Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Silverman, Michael S.

2nd Supervisor

Coleman, Brenda L.

Affiliation

Sinai Health, Toronto

Co-Supervisor

Abstract

Methamphetamine and associated health service use are rising globally, with psychiatric complications that may impact women and men differently. However, there are no recent population-level estimates of mental health and addictions (MHA) service use among methamphetamine users. This thesis explores the relationship between methamphetamine use and MHA service use across Ontario from 2017 to 2019 by identifying methamphetamine users through drug screen results and identifies differences in psychiatric health service use between women and men who use methamphetamine. Service use was higher in people with a positive test compared to those with a negative test, sex affected the relationship between methamphetamine use and MHA service use differently across psychiatric diagnostic categories, and men were at higher risk of MHA ED visits and hospitalizations compared to women. Sex did not affect the risk of outpatient visits or length of hospitalization. These findings can guide health system planning and harm reduction efforts.

Summary for Lay Audience

Methamphetamine is a stimulant with significant health harms and its use is on the rise in Canada and internationally. This is also accompanied by a rise in mental health and addictions (MHA) service use for methamphetamine-related harms, including psychiatric complications such as depression and psychosis. Furthermore, evidence suggests that psychiatric complications of methamphetamine users can vary by sex, with authors of studies reporting that women who use methamphetamine may experience higher levels of mood and anxiety disorders, whereas more men may experience psychotic disorders. However, no studies report population-level findings on the rates of MHA service use associated with methamphetamine in Ontario and whether sex affects the rate of use. Therefore, this thesis aimed to understand: 1) the rate of mental health service use – including outpatient visits, ED visits, hospitalizations, and diagnostic categories 2) effect modification by sex on the rates of MHA service use, and 3) the sociodemographic and clinical factors associated with MHA use and total length of inpatient stay, within 12 months following a positive methamphetamine screen. Ontarians who had a methamphetamine/amphetamine urine/serum screen in 2017 or 2018 were identified through the Ontario Laboratory Information System (OLIS), a database with lab results for patients across Ontario. These individuals were included in the cohort and followed for 365 days to determine their rate of MHA service use, and for women and men in the cohort separately. Overall, service use was higher in people with a positive test compared to those with a negative test. Sex was identified as an effect modifier in the relationship between methamphetamine use and MHA service use across different psychiatric diagnostic categories. Men were at higher risk of MHA ED visits and hospitalizations compared to women. Sex did not affect the risk of outpatient visits or length of hospitalization. More information is needed on the effect of other sociodemographic on service use, including rurality and income quintile. These findings highlight the need for more research on the needs of methamphetamine users to guide health programming and interventions for harm reduction.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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