorder is common among young people who inject drugs and is associated with risky injection behavior.  The effect of emotional dysregulation, a core feature of borderline personality disorder, on risky injection behavior deserves further research.  Intervention strategies for self-harm behavior may be able to inform HIV prevention efforts for young PWID.