Severe Mental Health Conditions, Fentanyl Injection, and Severe Substance Use Disorders Are Associated with Violent Victimization Among Rural Appalachian Adults Who Inject Drugs.

Background: Despite evidence linking polyvictimization (i.e. two or more violence types such as physical assault and at least one adverse childhood experience) to substance use and mental health issues among people who inject drugs (PWID), research on its association with mental health, substance use, and socio-demographic factors among PWID remains limited.Objectives: We examined socio-demographics, mental health, and substance use factors associated with lifetime polyvictimization among PWID, focusing mainly on violent victimization, irrespective of perpetration/offending.Methods: We utilized cross-sectional data of 350 adults (169 females; 181 males) that examined the socio-ecologic factors influencing syringe service programs (SSPs) adoption among PWID in rural Appalachian Kentucky. Participant recruitment was via respondent-driven sampling (RDS) supplemented with direct community outreach. Our multivariable multinomial logistic regression examined socio-demographic, mental health, and substance use factors associated with polyvictimization.Results: Our multivariable multinomial logistic model indicated that female PWIDs were more than seven times likely to experience lifetime polyvictimization than male PWIDs (relative risk ratio or RRR = 7.49; p < .001). Additionally, PWIDs with severe symptoms of mental health disorders (MHD) in the past year were close to six times more likely to report lifetime polyvictimization (RRR = 5.88; p = .022). Those with severe substance use disorders (SUD) symptoms in the past year (RRR = 2.40; p = .035), and lifetime fentanyl injection (RRR = 2.29; p = .028), were also twice as likely to report lifetime polyvictimization.Conclusions: Tailored interventions and policies addressing complex trauma from polyvictimization, as well as comprehensive trauma-informed and gender-sensitive harm-reduction approaches, may be necessary to effectively treat SUD and related comorbidities in vulnerable PWI in rural Appalachia.