Spatial clustering of codeine use and its association with depression: a geospatial analysis of nationally representative South African data
Nyoni; Cuadros, DF; Gibbs, A; et al.Tanser, F; Slotow, R; Burns, JK; Tomita, A
Date: 15 November 2022
Article
Journal
Journal of Affective Disorders Reports
Publisher
Elsevier
Publisher DOI
Abstract
Background
There is an alarming trend in sub-Saharan Africa in the use of codeine-containing pharmaceuticals, but its risk of common comorbidities, such as mental health, remains unquantified at a national-level. We investigated the relationship between codeine use and onset of depression in South Africa at a population-level.
Methods
We ...
Background
There is an alarming trend in sub-Saharan Africa in the use of codeine-containing pharmaceuticals, but its risk of common comorbidities, such as mental health, remains unquantified at a national-level. We investigated the relationship between codeine use and onset of depression in South Africa at a population-level.
Methods
We used nationally representative panel data from the South Africa National Income Dynamic Study to investigate the relationship between exposure to codeine use in the community (i.e. residing in a codeine hotspot) and onset of depression. Geographical hotspots of codeine use were identified using Kulldorff spatial scan statistic in SaTScan. We quantified depression onset at Wave 5 (year 2017) between individuals residing inside and outside a codeine hotspot who were depression-free at enrolment (Wave 4: 2015) using generalised estimating equation (GEE) regression models.
Results
We identified four statistically significant hotspots of codeine use, mostly located at the northern part of the country. Among 13,020 participants who were depression-free at enrolment, residing within a codeine use hotspot was significantly associated with higher subsequent onset of depression (aRR=1.21, 95% CI:1.08-1.44).
Limitations
Data on diagnosis of depressive disorder were not available.
Conclusion
South Africa, a resource scarce nation with chronically limited mental health services, is not spared from the global opioid epidemic and its impact on depression. Targeted scale-up access to agonist therapy to effectively treat (opioid) addiction in communities at risk for high exposure to codeine use could reduce the risk of subsequent mental health challenges.
Psychology
Faculty of Health and Life Sciences
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Except where otherwise noted, this item's licence is described as © 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).