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Background: Mental health problems are common among illicit drug users. However, the interrelationship between depression and heroin use and the associated factors has not been fully investigated in Asian populations. This study explores the prevalence of current major depression and associated factors among heroin users receiving methadone maintenance treatment (MMT) in Taiwan. Methods: This case-control study included 583 heroin users entering the MMT program at Tsaotun Psychiatric Center in Taiwan. Socio-demographic characteristics, heroin-related problems and prevalence of major depression were assessed. The participants were divided into a depressive group and a non-depressive group. Multivariate logistic regression was used to identify the relationship between the variables and current major depression. Results: One-third (33%) of the participants reported current major depression. Severity of heroin dependence, needle sharing behavior, anxiety, lifetime suicide attempts, poor family support, and non-drug related criminal record were found to be independently associated with current major depression. Conclusion: In addition to the serious morbidity of major depression itself, other serious problems were related to depression. It is suggested that maintenance programs should screen patients for depression and provide appropriate psychiatric services to treat depression. [ABSTRACT FROM PUBLISHER]