DAD_Dyadic .docx

Introduction: Nearly one in three adults with opioid use disorder (OUD) has co-occurring depression or anxiety. Pervasive stigma towards medication for OUD has been identified as a barrier to OUD treatment initiation and retention, but whether stigma also complicates patient mental health outcomes remains unclear. Methods: We analyzed longitudinal, dyadic data (n = 356 dyads) from a cohort of patients receiving buprenorphine from community health centers in California, who were accompanied by support persons (e.g., partner, family member, friend). We assessed how changes in support persons’ stigmatizing attitudes towards buprenorphine were associated with patients’ depressive and anxiety symptoms at 3-month follow-up using ordinary least squares regression models. To aid in clinical interpretability, we used logistic regression models to estimate the probability of clinically significant depressive and anxiety symptoms at 3-month follow-up. Results: Support persons’ changes in stigmatizing attitudes towards buprenorphine were significantly associated with patients’ depressive (χ2= 10.95, P = 0.012) and anxiety (χ2 = 14.40, P = 0.002) symptoms at follow-up, adjusted for patients’ sociodemographic characteristics and baseline symptoms. Patients whose support person reported increased stigma towards buprenorphine had the highest estimated probability of clinically significant depressive (36.7 % [95 % CI: 21.2, 52.1]) and anxiety symptoms (33.3 % [95 % CI: 18.7, 47.9]). Conclusions: Stigmatizing attitudes towards buprenorphine held by patients’ loved ones were associated with worse depression and anxiety outcomes. Interventions are needed to address the stigma towards MOUD among support persons; these interventions may also improve the mental health and wellbeing of patients with OUD.