Relationship Between Childhood Maltreatment And Mental Behavior Of Patients With Methamphetamine Use Disorder

ObjectiveMethamphetamine(MA)use disorder has become a serious public health and social problem.Previous studies have shown that childhood maltreatment(CM)is closely related to drug use disorders.This study will assess the detecting rate of CM in MA users under the background of Chinese culture,and the relationship between childhood maltreatment and depressive symptoms,emotional adjustment disorder,drug use behavior,willingness to quit drug use and life satisfaction,as well as the possible mechanism of relationships.The purpose of this study will be providing theoretical basis for the prevention of drug abuse and for mental and behavioral intervention treatment on MA users.MethodsA cross-sectional study design was conducted among 1,173 methamphet-amine users who were recruited from adult compulsory isolation centers in Anhui province.Field collective measurements(approximately 60 people per group)were conducted using a standardized structured questionnaire which included general demographic characteristics,substance use behavior characteristics,childhood maltreatment,depression symptoms,emotion regulation disorder,willingness to quit drug use and life satisfaction.The confirmatory factor analysis was conducted by AMOS21.0 software and Cronbach’sαcoefficient was calculated by SPSS23.0 software to test the applicability of the questionnaires to drug users.If the scores of scales followed the normal distribution,the differences between groups were analyzed by two independent samples t-test or ANOVA;if not,the differences between groups are analyzed by two independent samples Mann Whitney U test or k independent samples Kruskal Wallis H test.The count data was described by frequency distribution,and the differences between groups was analyzed by Chi-squared test.Pearson correlation or Spearman correlation was used for correlation analysis.The effects of different types of CM on the mental and behavioral characteristics of drug users were analyzed by multiple linear regression analysis or binary logistic regression analysis.Through the test of mediating effect and moderating effect of PROCESS for SPSS software,the path models of the influence of different types of CM on the mental and behavioral characteristics of drug users were explored.Results The used questionnaires were suitable for methamphetamine users and common method deviation was non-existent in this study.1.The detecting rate of total CM among methamphetamine users was 44.6%,20.6%had only one CM experience,and 24.0%had two or more CM experiences.On the types of CM,the detecting rates were 26.5%for childhood emotional neglect(CEN),24.6%for childhood physical neglect(CPN),18.0%for childhood sexual abuse(CSA),7.5%for childhood physical abuse(CPA)and 5.5%for childhood emotional abuse(CEA).There were statistically significant differences in the detecting rate of CEN,CEA and CSA between men and women(χ~2=6.962,p=0.008;χ~2=4.841,p=0.028;χ~2=4.245,p=0.039).The detecting rate of CSA in men was higher than that in women;the detecting rate of CEA and CEN in women was higher than that in men.2.The detecting rate of depressive symptoms(BDI-Ⅱ≥14)in methamphetamine users was 56.9%,including 20.8%of mild depression symptoms,21.6%of moderate depression symptoms and 14.6%of severe depression symptoms.There was gender difference in statistical significance on the detecting rate of depressive symptoms(BDI-Ⅱ≥14)(χ~2=17.601,p<0.001).The detecting rate of female depressive symptoms was higher than that of male.The distribution difference of gender in the detecting rate of depression symptoms degree classification(no depression,mild depression,moderate depression and severe depression symptoms)was statistically significant(χ~2=28.708,p<0.001),and the detecting rate of female moderate and severe depression symptoms was higher.3.After adjusting for factors of general demographics and drug use behavior,CSA(a OR=1.398,95%CI:1.018～1.921),CEN(a OR=1.566,95%CI:1.185～2.071)and CPN(a OR=1.602,95%CI:1.203～2.134)could increase the detecting rate of depressive symptoms(BDI-Ⅱ≥14 points).After adjusting for factors of general demographics,CSA(β=2.667,p<0.01)and CEN(β=1.694,p<0.05)could positively predict the score of depressive symptoms;CEN(β=0.857,p<0.01)and CPN(β=1.003,p<0.001)could positively predict the score of lack of emotional awareness(AWARENESS);CEA(β=0.881,p<0.05)and CSA(β=0.667,p<0.01)could positively predict the score of impulse control difficulties(IMPULSE);CEN(β=-1.787,p<0.001)and CPN(β=-1.012,p<0.05)could negatively predict the score of life satisfaction;CSA(β=-0.760,p<0.05)could negatively predict the age of first drug use;CSA(β=-0.935,p<0.001)could negatively predict the age of first sexual behavior.CSA(OR=2.044,95%CI:1.432～2.916)was a risk factor for high average frequency of MA use.CSA(β=0.080,p<0.01)and CEN(β=0.079,p<0.05)could positively predict the score of willingness to quit drug use.After adjusting for factors of general demographics,the numbers of CM could significantly predict the scores of depressive symptoms(β=1.518,p<0.001),the scores of AWARENESS(β=0.383,p<0.001),the scores of IMPULSE(β=0.205,p=0.009),the scores of life satisfaction(β=-1.057,p<0.001),the age of first sexual behavior(β=-0.161,p=0.004)and the scores of willingness to quit drug use(β=0.042,p<0.001).The results suggested that there may be a dose-response relationship between CM experience and mentioned variables previously.4.This study explored the path models of the relationship of CM types and depressive symptoms,average frequency of MA use and willingness to quit drug use.The results showed that IMPULSE played significant partial mediator roles between CSA and depressive symptoms(mediating effect value=0.182,95%CI:0.091～0.283);life satisfaction played significant partial mediator roles between CEN and depressive symptoms(mediating effect value=0.182,95%CI:0.091～0.283);the mediating or moderating effects between CSA and MA use frequency were not found in this study.IMPULSE(mediating effect value=0.026,95%CI:0.007～0.055),depressive symptoms(mediating effect value=0.091,95%CI:0.051～0.141)and life satisfaction(mediation effect value=0.023,95%CI:0.007～0.049)played significant complete mediator roles between CEA and willingness to quit drug use.IMPULSE and depressive symptoms(mediation effect value=0.034,95%CI:0.019～0.055)as well as life satisfaction and depression(mediation effect value=0.011,95%CI:0.005～0.020)played significant the chain mediator roles between CEA and willingness to quit drug use.AWARENESS(mediating effect value=0.022,95%CI:0.006～0.041),depressive symptoms(mediating effect value=0.036,95%CI:0.019～0.060)and life satisfaction(mediating effect value=0.018,95%CI:0.002～0.037)played significant partial mediator roles between CEN and willingness to quit drug use.Life satisfaction and depressive symptoms(mediating effect value=0.008,95%CI:0.004～0.016)played significant the chain mediator roles between CEN and willingness to quit drug use.ConclusionsChildhood maltreatment and depressive symptoms of patients with methamphetamine use disorder should be paid attention.Childhood maltreatment is related to depressive symptoms,emotional adjustment disorder and life satisfaction of drug users;childhood maltreatment is related to drug use behaviors such as age of first drug use,average frequency of MA use and age of first sexual behavior of drug users.CSA can play a direct role and also play an indirect role in depressive symptoms through emotional regulation disorder.CEN can play a direct role and also play an indirect role in depressive symptoms through life satisfaction.CEA and CEN can affect the willingness to quit drug use through emotional dysregulation,depressive symptoms and life satisfaction.