Seasonal Mental Health Symptoms Amongst Former Criminal Legal System-Involved Adolescents.

Patient trust in healthcare providers (PTP) contributes to effective healthcare delivery. It plays a vital role in shaping health behaviors (), determining treatment adherence (; ), and improving treatment outcomes (; ). When patients trust their providers, they are more likely to engage in care () and follow medical recommendations (; ). This is particularly crucial for chronic conditions, including substance use disorders (SUD), where treatment requires long-term commitment and ongoing engagement with healthcare professionals (; ). PTP is shaped by a range of factors at different levels (; ; ). At individual level, patients’ sociodemographic characteristics such as age (≥30 years), being male, or self-employed occupations have been shown to be associated with lower PTP (). Beyond individual characteristics, existing literature indicates that poor communication and limited engagement from healthcare providers significantly associate with PTP () and contribute to treatment noncompliance (; ). Conversely, respectful, consistent, and empathetic communication fosters a stronger therapeutic relationship () and reduces the risk of unsafe self-managing treatment (). In methadone treatment settings, for example, negative provider attitudes toward people who use drugs can limit patient-provider interaction and reflect broader stigma in healthcare, further eroding PTP (; ). Organizational factors, such as service quality and provider workload, also shape the environment in which PTP develops. High-quality services contribute to stronger PTP (), whereas heavy workloads could impair patient-provider interaction () and ultimately weaken PTP. Alongside service quality, social support from healthcare providers also plays a vital role in fostering PTP by helping patients feel understood, cared for, and supported throughout their healthcare experience (). Methadone Maintenance Treatment (MMT) has been one of the most widely used opioid substitution treatments globally (), with substantial evidence indicating its effectiveness in reducing illicit opioid use, decreasing criminal activities, and improving social functioning and quality of life among patients (; ). However, recent trends point to an increasing prevalence of methamphetamine use, including the co-use of methamphetamine and opioids (UNODC, 2015n.d.; ). The co-use of methamphetamine and opioids is associated with increased clinical complexity and elevated risks of negative health outcomes, including overdose and comorbid physical health conditions (; ). Polysubstance use is also linked to risky behaviors (; ) and poorer treatment outcomes (Russel et al. 2023). In addition to these clinical challenges, patients who co-use methamphetamine and heroin often experience heightened and compounded stigma within healthcare and treatment settings, including from providers and peers (). Such stigma, together with the clinical complexities associated with the co-use, may contribute to closer monitoring and more judgmental interactions, thereby straining relationships with providers and creating barriers to sustained engagement in treatment.