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Patrick J, Dale SK. Mental Health, Self-Care, and Engagement in Care among Black Women Living with HIV. Ethn Dis 2023; 33:116-123. [PMID: 38845736 PMCID: PMC11145728 DOI: 10.18865/ed.33.2-3.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Objectives Due to sociostructural factors, Black women living with human immunodeficiency virus (HIV) in the United States represent the highest percentage of women with HIV and experience mental health struggles that impact health behaviors. This study examines associations between mental health, self-care, medication adherence, engagement with healthcare, HIV-related healthcare visits, and hospitalization. Methods One hundred and nineteen Black women living with HIV in the Southeastern United States completed measures on scheduled visits (general and HIV-related healthcare), visits attended/missed/rescheduled, mental healthcare engagement (therapy and support groups), hospital visits (emergency room and overnight stays), medication adherence, and a clinician-administered interview assessing mental health. Results Higher self-care was associated with fewer emergency room visits (β=-0.31, P<.001) and hospitalizations (β=-0.22, P<.05). Higher post-traumatic stress disorder symptoms were associated with hospitalization (β=0.23, P<.05) and missed HIV-related visits (β=0.20, P<.05) but higher outpatient mental healthcare visits for group psychotherapy (β=0.20, P< .05). Higher suicidality was associated with lower HIV-related healthcare visits scheduled (β=-0.26, P<.01). Higher HIV load was associated with higher HIV-related healthcare visits scheduled (β=0.45, P<.001) and hospitalization (β=0.41, P<.001). Higher Wisepill medication adherence (β=-0.28, P<.01) and self-reported adherence (β=-0.33, P<.001) were associated with fewer HIV missed visits. Higher self-reported adherence was associated with fewer emergency room visits (β=-0.38, P<.001) and hospitalizations (β=-0.27, P<.001). Conclusions Our findings highlight the need for treating mental health symptoms and enhancing self-care among Black women living with HIV to improve engagement in care and health behaviors and decrease emergency room visits and hospitalization.
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Affiliation(s)
- Jordan Patrick
- Department of Psychology, University of Miami, Miami, FL
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2
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Meeder E, Matzaraki V, Vadaq N, van de Wijer L, van der Ven A, Schellekens A. Unbiased Metabolomics Links Fatty Acid Pathways to Psychiatric Symptoms in People Living with HIV. J Clin Med 2021; 10:jcm10235466. [PMID: 34884168 PMCID: PMC8658345 DOI: 10.3390/jcm10235466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022] Open
Abstract
Psychiatric symptoms are prevalent in people living with HIV (PLWH), especially depression, anxiety, impulsivity, and substance use. Various biological mechanisms might play a role in the occurrence of psychiatric symptoms in this population. A hypothesis free, data-driven metabolomics approach can further our understanding of these mechanisms. In this study, we identified metabolic pathways associated with impulsivity, depression and substance use in 157 PLWH. First, Spearman’s rank correlations between metabolite feature intensities and psychiatric symptom levels were calculated, while controlling for age, gender and body mass index. Subsequently, a mummichog pathway analysis was performed. Finally, we analyzed which individual metabolites drove the observed effects. In our cohort of PLWH, fatty acid-related pathways were associated with both depressive as well as impulsive symptomatology. Substance use showed most extensive metabolic associations, and was positively associated with short chain fatty acids (SCFA’s), and negatively associated with glutamate levels. These findings suggest that PUFA metabolism might be associated with both internalising and externalising symptomatology in PLWH. Furthermore, glutamate and SCFA’s—microbiome derivatives with known neuroactive properties—might be involved in substance use in these patients. Future studies should explore potential causal mechanisms involved and whether these findings are HIV-specific.
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Affiliation(s)
- Elise Meeder
- Department of Psychiatry, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 HE Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, 6525 AJ Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-648-021-927
| | - Vasiliki Matzaraki
- Department of General Internal Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (V.M.); (N.V.); (L.v.d.W.); (A.v.d.V.)
| | - Nadira Vadaq
- Department of General Internal Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (V.M.); (N.V.); (L.v.d.W.); (A.v.d.V.)
- Center for Tropical and Infectious Diseases (CENTRID), Faculty of Medicine, Diponegoro University, Dr. Kariadi Hospital, Semarang 1269, Indonesia
| | - Lisa van de Wijer
- Department of General Internal Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (V.M.); (N.V.); (L.v.d.W.); (A.v.d.V.)
| | - André van der Ven
- Department of General Internal Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (V.M.); (N.V.); (L.v.d.W.); (A.v.d.V.)
| | - Arnt Schellekens
- Department of Psychiatry, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 HE Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, 6525 AJ Nijmegen, The Netherlands
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Mathur S, Roberts-Toler C, Tassiopoulos K, Goodkin K, McLaughlin M, Bares S, Koletar SL, Erlandson KM. Detrimental Effects of Psychotropic Medications Differ by Sex in Aging People With HIV. J Acquir Immune Defic Syndr 2019; 82:88-95. [PMID: 31169770 PMCID: PMC6692226 DOI: 10.1097/qai.0000000000002100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mental health conditions are common among persons with HIV (PWH). An understanding of factors associated with prescription medication use for these conditions and clinical impact of the prescription medications may improve care of mental health disorders in PWH. METHODS Psychotropic medication use was examined among PWH within the AIDS Clinical Trials Group A5322 (HAILO) study. Multivariable logistic models and Cox regression models estimated the association between psychotropic medications (any/none) with baseline and incident slow gait (>1 s/m) and neurocognitive impairment (NCI) for more than 4 years. RESULTS Of 1035 participants, the median age was 51 years.81% were men, 30% black, non-Hispanic, and 20% Hispanic. Psychotropic medication use was similar between men (34%) and women (38%; P = 0.19). PWH using psychotropic medications had greater odds of baseline slow gait {odds ratio 1.61, [95% confidence interval (CI): 1.23 to 2.10]; P < 0.001}. Men but not women using psychotropic medications had an increased risk of developing slow gait [hazard ratio 1.85; (1.29 to 2.65) vs 0.77; (CI: 0.35 to 1.68), P interaction = 0.045]. The sex-specific odds ratios for medication use and NCI were qualitatively but not statistically different [men: 1.79; (1.14-2.80); women: 1.27; (0.56-2.90); P interaction = 0.47]. Psychotropic medication use was associated with an increased risk of incident NCI [hazard ratio 2.18; (95% CI: 1.23 to 3.84), P = 0.007] in both men and women. CONCLUSIONS Psychotropic medications are associated with impairment in functional outcomes of aging, with a greater risk of baseline NCI and incident slow gait among men. Further investigation is needed to optimize outcomes in PWH and prescription of psychotropic medications among both men and women.
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Affiliation(s)
- Swati Mathur
- University of Colorado, Department of Medicine, Aurora, CO
| | - Carla Roberts-Toler
- Harvard T. H. Chan School of Public Health, Center for Biostatistics in AIDS Research, Boston, MA
| | | | - Karl Goodkin
- East Tennessee State University, Department of Psychiatry and Behavioral Sciences, Johnson City, TN
| | - Milena McLaughlin
- Northwestern Memorial Hospital, Chicago, IL
- Midwestern University, Chicago College of Pharmacy, Downers Grove, IL
| | - Sara Bares
- University of Nebraska Medical Center, Department of Medicine, Omaha, NB
| | - Susan L. Koletar
- The Ohio State University Medical Center, Department of Medicine, Columbus, OH
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4
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George Dalmida S, Kraemer KR, Ungvary S, Di Valerio E, Koenig HG, Holstad MM. The Psychosocial and Clinical Well-Being of Women Living with Human Immunodeficiency Virus/AIDS. Nurs Clin North Am 2019; 53:203-225. [PMID: 29779514 DOI: 10.1016/j.cnur.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study examined factors impacting the psychological well-being of women living with human immunodeficiency virus/AIDS and the impact of depression on clinical outcomes. Nearly two-thirds of participants in this cross-sectional study reported significant depressive symptoms. Compared with women living with human immunodeficiency virus/AIDS without depressive symptoms, those with depression reported significantly poorer health outcomes. Health care providers should regularly screen these women for and adequately treat depression, and must collaborate with mental health providers and pastoral care counselors to address the mental health needs of women living with human immunodeficiency virus/AIDS to optimize their human immunodeficiency virus-related outcomes.
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Affiliation(s)
- Safiya George Dalmida
- University of Alabama, Capstone College of Nursing, 650 University Boulevard, Tuscaloosa, AL 35487, USA.
| | - Kyle R Kraemer
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, USA
| | - Stephen Ungvary
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, USA
| | - Elizabeth Di Valerio
- Department of Biological Sciences, University of Alabama, Box 870344, Tuscaloosa, AL 35487, USA
| | - Harold G Koenig
- Department of Psychiatry, Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710, USA; Department of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Marcia McDonnell Holstad
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA
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5
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Shadloo B, Amin-Esmaeili M, Motevalian A, Mohraz M, Sedaghat A, Gouya MM, Rahimi-Movaghar A. Psychiatric disorders among people living with HIV/AIDS in IRAN: Prevalence, severity, service utilization and unmet mental health needs. J Psychosom Res 2018; 110:24-31. [PMID: 29764602 DOI: 10.1016/j.jpsychores.2018.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND HIV and psychiatric disorders are closely correlated and are accompanied by some similar risk factors. OBJECTIVE The aim of this study was to assess psychiatric comorbidity and health service utilization for mental problems among people living with HIV/AIDS in Iran. METHODS A total of 250 cases were randomly selected from a large referral center for HIV treatment and care in Tehran, Iran. Psychiatric disorders in the past 12 months including mood, anxiety, and substance use disorders were assessed through face-to-face interview, using a validated Persian translation of the Composite International Diagnostic Interview (CIDI v2.1). Severity of psychiatric disorders, social support, socio-economic status, service utilization and HIV-related indicators were assessed. RESULTS Participants consisted of 147 men and 103 women. Psychiatric disorders were found in 50.2% (95% confidence interval: 43.8-56.6) of the participants. Major depressive disorder was the most prevalent diagnosis (32.1%), followed by substance use disorders (17.1%). In bivariate analysis, psychiatric disorders were significantly higher among male gender, single and unemployed individuals and those with lower social support. In multivariate regression analysis, only social support was independently associated with psychiatric disorders. Among those with a psychiatric diagnosis, 41.1% had used a health service for mental problems and 53% had received minimally adequate treatment. CONCLUSION The findings of the study highlight the importance of mental health services in the treatment of people living with HIV/AIDS.
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Affiliation(s)
- Behrang Shadloo
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Amin-Esmaeili
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Motevalian
- School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Sedaghat
- Iranian Center for Communicable Disease Control (CDC), Ministry of Health and Medical Education (MOHME), Tehran, Iran
| | - Mohammad Mehdi Gouya
- Iranian Center for Communicable Disease Control (CDC), Ministry of Health and Medical Education (MOHME), Tehran, Iran; School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
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Rooks-Peck CR, Adegbite AH, Wichser ME, Ramshaw R, Mullins MM, Higa D, Sipe TA. Mental health and retention in HIV care: A systematic review and meta-analysis. Health Psychol 2018; 37:574-585. [PMID: 29781655 PMCID: PMC6103311 DOI: 10.1037/hea0000606] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Mental health (MH) diagnoses, which are prevalent among persons living with HIV infection, might be linked to failed retention in HIV care. This review synthesized the quantitative evidence regarding associations between MH diagnoses or symptoms and retention in HIV care, as well as determined if MH service utilization (MHSU) is associated with improved retention in HIV care. METHOD A comprehensive search of the Centers for Disease Control and Prevention's HIV/AIDS Prevention Research Synthesis database of electronic (e.g., MEDLINE, EMBASE, PsycINFO) and manual searches was conducted to identify relevant studies published during January 2002-August 2017. Effect estimates from individual studies were pooled by using random-effects meta-analysis, and a moderator analysis was conducted. RESULTS Forty-five studies, involving approximately 57,334 participants in total, met the inclusion criteria: 39 examined MH diagnoses or symptoms, and 14 examined MHSU. Overall, a significant association existed between MH diagnoses or symptoms, and lower odds of being retained in HIV care (odds ratio, OR = 0.94; 95% confidence interval [CI] [0.90, 0.99]). Health insurance status (β = 0.004; Z = 3.47; p = .001) significantly modified the association between MH diagnoses or symptoms and retention in HIV care. In addition, MHSU was associated with an increased odds of being retained in HIV care (OR = 1.84; 95% CI [1.45, 2.33]). CONCLUSIONS Results indicate that MH diagnoses or symptoms are a barrier to retention in HIV care and emphasize the importance of providing MH treatment to HIV patients in need. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Mary M Mullins
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Darrel Higa
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Theresa Ann Sipe
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
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7
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Durbin A, Brown HK, Antoniou T, Sirotich F, Bansal S, Heifetz M, Roesslein K, Lunsky Y. Mental Health Disorders and Publicly Funded Service Use by HIV Positive Individuals: A Population-Based Cross-Sectional Study in Ontario, Canada. AIDS Behav 2017; 21:3457-3463. [PMID: 29098454 DOI: 10.1007/s10461-017-1949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We compared use of community and hospital-based mental health and addiction (MH&A) services by adults with and without HIV. This population-based study examined the probability and intensity of MH&A service use by individuals with (n = 5095) and without HIV (n = 2,753,091) in Ontario, Canada between 2013 and 2014. Adults with HIV were more likely than HIV-negative adults to use MH&A primary and psychiatric care, and to have MH&A emergency department visits and hospital admissions; they also used more of each service. Use of MH&A hospital services was particularly high for persons in the HIV group compared to the no HIV group.
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Affiliation(s)
- Anna Durbin
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Hilary K Brown
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Interdisciplinary Centre for Health and Society, University of Toronto Scarborough, Scarborough, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Frank Sirotich
- Research and Evaluation, Canadian Mental Health Association-Toronto Branch, Toronto, ON, Canada
- Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Symron Bansal
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Marina Heifetz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kay Roesslein
- LOFT Community Services/McEwan Housing & Support Services, Toronto, ON, Canada
| | - Yona Lunsky
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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8
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Relationship between ever reporting depressive symptoms and all-cause mortality in a cohort of HIV-infected adults in routine care. AIDS 2017; 31:1009-1016. [PMID: 28244956 DOI: 10.1097/qad.0000000000001431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether ever reporting depressive symptoms affects mortality in the modern HIV treatment era. DESIGN A cohort study of HIV-infected adults in routine clinical care at seven sites in the USA. METHODS We examined the effect of ever reporting depressive symptoms on all-cause mortality using data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We included individuals with at least one depression measure between 2005 and 2014. Depressive symptoms were measured with the Patient Health Questionnaire (PHQ)-9. We used weighted Kaplan-Meier curves and marginal structural Cox models with inverse probability weights to estimate the effect of ever reporting depressive symptoms (PHQ-9 ≥10) on all-cause mortality. RESULTS A total of 10 895 individuals were included. Participants were followed for a median of 3.1 years (35 621 total person-years). There were 491 (4.5%) deaths during the follow-up period (crude incidence rate 13.8/1000 person-years). At baseline, 28% of the population reported depressive symptoms. In the weighted analysis, there was no evidence that ever reporting depressive symptoms increased the hazard of all-cause mortality (hazard ratio 0.82, 95% confidence interval 0.55-1.24). CONCLUSION In a large cohort of HIV-infected adults in care in the modern treatment era, we observed no evidence that ever reporting depressive symptoms increased the likelihood of all-cause mortality, controlling for a range of time-varying factors. Antiretroviral therapy that is increasingly robust to moderate adherence and improved access to depression treatment may help to explain changes in the relationship between depressive symptoms and mortality in the modern treatment era.
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9
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Choi SKY, Boyle E, Cairney J, Collins EJ, Gardner S, Bacon J, Rourke SB. Prevalence, Recurrence, and Incidence of Current Depressive Symptoms among People Living with HIV in Ontario, Canada: Results from the Ontario HIV Treatment Network Cohort Study. PLoS One 2016; 11:e0165816. [PMID: 27802346 PMCID: PMC5089724 DOI: 10.1371/journal.pone.0165816] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/18/2016] [Indexed: 12/16/2022] Open
Abstract
Introduction Current studies of depression among people living with HIV focus on describing its point prevalence. Given the fluctuating nature of depression and its profound impacts on clinical and quality-of-life outcomes, this study aimed to examine the prevalence, recurrence and incidence of current depressive symptoms and its underlying catalysts longitudinally and systematically among these individuals. Methods We conducted a prospective cohort study between October 1, 2007 and December 31, 2012 using longitudinal linked data sources. Current depressive symptoms was identified using the Centre for Epidemiologic Studies Depression Scale or the Kessler Psychological Distress Scale, first at baseline and again during follow-up interviews. Multivariable regressions were used to characterize the three outcomes. Results Of the 3,816 HIV-positive participants, the point prevalence of depressive symptoms was estimated at 28%. Of the 957 participants who were identified with depressive symptoms at baseline and who had at least two years of follow-up, 43% had a recurrent episode. The cumulative incidence among 1,745 previously depressive symptoms free participants (at or prior to baseline) was 14%. During the five-year follow-up, our multivariable models showed that participants with greater risk of recurrent cases were more likely to feel worried about their housing situation. Participants at risk of developing incident cases were also likely to be younger, gay or bisexual, and unable to afford housing-related expenses. Conclusions Depressive symptoms are prevalent and likely to recur among people living with HIV. Our results support the direction of Ontario’s HIV/AIDS Strategy to 2026, which addresses medical concerns associated with HIV (such as depression) and the social drivers of health in order to enhance the overall well-being of people living with or at risk of HIV. Our findings reinforce the importance of providing effective mental health care and demonstrate the need for long-term support and routine management of depression, particularly for individuals at high risk.
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Affiliation(s)
- Stephanie K Y Choi
- The Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Eleanor Boyle
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - John Cairney
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Infant and Child Health Lab, McMaster University, Hamilton, Ontario, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Collins
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,University Health Network, Toronto, Ontario, Canada
| | - Sandra Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jean Bacon
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Sean B Rourke
- Ontario HIV Treatment Network, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,St. Michael's Hospital, Toronto, Ontario, Canada
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10
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Choi SKY, Boyle E, Cairney J, Gardner S, Collins EJ, Bacon J, Rourke SB. Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study. PLoS One 2016; 11:e0156652. [PMID: 27280751 PMCID: PMC4900603 DOI: 10.1371/journal.pone.0156652] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/17/2016] [Indexed: 01/06/2023] Open
Abstract
Background Major depression can profoundly impact clinical and quality-of-life outcomes of people living with HIV, and this disease is underdiagnosed and undertreated in many HIV-positive individuals. Here, we describe the prevalence of publicly funded primary and secondary mental health service use and antidepressant use, as well as mental health care for depression in accordance with existing Canadian guidelines for HIV-positive patients with depression in Ontario, Canada. Methods We conducted a prospective cohort study linking data from the Ontario HIV Treatment Network Cohort Study with administrative health databases in the province of Ontario, Canada. Current depression was assessed using the Center for Epidemiologic Depression Scale or the Kessler Psychological Distress Scale. Multivariable regressions were used to characterize prevalence outcomes. Results Of 990 HIV-positive patients with depression, 493 (50%) patients used mental health services; 182 (18%) used primary services (general practitioners); 176 (18%) used secondary services (psychiatrists); and 135 (14%) used both. Antidepressants were used by 407 (39%) patients. Patients who identified as gay, lesbian, or bisexual, as having low income or educational attainment, or as non-native English speakers or immigrants to Canada were less likely to obtain care. Of 493 patients using mental health services, 250 (51%) received mental health care for depression in accordance with existing Canadian guidelines. Conclusions Our results showed gaps in delivering publicly funded mental health services to depressed HIV-positive patients and identified unequal access to these services, particularly among vulnerable groups. More effective mental health policies and better access to mental health services are required to address HIV-positive patient needs and reduce depression’s impact on their lives.
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Affiliation(s)
- Stephanie K. Y. Choi
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- The Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eleanor Boyle
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - John Cairney
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sandra Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Evan J. Collins
- University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jean Bacon
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Sean B. Rourke
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
- * E-mail:
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11
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Associations between HIV and schizophrenia and their effect on HIV treatment outcomes: a nationwide population-based cohort study in Denmark. Lancet HIV 2015; 2:e344-50. [PMID: 26423377 DOI: 10.1016/s2352-3018(15)00089-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Associations between HIV and schizophrenia in people with and without substance use disorders and the effect on timeliness of HIV diagnosis, antiretroviral therapy (ART), and treatment outcomes are poorly understood. We aimed to assess the association between HIV and schizophrenia and the effect on HIV treatment outcomes in people with and without substance use disorders. METHODS We did a population-based cohort study with data from nationwide registries in Denmark to investigate the risk of schizophrenia after a diagnosis of HIV and the risk of HIV after a diagnosis of schizophrenia, accounting for substance misuse, timeliness of HIV diagnosis, and treatment success in relation to schizophrenia. We selected the cohort from people born in Denmark between Jan 1, 1955, and Dec 31, 1995, who we followed up from their 16th birthday or Jan 1, 1995 (whichever occurred last) until their death, emigration from Denmark, onset of schizophrenia, or Dec 31, 2011 (whichever came first). We estimated incidence rate ratios (IRRs) with Poisson and Cox regression, with adjustment for calendar period, and age and its interaction with sex. FINDINGS We identified 2,786,286 individuals, of whom we included 2,646,154 people in analyses of risk of schizophrenia diagnosis and 2,658,662 people in analyses of risk of HIV diagnosis. In 35,353,633 person-years of follow up, HIV was associated with an increased risk of schizophrenia (IRR 4·09, 95% CI 2·73-5·83) and acute psychosis (7·15, 4·45-10·8); the IRR was highest within the first year of HIV diagnosis for both disorders (8·24, 2·95-17·7 and 12·7, 3·15-32·9, respectively). Schizophrenia was not associated with an increased risk of HIV in individuals without substance misuse disorders (IRR 1·42, 95% CI 0·81-2·27). The risk of schizophrenia in individuals with HIV decreased after ART (IRR 0·53, 0·32-0·87). The risk of acute psychosis did not differ between HIV-infected individuals receiving antiretroviral regimens with and without efavirenz (IRR 0·70, 95% CI 0·32-1·54). We recorded no differences in CD4 cell counts, time to ART, or viral suppression between individuals with schizophrenia with HIV and those without schizophrenia when substance use was taken into account. Between 1999 and 2011, the mortality rate ratio comparing HIV-infected individuals with schizophrenia with HIV-negative individuals without schizophrenia was 25·8 (95% CI 18·8-34·3). INTERPRETATION Our findings emphasise the need for interventions to prevent HIV in people with schizophrenia, especially for those with substance use disorders, and for accessible mental health services for individuals with HIV. FUNDING Stanley Medical Research Institute, Lundbeck Foundation, Preben and Anna Simonsen Fund, Novo Nordisk Foundation, The Danish AIDS Foundation, and the Augustinus Foundation.
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Parhami I, Fong TW, Siani A, Carlotti C, Khanlou H. Documentation of psychiatric disorders and related factors in a large sample population of HIV-positive patients in California. AIDS Behav 2013; 17:2792-801. [PMID: 23247363 DOI: 10.1007/s10461-012-0386-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This retrospective cohort study examined electronic medical records of HIV-positive patients in California (N = 7,834) to find the prevalence of any psychiatric condition and the associations between several factors and the likelihood of these disorders. Approximately 53 % of the patients in this study had a documented psychiatric condition, including 23 % who had a mood disorder, 19 % who had a substance-related disorder, and 16 % who had an anxiety disorder. After controlling for potential confounders, significant positive associations (p < 0.001) were found between female gender and the presence of any mood disorder (adjusted odds ratio [95 % confidence interval, 95 %CI] = 1.58 [1.26-1.99]) or anxiety disorder (AOR = 1.54 [1.18-2.02]) and between homosexual orientation and the presence of any psychiatric condition (AOR = 1.33 [1.15-1.55]), mood disorder (AOR = 1.71 [1.42-2.07]), or anxiety disorder (AOR = 1.41 [1.22-1.88]). There were also significant negative associations between African-American race and the presence of any psychiatric condition (AOR = 0.68 [0.60-0.77]), mood disorder (AOR = 0.74 [0.64-0.86]), anxiety disorder (AOR = 0.43 [0.36-0.52]), or substance-related disorder (AOR = 0.78 [0.67-0.91]) and between state/federal insurance and the presence of any psychiatric condition (AOR = 0.70 [0.62-0.79]), mood disorder (AOR = 0.71 [0.62-0.80]), or anxiety disorder (AOR = 0.77 [0.66-0.89]).
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Affiliation(s)
- Iman Parhami
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA,
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Himelhoch S, Medoff D, Maxfield J, Dihmes S, Dixon L, Robinson C, Potts W, Mohr DC. Telephone based cognitive behavioral therapy targeting major depression among urban dwelling, low income people living with HIV/AIDS: results of a randomized controlled trial. AIDS Behav 2013; 17:2756-64. [PMID: 23644816 PMCID: PMC10839944 DOI: 10.1007/s10461-013-0465-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED This pilot randomized controlled trial evaluated a previously developed manualized telephone based cognitive behavioral therapy (T-CBT) intervention compared to face-to-face (f2f) therapy among low-income, urban dwelling HIV infected depressed individuals. The primary outcome was the reduction of depressive symptoms as measured by the Hamliton rating scale for depression scale. The secondary outcome was adherence to HAART as measured by random telephone based pill counts. Outcome measures were collected by trained research assistants masked to treatment allocation. Analysis was based on intention-to-treat. Thirty-four participants met eligibility criteria and were randomly assigned to receive T-CBT (n = 16) or f2f (n = 18). There was no statistically significant difference in depression treatment outcomes comparing f2f to T-CBT. Within group evaluation demonstrated that both the T-CBT and the f2f psychotherapy groups resulted in significant reductions in depressive symptoms. Those who received the T-CBT were significantly more likely to maintain their adherence to antiretroviral medication compared to the f2f treatment. None of the participants discontinued treatment due to adverse events. T-CBT can be delivered to low-income, urban dwelling HIV infected depressed individuals resulting in significant reductions in depression symptoms and improved adherence to antiretroviral medication. TRIAL REGISTRY Clinical Trial.gov identifier: NCT01055158.
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Affiliation(s)
- Seth Himelhoch
- Department of Psychiatry, Division of Services Research, University of Maryland School of Medicine, 737 West Lombard St., Room 516, Baltimore, MD, 21212, USA,
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Satre DD, DeLorenze GN, Quesenberry CP, Tsai A, Weisner C. Factors associated with treatment initiation for psychiatric and substance use disorders among persons with HIV. Psychiatr Serv 2013; 64:745-53. [PMID: 23584606 PMCID: PMC4030718 DOI: 10.1176/appi.ps.201200064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Prior studies of individuals with HIV infection have found that accessing psychiatric and substance abuse treatment when needed can improve health and prolong life, yet little is known about factors associated with treatment initiation. METHODS In a retrospective cohort design including individuals with HIV infection (≥14 years old) in an integrated health care system in Northern California, this study included 822 patients with a major psychiatric diagnosis and 1,624 with a substance use disorder diagnosis. Data were extracted from a regional HIV registry and computerized databases. RESULTS Twenty-four percent (N=198) of study patients with psychiatric diagnoses and 15% (N=245) with substance abuse or dependence received one or more specialty care visits within 12 months of diagnosis. Among patients with a psychiatric diagnosis, significant predictors of visiting a psychiatry clinic included not having an AIDS diagnosis at baseline or before the study (p=.049), having a diagnosis of major depression (p=.013), having a diagnosis of bipolar disorder (p<.001), and receiving a psychiatric diagnosis in 1996 versus later years of the study (p<.01). Among patients with a substance use disorder, significant predictors of initiating substance abuse treatment included age <30 (p=.015) and being in the HIV transmission risk group of injection drug use (p<.001). CONCLUSIONS Clinical, diagnostic, and demographic factors were associated with specialty care treatment initiation in this sample of individuals with HIV infection and substance use or psychiatric disorders. Developing strategies to enhance treatment initiation has the potential to improve outcomes for individuals with HIV infection.
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Affiliation(s)
- Derek D Satre
- Division of Research, Kaiser Permanente, Oakland, California, USA.
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Jernigan MG, Kipp GM, Rather A, Jenkins MT, Chung AM. Clinical implications and management of drug-drug interactions between antiretroviral agents and psychotropic medications. Ment Health Clin 2013. [DOI: 10.9740/mhc.n139874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medications used in the treatment of human immunodeficiency virus (HIV) often have drug-drug interactions which complicate treatment of psychiatric illnesses in HIV-infected patients. Protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) are the two classes of HIV medications most likely to be involved with interactions, with the majority occurring via the cytochrome P450 (CYP450) system. These interactions can result in either increased or decreased exposure to psychotropic and antiretroviral medications, often requiring dosage adjustments and increased monitoring. This article reviews some of the major drug interactions with antiretroviral agents.
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Wu ES, Rothbard A, Blank MB. Using psychiatric symptomatology to assess risk for HIV infection in individuals with severe mental illness. Community Ment Health J 2011; 47:672-8. [PMID: 21479681 DOI: 10.1007/s10597-011-9402-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 03/30/2011] [Indexed: 11/26/2022]
Abstract
In this study, we use the Colorado Symptom Index, a measure of psychiatric symptomatology, to identify vulnerable subgroups within the severely mentally ill population at elevated risk for HIV infection. Baseline data on 228 HIV positive and 281 HIV negative participants from two clinical trials were used. With years to HIV diagnosis as our primary endpoint, Kaplan-Meier estimates were calculated to find a CSI cut-off score, and a Cox proportional hazards model was used to obtain relative risks of infection for the two CSI categories created by the cut point. We found that a CSI score ≥ 30 was associated with a 47% increased risk for HIV infection (P < 0.01). While this study establishes the foundation for using CSI scores to identify a vulnerable subgroup within the SMI community, further studies should develop effective approaches to mitigate psychiatric symptomatology in order to examine the impact on HIV transmission risky behaviors.
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Affiliation(s)
- Evan S Wu
- Department of Psychiatry, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, USA.
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Himelhoch S, Mohr D, Maxfield J, Clayton S, Weber E, Medoff D, Dixon L. Feasibility of telephone-based cognitive behavioral therapy targeting major depression among urban dwelling African-American people with co-occurring HIV. PSYCHOL HEALTH MED 2011; 16:156-65. [PMID: 21328144 DOI: 10.1080/13548506.2010.534641] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Given the burden of depression among those with HIV, and the impact of HIV on urban minority communities there is an urgent need to assess innovative treatment interventions that not only treat depression but do so in a way that allows for increased access to mental health care. This single site, uncontrolled, pilot study sought to determine the feasibility and depression outcomes of an 11-session telephone-based cognitive behavioral therapy intervention delivered over 14 weeks targeting low-income, urban-dwelling, HIV-infected African-American people with major depression. The diagnosis of major depression was made using the Mini International Neuropsychiatric Interview. The primary outcome was the Hamilton Depression Rating Scale (HAM-D) and the secondary outcome was the Quick Inventory of Depression Symptomatology-Self Report (QIDS-SR). Feasibility and satisfaction were also assessed. Assessments occurred at baseline, midpoint and at study conclusion (14 weeks). Fifteen people were screened for the study. Six HIV-infected, low-income, African-American people individuals (five females and one male) were eligible and participated in the study. All patients finished the study. On average, participants completed nine sessions. The sessions lasted for an average of 48 min (SD = 11.5). Compared to mean HAM-D score at baseline (HAM-D = 22.8 (SD = 3.1), the mean HAM-D score was significantly reduced at study conclusion (HAM-D = 9.8 (SD = 7.4); (t (5) = 4.6, p = 0.006); (Cohen d = 1.9)). Compared to the mean QIDS-SR score at baseline (QIDS-SR = 15.5 (SD = 4.2) the mean QIDS score was significantly reduced at study conclusion (QIDS = 7.0 (SD = 5.4);(t (5) = 3.2, p = 0.02); (Cohen d = 1.3)).The mean satisfaction scores across all participants at post-treatment was 5.7 (SD = 0.3) with of a maximum score of 6. Telephone-based CBT can be delivered to low-income, urban-dwelling ethnic minority HIV-infected people resulting in significant reductions in depression symptoms with high satisfaction. The efficacy of this intervention will be assessed in a planned randomized control trial.
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Affiliation(s)
- Seth Himelhoch
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
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