A Survey of Psychological Symptoms and Brief Cognitive Assessment Among Methadone Clinic Patients in Yunnan Province

A Survey of Psychological Symptoms and Brief Cognitive Assessment Among Methadone Clinic Patients in Yunnan Province | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article A Survey of Psychological Symptoms and Brief Cognitive Assessment Among Methadone Clinic Patients in Yunnan Province Wen Yang, Xiao Luo, Ke Bi, Yuansen Li, Xuan Fan, Xingyu Liu, Yu Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6716335/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Cognitive and psychological impairments are commonly found among heroin-dependent individuals receiving methadone maintenance treatment (MMT). This study investigates the screening methods and influencing factors of cognitive and psychological impairments in this population, aiming to improve treatment adherence and social functioning in MMT patients. Methods In a cross-sectional study conducted from December 2022-December 2023, a total of 293 valid questionnaires were collected and included in the study.The Yunnan Province MMT outpatient clinic conducted a questionnaire survey, which included general sociological data, the SCL-90 (90-item Self-rating Scale for Symptoms) questionnaire to investigate psychological status, the MMSE (Mini-Mental State Examination) scale to assess cognitive function, and an analysis of the factors affecting the psychological cognition of the patients. The analyses were based in part on conventional statistical testing (t-test, χ 2 -test,and Binary logistic regression). Results ( 1 )In our sample, the prevalence of cognitive impairment was 52.2%, with a prevalence of depressive symptoms at 64.8% and anxiety symptoms at 54.3%; ( 2 )Influencing factors of cognitive impairment in MMT patients with different characteristics: age level differences was statistically significant. (P < 0.05); ( 3 ) The SCL-90 scale of MMT patients showed a statistically significant difference in the nine factors of mental symptoms compared with the Chinese positive normal mode (P < 0.001); ( 4 )The factors affecting depression of MMT patients with different characteristics were statistically different: whether they lived alone (P < 0.05). Conclusion A significant proportion of Chinese patients undergoing MMT experience depression, anxiety, and cognitive impairments during the course of treatment. It is necessary to provide timely and effective psychological interventions for this high-risk population and control the influencing factors. Biological sciences/Psychology Health sciences/Health care Cognitive impairment Anxiety Depression individuals who used drugs Methadone maintenance treatment Background The World Health Organization (WHO) identifies alcohol, tobacco, and heroin as among the most toxic substances, contributing significantly to the global burden of disease and drug-related mortality( 1 ). Published in 2024, the 2023 China Drug Situation Report reveals a current heroin user count of 305,000 in China( 2 ).The "Golden Triangle," comprising Myanmar (formerly Burma), Laos, and Thailand, continues to be a major source of illicit drugs entering China. This region's extensive history of opium production, along with its geographical proximity to Yunnan Province, plays a crucial role in the drug dynamics affecting China’s drug abuse challenges. We acknowledge substance use disorders as a chronic and relapsing brain disorder, characterized by compulsive drug-seeking and usage behaviors despite awareness of the associated adverse consequences( 3 ). Individuals who engage in drug use frequently become entrapped in a detrimental cycle of "drug use-detoxification-relapse-struggle-abstinence," which exacerbates harm to the body, resulting in damage to the nervous system( 4 , 5 ), the onset of neuropsychiatric disorders, significant detriments to both the physical and mental health of patients( 6 , 7 ), and an increased disease burden( 8 ) . In recent years, heroin use in China has been steadily decreasing due to the continuous efforts of anti-drug and drug rehabilitation work. Heroin use in 2023 decreased by 26.7% compared to 2022( 2 ). Heroin emerged as the dominant illicit drug during the late 1990s, prompting the implementation of numerous interventions to address the issue, including MMT( 11 ). Methadone is a long-acting synthetic opioid agonist that prevents opioid-related withdrawal( 12 ), China launched the MMT program in 2003 as a key component of harm reduction strategies. By 2019, there were over 680 methadone therapy centers in China, serving about 300,000 MMT patients( 13 ).Despite achieving significant success, the MMT program still faces numerous challenges, such as poor treatment adherence, low retention rates, low quality of life, and prominent psychological issues( 14 , 15 ). Studies show that heroin addiction relapse is very common and the high prevalence of depression and suicidality in substance-dependent individuals (if untreated) will induce patient relapse and increase the risk of overdose( 9 ).The relapse rate of heroin abusers within one month after quitting drug use is 54.57%. The relapse rate from the first to the third month accounts for 31.76%, while within the first six months it reaches 93.31%. Within the first year, the relapse rate amounts to 96.68%( 10 ). According to current research,Methadone users who experience long-term co-occurring depression, anxiety, and cognitive impairment face a serious risk of significantly impaired social functioning,cognitive dysfunction in patients with MMT is associated with depression and anxiety( 16 ). The majority of patients undergoing MMT tend to persist in engaging in unhealthy lifestyle behaviors, which consequently leads to considerable physical and mental health morbidity( 17 – 20 ).Studies indicate that prolonged heroin consumption can result in cognitive impairments, which may link to the psychological and cognitive status observed in individuals attending MMT clinics( 21 , 22 ). Depression, a prevalent, costly, and debilitating condition, is associated with an elevated risk of suicide and represents one of the foremost global public health challenges ( 23 ).The WHO estimates that depression will affect 5% of adults globally in 2023. Depression is associated with severe outcomes, including an increased risk of suicide( 24 ). Individuals with substance dependence are particularly susceptible to depressive disorders, which in turn can exacerbate substance dependence( 25 ). This cyclical relationship can severely impair social functioning, adversely affect both physical and mental health, and contribute to a heightened social and economic burden. Symptoms of anxiety disorders include excessive worry, social and performance-related fears, unexpected or situational panic attacks, anticipatory anxiety, and avoidance behaviors( 26 ).Anxiety disorders are associated with increased health care utilization and reduced quality of life and functioning( 27 ). A bidirectional relationship exists between mood disorders, such as depression and anxiety, and substance abuse( 28 , 29 ). Patients with comorbid mood disorders and substance use disorders are also at an elevated risk of suicide( 30 ). Previous studies have revealed a significant prevalence of depression, anxiety, and Post-Traumatic Stress Disorder (PTSD) among heroin users and those with other addictive disorders, a condition that is associated with poorer treatment outcomes and a worse prognosis( 31 ). These findings underscore the importance of identifying and addressing psychiatric issues in heroin users, as the effective treatment of co-morbid mental illnesses may enhance the prognosis of heroin use disorders. Clinically, cognitive decline can hinder the response to addiction treatment and elevate dropout rates. Even after the cessation of drug abuse, cognitive decline can remain irreversible( 32 ). Despite MMT widespread use, there are still some challenges, such as severe dependency, depression, and anxiety( 33 ). Many patients with MMT suffer from mental health problems, including depression and anxiety( 34 , 35 ). Numerous previous studies have demonstrated that chronic heroin users, including those enrolled in MMT and those who are abstinently formerly dependent, exhibit impaired visual memory, working memory, impulsivity, and compulsivity( 16 , 36 – 38 ).Furthermore, research indicates that MMT significantly contributes to the occurrence of depression( 39 ). There is a strong correlation between high suicide rates and anxiety among MMT patients( 13 ).A considerable proportion of methadone maintenance treatment clients in China have experienced depression and anxiety during treatment( 40 ). Cognitive impairments, anxiety, and depression are frequently observed psychological symptoms in individuals undergoing MMT for heroin dependence. However, the risk factors contributing to these symptoms in MMT patients have not been thoroughly studied or characterized in existing literature. This study employs a self-designed questionnaire to examine the current status and influencing factors of cognition, anxiety, and depression among MMT patients. Consequently, the objective of this research is to assess the prevalence of cognitive impairment, depression, and anxiety in MMT outpatients in Yunnan. METHODS Participants A total of 298 questionnaires were randomly collected from 10 methadone clinics in Yunnan Province, China. Five questionnaires were excluded due to incomplete responses. Participants received a remuneration of 100 Chinese Yuan after completing the questionnaire. The average duration of heroin use was 19.08 ± 8.17 years, while the average duration of methadone maintenance treatment was 9.39 ± 6.11 years.The inclusion criteria were :(a) meeting the DSM-5(The diagnostic and statistical manual of mental disorders,DSM) diagnostic classification criteria for substance abuse, (b) first-time participation in the Psychiatric Cognitive Scale survey, (c) age 18–70, (d) consent to participate in the program and signed informed consent. The exclusion criteria are :(a) serious physical illness; (b) presence of a psycho-neurological disorder prior to exposure to heroin.This study has been approved by the Ethics Committee of the First Affiliated Hospital of Kunming Medical University (Ethical Approval Number: 2012-1-2) and strictly adheres to the relevant ethical guidelines established by the Ethics Committee.We guarantee the privacy and data security of all participants. All participant information is anonymized and used only for research purposes.We adhere to the provisions of the Declaration of Helsinki and relevant laws and regulations in China, ensuring that the study complies with all relevant ethical principles.Before participating in the study, all participants received a detailed explanation of the study's purpose, procedures, risks, and benefits.Participants were informed of their right to refuse to participate in the study and to withdraw at any stage of the study.All participants signed informed consent forms voluntarily and after fully understanding the study's contents. Materials Investigation contents: Trained professional investigators (including sociology professionals and psychiatrists) will conduct a self-prepared structured questionnaire for MMT patients. The survey included MMT patients' general personal data, disease history and drug use history, personal life history, drug abuse, drug craving, psychological status, and cognitive status. Survey Tools: SCL-90 (90-item Self-rating Scale for Symptoms), MMSE (Mini-Mental State Examination), and SCL-90 scale were fully explained by the investigator and then filled in by the MMT patients themselves. For example, the MMT patients with low education levels or illiteracy were asked item by item by the investigator. The MMT patients were told the meaning of the question in a neutral way without any hint or bias. The MMSE is evaluated by investigators. The SCL-90 is a widely used self-report instrument for assessing clinical psychiatric symptoms and mental health status( 41 ).In the SCL-90, healthy people are distinguished from mentally ill patients( 42 ).SCL-90 includes 90 items for 9 factors (somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia, psychosis, and others), Each item on the scale was measured on a five-point Likert scale, with 1–5 representing the severity of the symptoms as follows: “1 = from no”, “2 = light”, “3 = moderate”, “4 = quite heavy”, and “5 = severe”. Thus, a higher score reflected a higher frequency and intensity of symptoms. If the total score is more than 160, or the number of positive items is more than 43, or the score of any factor is more than 2 points, positive screening should be considered. After evaluating the results of the SCL-90 questionnaire, we further analyze the levels of depression and anxiety. Based on the scores obtained from the depression and anxiety subscales of the SCL-90. The MMSE is a widely used assessment tool in clinical and research settings for evaluating cognitive impairment( 43 ). The total score of MMSE was 30 points, including seven cognitive domains (time orientation, place orientation, immediate memory, attention and computation,delayed memory, language, and visual space). There are 30 questions in total, with 1 point for each correct answer and 0 points for each wrong answer or unknown answer. The total score ranges from 0 to 30 points, and less than 27 points indicates cognitive dysfunction. The severity of cognitive impairment is classified as follows: 0–9 points: severe dementia; 10–20 points: moderate dementia; Score 21–26: Mild cognitive impairment. Procedure All participants were informed about the general nature of the survey and that it would take no more than one hour to complete. Upon arriving at the interview room individually, they were assured of confidentiality and provided with informed consent. We administered a self-compiled, structured questionnaire to all participants. First, all participants were asked to complete a demographic questionnaire, followed by the SCL-90 and MMSE tests. Each participant was accompanied by a psychiatrist who provided explanations and instructions on the answering criteria before the SCL-90 and MMSE scales were administered. The SCL-90 was completed independently by the participants, while the MMSE was administered by the psychiatrist. After the completion of the questionnaire, two medical staff members reviewed and controlled the collected questionnaires, excluding 5 incomplete questionnaires. Data diagnostics Statistical Analysis All data were input by two people to ensure the correct input of the results, and then imported into SPSS26.0 statistical analysis software for data analysis.Participant characteristics were described as number and percent for categorical variables and mean and standard deviation for continuous variables. Comparisons of the incidence rates of different characteristics among MMT patients were conducted using the chi-square test. Binary logistic regression analysis was performed using a stepwise variable selection method to identify the factors influencing cognitive and psychological disorders in MMT patients, with a significance level of α = 0.05. Results Patient characteristics Basic Characteristics and drug use characteristi survey MMT patients 293 cases signed informed consent and completed valid questionnaires before the survey. Table 1 Cognitive and psychological characteristics Cognitive Status of the MMT patients In the test, there were 153 cases (52.2%) of cognitive impairment, among which 137 cases were mild (46.8%), 16 cases were moderate (5.5%), and 0 cases were severe.Table 2 shows that the age factor significantly contributes to cognitive impairment in MMT patients(P<0.05).Table 3 Investigation on Psychological Status of MMT patients In the MMT patients, SCL-90 was compared with the norm of the normal population in China(n = 1388)( 44 ), and the 9 factors of mental state showed significant statistical differences compared with the normal population(P<0.001).Table 4 There were 190 cases (64.8%) of depressive symptoms and 159 cases (54.3%) of anxiety symptoms.Table 5 Shows that living alone significantly influences the development of depressive disorders in MMT patients(P<0.05).Table 6 Discussion Our research findings suggest that cognitive impairments, depression, and anxiety are prevalent health concerns among patients undergoing MMT. Despite the substantial therapeutic benefits of MMT as a substitution therapy for heroin dependence, the cognitive and mental health of these patients continue to warrant significant attention. Our survey of MMT clinics demonstrated that patients experience considerable impairments in social functioning, with 76.1% of the patient population being unemployed. A comprehensive examination of their income sources indicated that the majority of individuals depend on government assistance or familial support to maintain their livelihoods. This underscores the necessity of developing strategies to enhance social functioning among these patients, identifying and addressing risk factors that contribute to impaired social functioning, and facilitating their reintegration into society. Historical patterns of heroin use among MMT patients reveal recurrent cycles of relapse and withdrawal. Despite the implementation of MMT as a substitution therapy, urine screenings identified 11 cases of patients testing positive for heroin. An investigation into the underlying reasons for their initial heroin use indicated that 66.1% of patients initiated use due to curiosity, while 22.2% were influenced by external factors. These findings suggest that individual characteristics, psychological factors, and environmental influences significantly contribute to substance dependency. Consequently, it is imperative to conduct a more comprehensive analysis of the personality traits, personal developmental histories, and cultural contexts associated with these patients.Moreover, patients undergoing MMT exhibit elevated prevalence rates of HIV (22.2%) and Hepatitis C Virus (HCV) infections (49.8%). The correlation between injection drug use and the acquisition and transmission of HIV and HCV may explain this phenomenon( 45 ). Cross-sectional surveys offer valuable insights into the comorbidity of additional diseases among MMT patients, revealing that 25.6% suffer from hypertension and 2.7% from diabetes. The relatively low detection rates of other diseases suggest a lack of awareness regarding their health conditions and an absence of routine health check-ups among MMT patients. This makes it even more important to take a combined approach to managing the health of MMT patients. This should include regular medical checks as well as education and treatment for infectious diseases. Substance abuse not only disrupts and impairs typical learning and memory processes but also diminishes the capacity for self-regulation regarding substance use( 46 ). Cognitive impairment can result in a significant decline in patients' cognitive abilities and adherence to treatment, thereby adversely affecting therapeutic outcomes. Currently, there is a paucity of cognitive research focusing on patients undergoing MMT. A review of the literature indicates that individuals with methadone dependence often experience cognitive dysfunction, including deficits in visuospatial memory and chronic impairments in working memory( 47 ). The Montreal Cognitive Assessment (MoCA) scale was utilized to evaluate the cognitive function of patients undergoing methadone treatment who exhibited significant cognitive impairment( 48 ). Research indicates that patients receiving MMT demonstrate deficits in cognitive prospective memory, sustained attention, and response inhibition( 49 ).In this study, an evaluation of cognitive function using the MMSE was conducted on 293 patients undergoing Methadone Maintenance Treatment at an MMT clinic. The findings revealed that approximately 52.2% of these patients exhibited cognitive dysfunction. Furthermore, age was identified as a risk factor for cognitive impairment, corroborating previous research that recognized age as a significant factor influencing cognitive function.Given that cognitive dysfunction may result in impaired social functioning among patients, it is imperative to assess cognitive function early in older adults. Appropriate intervention strategies should be implemented to prevent and delay further cognitive decline, enhance treatment adherence, and restore both social functioning and quality of life. Depression and Anxiety Disorders: Multiple surveys conducted on the anxiety levels of patients undergoing MMT in China revealed incidence rates of anxiety at 23.0%, 30.5%, and 33.6%, respectively( 13 , 50 ).We observed a significant disparity between the psychological status of patients undergoing MMT and the general population when administering the SCL-90 questionnaire; the incidence rates of depression and anxiety among MMT patients were 64.8% and 54.3%, respectively. Upon analyzing risk factors, it was identified that living alone constitutes a significant risk factor for depression. Living alone is a prevalent form of social isolation, which has been associated with increased rates of depression, diminished perceived health and quality of life, and heightened experiences of loneliness, as reported by several authors( 51 , 52 ).Our statistical analysis indicated that 66.2% of the 293 patients diagnosed with MMT were living alone, with 75.3% of this group being unemployed. These findings suggest that a substantial proportion of these patients may be experiencing social isolation. Social isolation is a critical factor that can contribute to substance dependence and deteriorating mental health. It serves as a catalyst for adverse outcomes, including relapse, increased substance use, and both fatal and non-fatal overdoses, as well as exacerbation of mental health symptoms.The rehabilitation of individuals with substance dependence is contingent upon social interactions, in-person services and support groups, as well as access to resources necessary for sustaining mental health recovery( 53 ). Individuals residing in regions characterized by lower levels of social isolation and residential stability exhibit an elevated risk of substance dependence( 54 ). Research utilizing a rat model has demonstrated that symptoms of depression and anxiety tend to escalate during MMT; however, a stimulating living environment can mitigate the incidence of depression and anxiety associated with MMT( 55 ). Positive life experiences and stress-reducing interventions may inhibit the onset of drug addiction( 56 ). Additionally, peer-facilitated activities have the potential to enhance the mental health of patients undergoing MMT, thereby mitigating the risk of anxiety and depression( 57 ). To mitigate the risk of depression and anxiety disorders among heroin and drug-dependent patients, as well as to prevent the exacerbation of substance dependence associated with these mental health issues and the subsequent negative impacts on physical and mental well-being, it is essential to enhance patients' social interpersonal communication. This can be achieved by strengthening social connections, providing a supportive living environment, and facilitating access to community resources, including volunteers and medical rehabilitation personnel, to promote social engagement and activities. Furthermore, our research indicates that individuals undergoing MMT exhibit significantly elevated rates of smoking and alcohol consumption. A survey conducted among MMT patients in Shanghai, China, revealed a 30.9% prevalence of alcohol use disorder( 58 ).Those MMT patients who consume alcohol are frequently confronted with adverse outcomes and health-related risks, including drug overdose, liver complications (notably hepatitis C and cirrhosis), and issues associated with methadone use, such as respiratory depression( 59 ), which can lead to impaired cognitive function( 60 ). Patients undergoing MMT who drink alcohol at the same time have worse clinical outcomes, such as higher relapse rates and shorter survival rates. It also greatly lowers their quality of life, especially when it comes to social functioning( 61 ). Furthermore, studies indicate that over 75% of individuals diagnosed with opioid use disorder are also cigarette smokers ( 62 ). Smoking represents a prevalent comorbid health risk among individuals undergoing addiction treatment, with significantly higher smoking rates compared to the general population. Notably, between 85% and 98% of individuals engaged in MMT are smokers. This population is at an elevated risk for tobacco-related diseases, exhibiting a mortality rate four times greater than that of smokers not receiving MMT( 63 , 64 ). Alcohol and smoking are also forms of substance dependence. Our survey revealed that the prevalence of smoking among MMT patients is 93.5%, while the prevalence of alcohol consumption is 34.5%. Prior clinical research has established a correlation between smoking and alcohol use and an elevated incidence of mental health disorders. The manifestation of anxiety and depression may be concomitant with issues of substance dependence, which further exacerbates the detrimental effects on both physical and mental health, ultimately resulting in suboptimal treatment outcomes. Consequently, patients undergoing MMT may exhibit increased challenges related to substance dependence. In managing and monitoring these individuals within clinical community hospital settings, it is imperative to consider the severity of their dependence issues. Prompt interventions should be implemented, including the provision of health education, smoking and alcohol cessation programs, social support networks, mutual aid groups, and alternative exercise initiatives. Conclusions Patients diagnosed with MMT frequently exhibit cognitive impairments and psychological abnormalities, with depression and anxiety being particularly prevalent mental disorders that substantially impact their social functioning and exacerbate their social burden. Consequently, it is imperative to conduct screenings for cognitive and mental disorders in this patient population and to implement early interventions targeting the risk factors associated with these conditions, such as Cognitive Behavioral Therapy (CBT)( 65 , 66 ),and Educational and Behavioral Counseling(EBC)( 67 ).Psychotherapy has the potential to enhance adherence to MMT while simultaneously improving the mental health and cognitive status of MMT patients, thereby contributing to disease prevention. For older MMT patients with lower educational attainment, cognitive therapy should be administered to delay and prevent the progression of cognitive impairment. Additionally, patients who live alone should receive social support to facilitate interpersonal communication and participation in social group activities, thereby promoting their integration into society. Furthermore, patients who smoke or consume alcohol should be encouraged to modify these behaviorsmplement pharmacological interventions to address smoking and alcohol consumption. Engage in smoking cessation and alcohol withdrawal support groups, as well as other intervention strategies, to mitigate substance dependence. This approach aims to decrease the prevalence of depression and anxiety by addressing risk factors, thereby restoring patients' social functioning and enhancing their physical and mental well-being. This study possesses several limitations that warrant consideration in subsequent research endeavors. Firstly, the reliance on self-reported questionnaires introduces potential biases, including recall bias, social desirability bias, and subjective bias. Secondly, the utilization of a cross-sectional design precludes the establishment of temporal causality, thereby inhibiting the ability to discern whether specific factors are direct causes or consequences of cognitive impairment or psychological issues. Future research could benefit from employing a diverse array of data collection methods, such as interviews or observations, to corroborate the findings derived from self-reported questionnaires. Abbreviations MMT Methadone Maintenance Treatment SCL-90 90-item Self-rating Scale for Symptoms MMSE Mini-Mental State Examination DSM The diagnostic and statistical manual of mental disorders WHO World Health Organization PTSD Post-Traumatic Stress Disorder HIV Human Immunodeficiency Virus HCV Hepatitis C Virus MoCA Montreal Cognitive Assessment Declarations Acknowledgements Not applicable. Authors’contributions Yang Wen: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources Luo Xiao, Bi Ke, Li Yuansen: Data Curation, Formal Analysis, Methodology Fan Xuan, Liu Xingyu: Data Curation, Formal Analysis, Investigation Xu Yu: Conceptualization, Funding Acquisition, Supervision Authors’information 1.Yunnan University,Kunming,China 2.Yunnan Drug Dependence Treatment Innovation Center,Kunming,China 3.The First People's Hospital of Yunnan Province,Kunming,China 4.Kunming Medical University,Kunming,China Availability of data and materials Data sets used and/or analyzed during the current study are available from corresponding authors upon reasonable request. Ethics approval and consent to participate The entire protocol and recruitment process of this study have been approved by the Research Committee of the First Affiliated Hospital (2021-1-2). All participants provided written informed consent before enrollment. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details Yunnan Drug Dependence Treatment Innovation Center, Yunnan University, South Outer Ring Road, Chenggong District, Kunming City, Yunnan Province, 650500 Funding This research project was supported by the following funding sources: Yunnan Provincial Drug Dependence Treatment Technology Innovation Center (Grant No. 202305AK340001), and Kunming University of Science and Technology Medical Joint Special Fund (Grant No. KUST-KH2023010Y). References Peacock A, Leung J, Larney S, Colledge S, Hickman M, Rehm J, et al. Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction. 2018;113(10):1905-26. Commission TOotCNNC. The 2023 China Report on the Drug Situation. China Anti-Drug Journal. 2024;3. Koob GF, Kandel DB, Baler RD, Volkow ND. Neurobiology of Addiction. 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Impulsivity and opioid drugs: differential effects of heroin, methadone and prescribed analgesic medication. Psychological Medicine. 2014;45(6):1167-79. Tolomeo S, Matthews K, Steele D, Baldacchino A. Compulsivity in opioid dependence. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2018;81:333-9. Tolomeo S, Gray S, Matthews K, Steele JD, Baldacchino A. Multifaceted impairments in impulsivity and brain structural abnormalities in opioid dependence and abstinence. Psychological Medicine. 2016;46(13):2841-53. Peles E, Schreiber S, Naumovsky Y, Adelson M. Depression in methadone maintenance treatment patients: Rate and risk factors. Journal of Affective Disorders. 2007;99(1-3):213-20. Yin W, Pang L, Cao X, McGoogan JM, Liu M, Zhang C, et al. Factors associated with depression and anxiety among patients attending community‐based methadone maintenance treatment in China. Addiction. 2014;110(S1):51-60. Derogatis LR, Lipman RS, Covi L. 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Effects of Opioid Dependence on Visuospatial Memory and Its Associations With Depression and Anxiety. Front Psychiatry. 2019;10:743. Zeng T, Li S, Wu L, Feng Z, Fan X, Yuan J, et al. A Comparison Study of Impulsiveness, Cognitive Function, and P300 Components Between Gamma-Hydroxybutyrate and Heroin-Addicted Patients: Preliminary Findings. Front Hum Neurosci. 2022;16:835922. Redžepagić Š, Ladas AI. Prospective Memory, Sustained Attention and Response Inhibition in Poly-Substance Users Stable on Methadone Maintenance Treatment. Substance Use & Misuse. 2023;58(3):397-405. C. J. Stam WdH, 2 A. Daffertshofer,3 B. F. Jones,4 I. Manshanden,1 A. M. van Cappellen van Walsum,5,6 T. Montez,7 J. P. A. Verbunt,1,8 J. C. de Munck,8 B. W. van Dijk,1,8 H. W. Berendse2 and P. Scheltens2. Graph theoretical analysis of magnetoencephalographic functional connectivity in Alzheimer’s disease. Brain 2009;132:213-4. Sok SR, Yun EK. A comparison of physical health status, self-esteem, family support and health-promoting behaviours between aged living alone and living with family in Korea. J Clin Nurs. 2011;20(11-12):1606-12. Joutsenniemi K, Martelin T, Martikainen P, Pirkola S, Koskinen S. Living arrangements and mental health in Finland. J Epidemiol Community Health. 2006;60(6):468-75. Jeffers A, Meehan AA, Barker J, Asher A, Montgomery MP, Bautista G, et al. Impact of Social Isolation during the COVID-19 Pandemic on Mental Health, Substance Use, and Homelessness: Qualitative Interviews with Behavioral Health Providers. Int J Environ Res Public Health. 2022;19(19). Yang TC, Shoff C, Shaw BA, Strully K. Neighborhood characteristics and opioid use disorder among older Medicare beneficiaries: An examination of the role of the COVID-19 pandemic. Health Place. 2023;79:102941. Lari M, Miladi-Gorji H, Najafi M, Rezaei AM. Environmental Enrichment Ameliorates Psychological Dependence Symptoms and Voluntary Morphine Consumption in Morphine Withdrawn Rats Under Methadone Maintenance Treatment. Basic Clin Neurosci. 2021;12(5):607-16. Solinas M, Thiriet N, Chauvet C, Jaber M. Prevention and treatment of drug addiction by environmental enrichment. Prog Neurobiol. 2010;92(4):572-92. Abrantes AM, Van Noppen D, Bailey G, Uebelacker LA, Buman M, Stein MD. A Feasibility Study of a Peer-Facilitated Physical Activity Intervention in Methadone Maintenance. Ment Health Phys Act. 2021;21. Gong Y, Zhang L, Long J, Wu Q, Zhang J, Bao J, et al. Feasibility of a Brief Intervention to Decrease Harmful Alcohol Use Among Methadone Maintenance Treatment Clients in Shanghai: A Randomized Controlled Trial. Journal of Addiction Medicine. 2023;17(3):294-9. Staiger PK, Richardson B, Long CM, Carr V, Marlatt GA. Overlooked and underestimated? Problematic alcohol use in clients recovering from drug dependence. Addiction. 2012;108(7):1188-93. Kleykamp BA, Vandrey RG, Bigelow GE, Strain EC, Mintzer MZ. Effects of methadone plus alcohol on cognitive performance in methadone-maintained volunteers. The American Journal of Drug and Alcohol Abuse. 2015;41(3):251-6. Senbanjo R, Wolff K, Marshall J. Excessive alcohol consumption is associated with reduced quality of life among methadone patients. Addiction. 2006;102(2):257-63. Guydish J, Passalacqua E, Tajima B, Chan M, Chun J, Bostrom A. Smoking Prevalence in Addiction Treatment: A Review. Nicotine & Tobacco Research. 2011;13(6):401-11. Jennifer G . Clarke MD, Michael D. Stein, M.D., Kelly A. McGarry, M.D., Aruna Gogineni, Ph.D. Interest in Smoking Cessation Among Injection Drug Users. The American Journal on Addictions 2001;10:159-66. de Dios MA, Anderson BJ, Caviness CM, Stein MD. Early Quit Days Among Methadone-Maintained Smokers in a Smoking Cessation Trial. Nicotine & Tobacco Research. 2014;16(11):1463-9. Magill M, Ray L, Kiluk B, Hoadley A, Bernstein M, Tonigan JS, et al. A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. J Consult Clin Psychol. 2019;87(12):1093-105. Wen H, Xiang X, Jiang Y, Zhang H, Zhang P, Chen R, et al. Comparative efficacy of psychosocial interventions for opioid-dependent people receiving methadone maintenance treatment: A network meta-analysis. Addiction. 2023;118(6):1029-39. Liu P, Song R, Zhang Y, Liu C, Cai B, Liu X, et al. Educational and Behavioral Counseling in a Methadone Maintenance Treatment Program in China: A Randomized Controlled Trial. Front Psychiatry. 2018;9:113. Tables Tables 1 to 6 are available in the Supplementary Files section Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6716335","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":492958676,"identity":"f72a5dee-aa0c-438c-9e3f-8742b6686cf5","order_by":0,"name":"Wen Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYBADHn725gMHEiok5OSJ1SIj2XMs8cCDMxbGhg1EarExuJGjfPBhW0UiwwECSg2Onz38mqfiDo/BmTMMBxLnSSQwNjA/fHQDn5YzeWnWPGee8Uge7z1wIHGbRB47A5uxcQ4+LQdyzIxz2w7z8J05lwDSUszYwMMmjVfL+TdALf8O8zDcyDE4kDhHIrHhACEtN3KMH+c2HOYRAGtpIEKL5I03Zsx/jh3mAQZywoGEYxLGhs0E/MJ3Psf444yaw/bAqDz88UdNnZw8e/PDx/i0KBxgYJNAFWLGoxwE5BsYmD8QUDMKRsEoGAUjHQAAyVxY5dbZpSQAAAAASUVORK5CYII=","orcid":"","institution":"The First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Wen","middleName":"","lastName":"Yang","suffix":""},{"id":492958678,"identity":"9f2fad29-1176-4f65-b257-62120b9912d4","order_by":1,"name":"Xiao Luo","email":"","orcid":"","institution":"First Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Luo","suffix":""},{"id":492958679,"identity":"a055f75d-2777-4b76-bbd4-380010933d69","order_by":2,"name":"Ke Bi","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ke","middleName":"","lastName":"Bi","suffix":""},{"id":492958681,"identity":"50e504ee-f32a-4681-a738-d617bb85f4d7","order_by":3,"name":"Yuansen Li","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yuansen","middleName":"","lastName":"Li","suffix":""},{"id":492958682,"identity":"de4f4c7e-0fa7-46e6-b079-6c023f839fb5","order_by":4,"name":"Xuan Fan","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xuan","middleName":"","lastName":"Fan","suffix":""},{"id":492958683,"identity":"9d1c7615-f024-4632-abdb-50ecc5f2149b","order_by":5,"name":"Xingyu Liu","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xingyu","middleName":"","lastName":"Liu","suffix":""},{"id":492958686,"identity":"9d69bb14-012c-445d-9297-00988a4e416c","order_by":6,"name":"Yu Xu","email":"","orcid":"","institution":"First Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2025-05-21 12:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6716335/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6716335/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104781953,"identity":"0de0a46a-9c84-40f5-91c0-167f81616ec6","added_by":"auto","created_at":"2026-03-17 07:56:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":456929,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6716335/v1/d1ed7e20-c517-40f1-8e4e-15afd82b3d35.pdf"},{"id":87987524,"identity":"f8bc8518-2f2e-490e-a57b-8683b2e4e341","added_by":"auto","created_at":"2025-07-31 07:41:43","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":57239,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6716335/v1/393192504509e27daf639dc6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Survey of Psychological Symptoms and Brief Cognitive Assessment Among Methadone Clinic Patients in Yunnan Province","fulltext":[{"header":"Background","content":"\u003cp\u003eThe World Health Organization (WHO) identifies alcohol, tobacco, and heroin as among the most toxic substances, contributing significantly to the global burden of disease and drug-related mortality(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Published in 2024, the 2023 China Drug Situation Report reveals a current heroin user count of 305,000 in China(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).The \"Golden Triangle,\" comprising Myanmar (formerly Burma), Laos, and Thailand, continues to be a major source of illicit drugs entering China. This region's extensive history of opium production, along with its geographical proximity to Yunnan Province, plays a crucial role in the drug dynamics affecting China\u0026rsquo;s drug abuse challenges. We acknowledge substance use disorders as a chronic and relapsing brain disorder, characterized by compulsive drug-seeking and usage behaviors despite awareness of the associated adverse consequences(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Individuals who engage in drug use frequently become entrapped in a detrimental cycle of \"drug use-detoxification-relapse-struggle-abstinence,\" which exacerbates harm to the body, resulting in damage to the nervous system(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), the onset of neuropsychiatric disorders, significant detriments to both the physical and mental health of patients(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), and an increased disease burden(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) .\u003c/p\u003e\u003cp\u003eIn recent years, heroin use in China has been steadily decreasing due to the continuous efforts of anti-drug and drug rehabilitation work. Heroin use in 2023 decreased by 26.7% compared to 2022(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Heroin emerged as the dominant illicit drug during the late 1990s, prompting the implementation of numerous interventions to address the issue, including MMT(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Methadone is a long-acting synthetic opioid agonist that prevents opioid-related withdrawal(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), China launched the MMT program in 2003 as a key component of harm reduction strategies. By 2019, there were over 680 methadone therapy centers in China, serving about 300,000 MMT patients(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).Despite achieving significant success, the MMT program still faces numerous challenges, such as poor treatment adherence, low retention rates, low quality of life, and prominent psychological issues(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStudies show that heroin addiction relapse is very common and the high prevalence of depression and suicidality in substance-dependent individuals (if untreated) will induce patient relapse and increase the risk of overdose(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).The relapse rate of heroin abusers within one month after quitting drug use is 54.57%. The relapse rate from the first to the third month accounts for 31.76%, while within the first six months it reaches 93.31%. Within the first year, the relapse rate amounts to 96.68%(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). According to current research,Methadone users who experience long-term co-occurring depression, anxiety, and cognitive impairment face a serious risk of significantly impaired social functioning,cognitive dysfunction in patients with MMT is associated with depression and anxiety(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The majority of patients undergoing MMT tend to persist in engaging in unhealthy lifestyle behaviors, which consequently leads to considerable physical and mental health morbidity(\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).Studies indicate that prolonged heroin consumption can result in cognitive impairments, which may link to the psychological and cognitive status observed in individuals attending MMT clinics(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDepression, a prevalent, costly, and debilitating condition, is associated with an elevated risk of suicide and represents one of the foremost global public health challenges (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).The WHO estimates that depression will affect 5% of adults globally in 2023. Depression is associated with severe outcomes, including an increased risk of suicide(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Individuals with substance dependence are particularly susceptible to depressive disorders, which in turn can exacerbate substance dependence(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This cyclical relationship can severely impair social functioning, adversely affect both physical and mental health, and contribute to a heightened social and economic burden. Symptoms of anxiety disorders include excessive worry, social and performance-related fears, unexpected or situational panic attacks, anticipatory anxiety, and avoidance behaviors(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).Anxiety disorders are associated with increased health care utilization and reduced quality of life and functioning(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA bidirectional relationship exists between mood disorders, such as depression and anxiety, and substance abuse(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Patients with comorbid mood disorders and substance use disorders are also at an elevated risk of suicide(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Previous studies have revealed a significant prevalence of depression, anxiety, and Post-Traumatic Stress Disorder (PTSD) among heroin users and those with other addictive disorders, a condition that is associated with poorer treatment outcomes and a worse prognosis(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). These findings underscore the importance of identifying and addressing psychiatric issues in heroin users, as the effective treatment of co-morbid mental illnesses may enhance the prognosis of heroin use disorders. Clinically, cognitive decline can hinder the response to addiction treatment and elevate dropout rates. Even after the cessation of drug abuse, cognitive decline can remain irreversible(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite MMT widespread use, there are still some challenges, such as severe dependency, depression, and anxiety(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Many patients with MMT suffer from mental health problems, including depression and anxiety(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Numerous previous studies have demonstrated that chronic heroin users, including those enrolled in MMT and those who are abstinently formerly dependent, exhibit impaired visual memory, working memory, impulsivity, and compulsivity(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).Furthermore, research indicates that MMT significantly contributes to the occurrence of depression(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). There is a strong correlation between high suicide rates and anxiety among MMT patients(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).A considerable proportion of methadone maintenance treatment clients in China have experienced depression and anxiety during treatment(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCognitive impairments, anxiety, and depression are frequently observed psychological symptoms in individuals undergoing MMT for heroin dependence. However, the risk factors contributing to these symptoms in MMT patients have not been thoroughly studied or characterized in existing literature. This study employs a self-designed questionnaire to examine the current status and influencing factors of cognition, anxiety, and depression among MMT patients. Consequently, the objective of this research is to assess the prevalence of cognitive impairment, depression, and anxiety in MMT outpatients in Yunnan.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eA total of 298 questionnaires were randomly collected from 10 methadone clinics in Yunnan Province, China. Five questionnaires were excluded due to incomplete responses. Participants received a remuneration of 100 Chinese Yuan after completing the questionnaire. The average duration of heroin use was 19.08\u0026thinsp;\u0026plusmn;\u0026thinsp;8.17 years, while the average duration of methadone maintenance treatment was 9.39\u0026thinsp;\u0026plusmn;\u0026thinsp;6.11 years.The inclusion criteria were :(a) meeting the DSM-5(The diagnostic and statistical manual of mental disorders,DSM) diagnostic classification criteria for substance abuse, (b) first-time participation in the Psychiatric Cognitive Scale survey, (c) age 18\u0026ndash;70, (d) consent to participate in the program and signed informed consent. The exclusion criteria are :(a) serious physical illness; (b) presence of a psycho-neurological disorder prior to exposure to heroin.This study has been approved by the Ethics Committee of the First Affiliated Hospital of Kunming Medical University (Ethical Approval Number: 2012-1-2) and strictly adheres to the relevant ethical guidelines established by the Ethics Committee.We guarantee the privacy and data security of all participants. All participant information is anonymized and used only for research purposes.We adhere to the provisions of the Declaration of Helsinki and relevant laws and regulations in China, ensuring that the study complies with all relevant ethical principles.Before participating in the study, all participants received a detailed explanation of the study's purpose, procedures, risks, and benefits.Participants were informed of their right to refuse to participate in the study and to withdraw at any stage of the study.All participants signed informed consent forms voluntarily and after fully understanding the study's contents.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMaterials\u003c/h3\u003e\n\u003cp\u003eInvestigation contents: Trained professional investigators (including sociology professionals and psychiatrists) will conduct a self-prepared structured questionnaire for MMT patients. The survey included MMT patients' general personal data, disease history and drug use history, personal life history, drug abuse, drug craving, psychological status, and cognitive status.\u003c/p\u003e\u003cp\u003eSurvey Tools: SCL-90 (90-item Self-rating Scale for Symptoms), MMSE (Mini-Mental State Examination), and SCL-90 scale were fully explained by the investigator and then filled in by the MMT patients themselves. For example, the MMT patients with low education levels or illiteracy were asked item by item by the investigator. The MMT patients were told the meaning of the question in a neutral way without any hint or bias. The MMSE is evaluated by investigators.\u003c/p\u003e\u003cp\u003eThe SCL-90 is a widely used self-report instrument for assessing clinical psychiatric symptoms and mental health status(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).In the SCL-90, healthy people are distinguished from mentally ill patients(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).SCL-90 includes 90 items for 9 factors (somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia, psychosis, and others), Each item on the scale was measured on a five-point Likert scale, with 1\u0026ndash;5 representing the severity of the symptoms as follows: \u0026ldquo;1\u0026thinsp;=\u0026thinsp;from no\u0026rdquo;, \u0026ldquo;2\u0026thinsp;=\u0026thinsp;light\u0026rdquo;, \u0026ldquo;3\u0026thinsp;=\u0026thinsp;moderate\u0026rdquo;, \u0026ldquo;4\u0026thinsp;=\u0026thinsp;quite heavy\u0026rdquo;, and \u0026ldquo;5\u0026thinsp;=\u0026thinsp;severe\u0026rdquo;. Thus, a higher score reflected a higher frequency and intensity of symptoms. If the total score is more than 160, or the number of positive items is more than 43, or the score of any factor is more than 2 points, positive screening should be considered. After evaluating the results of the SCL-90 questionnaire, we further analyze the levels of depression and anxiety. Based on the scores obtained from the depression and anxiety subscales of the SCL-90.\u003c/p\u003e\u003cp\u003eThe MMSE is a widely used assessment tool in clinical and research settings for evaluating cognitive impairment(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). The total score of MMSE was 30 points, including seven cognitive domains (time orientation, place orientation, immediate memory, attention and computation,delayed memory, language, and visual space). There are 30 questions in total, with 1 point for each correct answer and 0 points for each wrong answer or unknown answer. The total score ranges from 0 to 30 points, and less than 27 points indicates cognitive dysfunction. The severity of cognitive impairment is classified as follows: 0\u0026ndash;9 points: severe dementia; 10\u0026ndash;20 points: moderate dementia; Score 21\u0026ndash;26: Mild cognitive impairment.\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eAll participants were informed about the general nature of the survey and that it would take no more than one hour to complete. Upon arriving at the interview room individually, they were assured of confidentiality and provided with informed consent. We administered a self-compiled, structured questionnaire to all participants. First, all participants were asked to complete a demographic questionnaire, followed by the SCL-90 and MMSE tests. Each participant was accompanied by a psychiatrist who provided explanations and instructions on the answering criteria before the SCL-90 and MMSE scales were administered. The SCL-90 was completed independently by the participants, while the MMSE was administered by the psychiatrist. After the completion of the questionnaire, two medical staff members reviewed and controlled the collected questionnaires, excluding 5 incomplete questionnaires.\u003c/p\u003e\n\u003ch3\u003eData diagnostics\u003c/h3\u003e\n\u003cp\u003eStatistical Analysis All data were input by two people to ensure the correct input of the results, and then imported into SPSS26.0 statistical analysis software for data analysis.Participant characteristics were described as number and percent for categorical variables and mean and standard deviation for continuous variables. Comparisons of the incidence rates of different characteristics among MMT patients were conducted using the chi-square test. Binary logistic regression analysis was performed using a stepwise variable selection method to identify the factors influencing cognitive and psychological disorders in MMT patients, with a significance level of α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003ePatient characteristics\u003c/h2\u003e\n \u003cp\u003eBasic Characteristics and drug use characteristi survey MMT patients 293 cases signed informed consent and completed valid questionnaires before the survey. Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eCognitive and psychological characteristics\u003c/h3\u003e\n\u003cp\u003eCognitive Status of the MMT patients In the test, there were 153 cases (52.2%) of cognitive impairment, among which 137 cases were mild (46.8%), 16 cases were moderate (5.5%), and 0 cases were severe.Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows that the age factor significantly contributes to cognitive impairment in MMT patients(P\u0026lt;0.05).Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e Investigation on Psychological Status of MMT patients In the MMT patients, SCL-90 was compared with the norm of the normal population in China(n\u0026thinsp;=\u0026thinsp;1388)(\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e), and the 9 factors of mental state showed significant statistical differences compared with the normal population(P\u0026lt;0.001).Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e There were 190 cases (64.8%) of depressive symptoms and 159 cases (54.3%) of anxiety symptoms.Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e Shows that living alone significantly influences the development of depressive disorders in MMT patients(P\u0026lt;0.05).Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur research findings suggest that cognitive impairments, depression, and anxiety are prevalent health concerns among patients undergoing MMT. Despite the substantial therapeutic benefits of MMT as a substitution therapy for heroin dependence, the cognitive and mental health of these patients continue to warrant significant attention. Our survey of MMT clinics demonstrated that patients experience considerable impairments in social functioning, with 76.1% of the patient population being unemployed. A comprehensive examination of their income sources indicated that the majority of individuals depend on government assistance or familial support to maintain their livelihoods. This underscores the necessity of developing strategies to enhance social functioning among these patients, identifying and addressing risk factors that contribute to impaired social functioning, and facilitating their reintegration into society. Historical patterns of heroin use among MMT patients reveal recurrent cycles of relapse and withdrawal. Despite the implementation of MMT as a substitution therapy, urine screenings identified 11 cases of patients testing positive for heroin. An investigation into the underlying reasons for their initial heroin use indicated that 66.1% of patients initiated use due to curiosity, while 22.2% were influenced by external factors. These findings suggest that individual characteristics, psychological factors, and environmental influences significantly contribute to substance dependency. Consequently, it is imperative to conduct a more comprehensive analysis of the personality traits, personal developmental histories, and cultural contexts associated with these patients.Moreover, patients undergoing MMT exhibit elevated prevalence rates of HIV (22.2%) and Hepatitis C Virus (HCV) infections (49.8%). The correlation between injection drug use and the acquisition and transmission of HIV and HCV may explain this phenomenon(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Cross-sectional surveys offer valuable insights into the comorbidity of additional diseases among MMT patients, revealing that 25.6% suffer from hypertension and 2.7% from diabetes. The relatively low detection rates of other diseases suggest a lack of awareness regarding their health conditions and an absence of routine health check-ups among MMT patients. This makes it even more important to take a combined approach to managing the health of MMT patients. This should include regular medical checks as well as education and treatment for infectious diseases.\u003c/p\u003e\u003cp\u003eSubstance abuse not only disrupts and impairs typical learning and memory processes but also diminishes the capacity for self-regulation regarding substance use(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Cognitive impairment can result in a significant decline in patients' cognitive abilities and adherence to treatment, thereby adversely affecting therapeutic outcomes. Currently, there is a paucity of cognitive research focusing on patients undergoing MMT. A review of the literature indicates that individuals with methadone dependence often experience cognitive dysfunction, including deficits in visuospatial memory and chronic impairments in working memory(\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). The Montreal Cognitive Assessment (MoCA) scale was utilized to evaluate the cognitive function of patients undergoing methadone treatment who exhibited significant cognitive impairment(\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Research indicates that patients receiving MMT demonstrate deficits in cognitive prospective memory, sustained attention, and response inhibition(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e).In this study, an evaluation of cognitive function using the MMSE was conducted on 293 patients undergoing Methadone Maintenance Treatment at an MMT clinic. The findings revealed that approximately 52.2% of these patients exhibited cognitive dysfunction. Furthermore, age was identified as a risk factor for cognitive impairment, corroborating previous research that recognized age as a significant factor influencing cognitive function.Given that cognitive dysfunction may result in impaired social functioning among patients, it is imperative to assess cognitive function early in older adults. Appropriate intervention strategies should be implemented to prevent and delay further cognitive decline, enhance treatment adherence, and restore both social functioning and quality of life.\u003c/p\u003e\u003cp\u003eDepression and Anxiety Disorders: Multiple surveys conducted on the anxiety levels of patients undergoing MMT in China revealed incidence rates of anxiety at 23.0%, 30.5%, and 33.6%, respectively(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).We observed a significant disparity between the psychological status of patients undergoing MMT and the general population when administering the SCL-90 questionnaire; the incidence rates of depression and anxiety among MMT patients were 64.8% and 54.3%, respectively. Upon analyzing risk factors, it was identified that living alone constitutes a significant risk factor for depression. Living alone is a prevalent form of social isolation, which has been associated with increased rates of depression, diminished perceived health and quality of life, and heightened experiences of loneliness, as reported by several authors(\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e).Our statistical analysis indicated that 66.2% of the 293 patients diagnosed with MMT were living alone, with 75.3% of this group being unemployed. These findings suggest that a substantial proportion of these patients may be experiencing social isolation. Social isolation is a critical factor that can contribute to substance dependence and deteriorating mental health. It serves as a catalyst for adverse outcomes, including relapse, increased substance use, and both fatal and non-fatal overdoses, as well as exacerbation of mental health symptoms.The rehabilitation of individuals with substance dependence is contingent upon social interactions, in-person services and support groups, as well as access to resources necessary for sustaining mental health recovery(\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). Individuals residing in regions characterized by lower levels of social isolation and residential stability exhibit an elevated risk of substance dependence(\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Research utilizing a rat model has demonstrated that symptoms of depression and anxiety tend to escalate during MMT; however, a stimulating living environment can mitigate the incidence of depression and anxiety associated with MMT(\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). Positive life experiences and stress-reducing interventions may inhibit the onset of drug addiction(\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). Additionally, peer-facilitated activities have the potential to enhance the mental health of patients undergoing MMT, thereby mitigating the risk of anxiety and depression(\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). To mitigate the risk of depression and anxiety disorders among heroin and drug-dependent patients, as well as to prevent the exacerbation of substance dependence associated with these mental health issues and the subsequent negative impacts on physical and mental well-being, it is essential to enhance patients' social interpersonal communication. This can be achieved by strengthening social connections, providing a supportive living environment, and facilitating access to community resources, including volunteers and medical rehabilitation personnel, to promote social engagement and activities.\u003c/p\u003e\u003cp\u003eFurthermore, our research indicates that individuals undergoing MMT exhibit significantly elevated rates of smoking and alcohol consumption. A survey conducted among MMT patients in Shanghai, China, revealed a 30.9% prevalence of alcohol use disorder(\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e).Those MMT patients who consume alcohol are frequently confronted with adverse outcomes and health-related risks, including drug overdose, liver complications (notably hepatitis C and cirrhosis), and issues associated with methadone use, such as respiratory depression(\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e), which can lead to impaired cognitive function(\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). Patients undergoing MMT who drink alcohol at the same time have worse clinical outcomes, such as higher relapse rates and shorter survival rates. It also greatly lowers their quality of life, especially when it comes to social functioning(\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e). Furthermore, studies indicate that over 75% of individuals diagnosed with opioid use disorder are also cigarette smokers (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e). Smoking represents a prevalent comorbid health risk among individuals undergoing addiction treatment, with significantly higher smoking rates compared to the general population. Notably, between 85% and 98% of individuals engaged in MMT are smokers. This population is at an elevated risk for tobacco-related diseases, exhibiting a mortality rate four times greater than that of smokers not receiving MMT(\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). Alcohol and smoking are also forms of substance dependence. Our survey revealed that the prevalence of smoking among MMT patients is 93.5%, while the prevalence of alcohol consumption is 34.5%. Prior clinical research has established a correlation between smoking and alcohol use and an elevated incidence of mental health disorders. The manifestation of anxiety and depression may be concomitant with issues of substance dependence, which further exacerbates the detrimental effects on both physical and mental health, ultimately resulting in suboptimal treatment outcomes. Consequently, patients undergoing MMT may exhibit increased challenges related to substance dependence. In managing and monitoring these individuals within clinical community hospital settings, it is imperative to consider the severity of their dependence issues. Prompt interventions should be implemented, including the provision of health education, smoking and alcohol cessation programs, social support networks, mutual aid groups, and alternative exercise initiatives.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003ePatients diagnosed with MMT frequently exhibit cognitive impairments and psychological abnormalities, with depression and anxiety being particularly prevalent mental disorders that substantially impact their social functioning and exacerbate their social burden. Consequently, it is imperative to conduct screenings for cognitive and mental disorders in this patient population and to implement early interventions targeting the risk factors associated with these conditions, such as Cognitive Behavioral Therapy (CBT)(\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e),and Educational and Behavioral Counseling(EBC)(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e).Psychotherapy has the potential to enhance adherence to MMT while simultaneously improving the mental health and cognitive status of MMT patients, thereby contributing to disease prevention. For older MMT patients with lower educational attainment, cognitive therapy should be administered to delay and prevent the progression of cognitive impairment. Additionally, patients who live alone should receive social support to facilitate interpersonal communication and participation in social group activities, thereby promoting their integration into society. Furthermore, patients who smoke or consume alcohol should be encouraged to modify these behaviorsmplement pharmacological interventions to address smoking and alcohol consumption. Engage in smoking cessation and alcohol withdrawal support groups, as well as other intervention strategies, to mitigate substance dependence. This approach aims to decrease the prevalence of depression and anxiety by addressing risk factors, thereby restoring patients' social functioning and enhancing their physical and mental well-being.\u003c/p\u003e\u003cp\u003eThis study possesses several limitations that warrant consideration in subsequent research endeavors. Firstly, the reliance on self-reported questionnaires introduces potential biases, including recall bias, social desirability bias, and subjective bias. Secondly, the utilization of a cross-sectional design precludes the establishment of temporal causality, thereby inhibiting the ability to discern whether specific factors are direct causes or consequences of cognitive impairment or psychological issues. Future research could benefit from employing a diverse array of data collection methods, such as interviews or observations, to corroborate the findings derived from self-reported questionnaires.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMMT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMethadone Maintenance Treatment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSCL-90\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e90-item Self-rating Scale for Symptoms\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMMSE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMini-Mental State Examination\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDSM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eThe diagnostic and statistical manual of mental disorders\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePTSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePost-Traumatic Stress Disorder\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHCV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHepatitis C Virus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMoCA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMontreal Cognitive Assessment\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors’contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eYang Wen: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Resources\u003c/p\u003e\n\u003cp\u003eLuo Xiao, Bi Ke, Li Yuansen: Data Curation, Formal Analysis, Methodology\u003c/p\u003e\n\u003cp\u003eFan Xuan, Liu Xingyu: Data Curation, Formal Analysis, Investigation\u003c/p\u003e\n\u003cp\u003eXu Yu: Conceptualization, Funding Acquisition, Supervision\u003c/p\u003e\n\u003cp\u003eAuthors’information\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.Yunnan University,Kunming,China\u003c/p\u003e\n\u003cp\u003e2.Yunnan Drug Dependence Treatment Innovation Center,Kunming,China\u003c/p\u003e\n\u003cp\u003e3.The First People's Hospital of Yunnan Province,Kunming,China\u003c/p\u003e\n\u003cp\u003e4.Kunming Medical University,Kunming,China\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData sets used and/or analyzed during the current study are available from corresponding authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe entire protocol and recruitment process of this study have been approved by the Research Committee of the First\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAffiliated Hospital (2021-1-2). All participants provided written informed consent before enrollment.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthor details\u003c/p\u003e\n\u003cp\u003eYunnan Drug Dependence Treatment Innovation Center, Yunnan University, South Outer Ring Road, Chenggong District, Kunming City, Yunnan Province, 650500\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research project was supported by the following funding sources: Yunnan Provincial Drug Dependence Treatment Technology Innovation Center (Grant No. 202305AK340001), \u0026nbsp;and Kunming University of Science and Technology Medical Joint Special Fund (Grant No. KUST-KH2023010Y).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePeacock A, Leung J, Larney S, Colledge S, Hickman M, Rehm J, et al. 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Front Psychiatry. 2018;9:113.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 6 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cognitive impairment, Anxiety, Depression, individuals who used drugs, Methadone maintenance treatment","lastPublishedDoi":"10.21203/rs.3.rs-6716335/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6716335/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCognitive and psychological impairments are commonly found among heroin-dependent individuals receiving methadone maintenance treatment (MMT). This study investigates the screening methods and influencing factors of cognitive and psychological impairments in this population, aiming to improve treatment adherence and social functioning in MMT patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn a cross-sectional study conducted from December 2022-December 2023, a total of 293 valid questionnaires were collected and included in the study.The Yunnan Province MMT outpatient clinic conducted a questionnaire survey, which included general sociological data, the SCL-90 (90-item Self-rating Scale for Symptoms) questionnaire to investigate psychological status, the MMSE (Mini-Mental State Examination) scale to assess cognitive function, and an analysis of the factors affecting the psychological cognition of the patients. The analyses were based in part on conventional statistical testing (t-test, χ\u003csup\u003e2\u003c/sup\u003e-test,and Binary logistic regression).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)In our sample, the prevalence of cognitive impairment was 52.2%, with a prevalence of depressive symptoms at 64.8% and anxiety symptoms at 54.3%; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)Influencing factors of cognitive impairment in MMT patients with different characteristics: age level differences was statistically significant. (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) The SCL-90 scale of MMT patients showed a statistically significant difference in the nine factors of mental symptoms compared with the Chinese positive normal mode (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)The factors affecting depression of MMT patients with different characteristics were statistically different: whether they lived alone (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA significant proportion of Chinese patients undergoing MMT experience depression, anxiety, and cognitive impairments during the course of treatment. It is necessary to provide timely and effective psychological interventions for this high-risk population and control the influencing factors.\u003c/p\u003e","manuscriptTitle":"A Survey of Psychological Symptoms and Brief Cognitive Assessment Among Methadone Clinic Patients in Yunnan Province","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 07:41:39","doi":"10.21203/rs.3.rs-6716335/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c72d8ca-0135-4296-ad41-0e4d1f3e18cf","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52342893,"name":"Biological sciences/Psychology"},{"id":52342894,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2026-03-16T01:09:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-31 07:41:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6716335","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6716335","identity":"rs-6716335","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}