title: Factors associated with depression and anxiety among patients attending community-based methadone maintenance treatment in China.
abstract: OBJECTIVE
  To estimate the prevalence of, and identify factors associated with, depression and anxiety among community-based methadone maintenance treatment (MMT) clients in China.
  
  
  METHODS
  A cross-sectional survey.
  
  
  METHODS
  Nine MMT clinics, three each from three Chinese provinces (Yunnan, Anhui and Jiangsu) between October 2008 and February 2009.
  
  
  METHODS
  A total of 1301 MMT clients.
  
  
  METHODS
  A questionnaire, including the Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS), and on-site urine drug testing.
  
  
  RESULTS
  The prevalence of depression (SDS score≥53) and anxiety (SAS score≥50) in our sample was 38.3% [95% confidence interval (CI)=35.7, 40.9] and 18.4% (95% CI=16.3, 20.5), respectively, with 14.2% (95% CI=12.3, 16.1) displaying symptoms of both. Sample prevalence rates for depression [mean=49.69, standard deviation (SD)=10.34] and anxiety (mean=40.98, SD=10.66) were higher than the national average for each (t(0.05/2, 1300)=19.2, P<0.001 and t(0.05/2, 1300)=8.0, P<0.001, respectively). Employing multi-level modelling techniques, gender (P=0.03) and employment status (P<0.001) were found to be associated significantly with depression in a single-level model; however, in a multi-level mixed model, only employment status (P<0.001) was associated with depression. Gender (P=0.03), education level (P=0.02), marital status (P=0.04), employment status (P<0.001), positive urine drug test results (P=0.02) and daily methadone dose (P<0.001) were found to be associated significantly with anxiety in a single-level model, while only employment status (P<0.01) and positive results for the urine drug test (P=0.04) were associated with anxiety in a multi-level mixed model.
  
  
  CONCLUSIONS
  A considerable proportion of methadone maintenance treatment clients in China have experienced depression and anxiety during treatment. There is a need to provide tailored mental health interventions for this high-risk population.
authors.affiliation: National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China.
authors.forename: Wenyuan
authors.initials: W
authors.lastname: Yin
authors.forename: Lin
authors.initials: L
authors.lastname: Pang
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Cao
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: McGoogan
authors.forename: Michael
authors.initials: M
authors.lastname: Liu
authors.forename: Congbin
authors.initials: C
authors.lastname: Zhang
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Li
authors.forename: Jianhua
authors.initials: J
authors.lastname: Li
authors.forename: Keming
authors.initials: K
authors.lastname: Rou
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D001007:Anxiety / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D055030:Drug Users / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000523:psychology*; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation* / Q000652:urine; D015995:Prevalence; D012307:Risk Factors; D057566:Self Report; D016320:Substance Abuse Treatment Centers; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone
keywords: Anxiety; Zung's Self-Rating; depression; drug user; methadone maintenance treatment