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<p>Persons who inject drugs (PWID) commonly have adverse childhood experiences (ACEs) as well as substance use disorder (SUD). ACEs have been linked to psychological distress, which might affect the adoption of harmful behaviors like drug addiction. This study aims to determine the potential mediational role of psychological distress between ACEs and SUD moderated by gender among PWID living in Northeast Georgia. Data were collected from adult (≥ 18 years) HIV-negative PWID attending community-based organizations in Athens, Georgia during February-December 2023 (<i>n</i> = 172). Psychological distress was measured using the 6-item Kessler-6 scale, ACEs with the 11-item ACEs scale, and SUD with the 11-item Drug Use Disorder Identification Test. Moderated mediation analysis was performed using R. Mean scores for ACEs, distress, and SUD were 4.0 (Standard deviation (SD): 3.2, range:0–11), 13.0 (SD: 7.1, range: 0–24), and 28.7 (SD; 7.9, range: 7–42), respectively. In the adjusted model, ACEs were positively associated with distress (β = 0.44; <i>p</i> = 0.008), and distress was positively associated with SUD (β = 0.47; <i>p</i> &lt; 0.001). Although the adjusted direct effect of ACEs was not significantly associated with SUD (β = 0.02, <i>p</i> = 0.904), the indirect effect of ACEs on SUD through distress was statistically significant (β = 0.21, <i>p</i> = 0.016). Women had higher distress (β = 5.06, <i>p</i> &lt; 0.001), while among men, the indirect effect of ACEs on SUD through distress was significant (β = 0.28, <i>p</i> &lt; 0.001). These findings indicate that psychological distress mediates the relationship between ACEs and SUD among PWID and highlight gender-specific differences that may require targeted interventions to reduce SUD effectively.</p>

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Gender Differences in Adverse Childhood Experiences, Psychological Distress, and Substance Use Disorder Among Persons who Inject Drugs in Northeast Georgia, USA: A Moderated Mediation Analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月10日

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  • Samantha Clinton,
  • Deborah Shomuyiwa,
  • Golam Sarwar,
  • Liyuan Wang,
  • Tamora A. Callands,
  • Nathan B. Hansen,
  • Mohammad Rifat Haider

摘要

Persons who inject drugs (PWID) commonly have adverse childhood experiences (ACEs) as well as substance use disorder (SUD). ACEs have been linked to psychological distress, which might affect the adoption of harmful behaviors like drug addiction. This study aims to determine the potential mediational role of psychological distress between ACEs and SUD moderated by gender among PWID living in Northeast Georgia. Data were collected from adult (≥ 18 years) HIV-negative PWID attending community-based organizations in Athens, Georgia during February-December 2023 (n = 172). Psychological distress was measured using the 6-item Kessler-6 scale, ACEs with the 11-item ACEs scale, and SUD with the 11-item Drug Use Disorder Identification Test. Moderated mediation analysis was performed using R. Mean scores for ACEs, distress, and SUD were 4.0 (Standard deviation (SD): 3.2, range:0–11), 13.0 (SD: 7.1, range: 0–24), and 28.7 (SD; 7.9, range: 7–42), respectively. In the adjusted model, ACEs were positively associated with distress (β = 0.44; p = 0.008), and distress was positively associated with SUD (β = 0.47; p < 0.001). Although the adjusted direct effect of ACEs was not significantly associated with SUD (β = 0.02, p = 0.904), the indirect effect of ACEs on SUD through distress was statistically significant (β = 0.21, p = 0.016). Women had higher distress (β = 5.06, p < 0.001), while among men, the indirect effect of ACEs on SUD through distress was significant (β = 0.28, p < 0.001). These findings indicate that psychological distress mediates the relationship between ACEs and SUD among PWID and highlight gender-specific differences that may require targeted interventions to reduce SUD effectively.