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Satre DD, Sarovar V, Levine T, Leibowitz AS, Lea AN, Ridout KK, Hare CB, Luu MN, Flamm J, Dilley JW, Davy-Mendez T, Sterling SA, Silverberg MJ. Factors associated with suicidal ideation among people with HIV engaged in care. J Affect Disord 2024; 358:369-376. [PMID: 38723683 DOI: 10.1016/j.jad.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND People with HIV (PWH) are at elevated risk for suicidal ideation (SI), yet few studies have examined how substance use, clinical and sociodemographic factors are associated with SI among PWH. METHOD We used substance use (Tobacco, Alcohol, Prescription Medication, and Other Substance Use [TAPS]) and depression (PHQ-9) data from computerized screening of adult PWH in primary care clinics in Northern California, combined with health record data on psychiatric diagnoses, HIV diagnosis, treatment, and control (HIV RNA, CD4), insurance, and neighborhood deprivation index (NDI) to examine factors associated with SI (PHQ-9 item 9 score > 0). Adjusted odds ratios (aOR) for SI were obtained from logistic regression models. RESULTS Among 2829 PWH screened (92 % male; 56 % white; mean (SD) age of 54 (13) years; 220 (8 %) reported SI. Compared with no problematic use, SI was higher among those reporting one (aOR = 1.65, 95 % CI = 1.17, 2.33), two (aOR = 2.23, 95 % CI = 1.42, 3.49), or ≥ 3 substances (aOR = 4.49, 95 % CI = 2.41, 8.39). SI risk was higher for those with stimulant use (aOR = 3.55, 95 % CI = 2.25, 5.59), depression (aOR = 4.18, 95 % CI = 3.04, 5.74), and anxiety diagnoses (aOR = 1.67, 95 % CI = 1.19, 2.34), or Medicaid (aOR = 2.11, 95%CI = 1.24, 3.60) compared with commercial/other insurance. SI was not associated with HIV-related measures or NDI. LIMITATIONS SI was assessed with a single PHQ-9 item. Simultaneous SI and exposure data collection restricts the ability to establish substance use as a risk factor. CONCLUSIONS HIV care providers should consider multiple substance use, stimulant use, depression or anxiety, and public insurance as risk factors for SI and provide interventions when needed.
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Affiliation(s)
- Derek D Satre
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America; Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America.
| | - Varada Sarovar
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Tory Levine
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Amy S Leibowitz
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Alexandra N Lea
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Kathryn K Ridout
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America; The Permanente Medical Group, Oakland, CA 94612, United States of America
| | - C Bradley Hare
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Mitchell N Luu
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Jason Flamm
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - James W Dilley
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America
| | - Thibaut Davy-Mendez
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Infectious Diseases, Chapel Hill, NC 27599, United States of America
| | - Stacy A Sterling
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America; Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Michael J Silverberg
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
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Engler K, Avallone F, Cadri A, Lebouché B. Patient-reported outcome measures in adult HIV care: A rapid scoping review of targeted outcomes and instruments used. HIV Med 2024; 25:633-674. [PMID: 38282323 DOI: 10.1111/hiv.13599] [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] [Received: 05/12/2023] [Accepted: 11/20/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE There is international interest in the integration of patient-reported outcome measures (PROMs) into routine HIV care, but little work has synthesized the content of published initiatives. We conducted a rapid scoping review primarily to identify their selected patient-reported outcomes and respective instruments. METHODS Four databases were searched on 4 May 2022 (Medline, Embase, CINAHL and PsychINFO) for relevant English language documents published from 2005 onwards. Dual review of at least 20% of records, full texts and data extraction was performed. Outcomes and instruments were classified with an adapted 14-domain taxonomy. Instruments with evidence of validation were described. RESULTS Of 13 062 records generated for review, we retained a final sample of 94 documents, referring to 60 distinct initiatives led mostly in the USA (n = 29; 48% of initiatives), Europe (n = 16; 27%) and Africa (n = 9; 15%). The measured patient-reported outcome domains were: mental health (n = 42; 70%), substance use (n = 23; 38%), self-management (n = 16; 27%), symptoms (n = 12; 20%), sexual/reproductive health (n = 12; 20%), physical health (n = 9; 15%), treatment (n= 8; 13%), cognition (n = 7; 12%), quality of life (n = 7; 12%), violence/abuse (n = 6; 10%), stigma (n = 6; 10%), socioeconomic issues (n = 5; 8%), social support (n = 3; 5%) and body/facial appearance (n = 1; 2%). Initiatives measured 2.6 outcome domains, on average (range = 1-11). In total, 62 distinct validated PROMs were identified, with 53 initiatives (88%) employing at least one (M = 2.2). Overwhelmingly, the most used instrument was any version of the Patient Health Questionnaire to measure symptoms of depression, employed by over a third (26; 43%) of initiatives. CONCLUSION Published PROM initiatives in HIV care have spanned 19 countries and disproportionately target mental health and substance use.
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Affiliation(s)
- Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Francesco Avallone
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Abdul Cadri
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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3
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Funnell EL, Spadaro B, Martin-Key NA, Benacek J, Bahn S. Perception of Apps for Mental Health Assessment With Recommendations for Future Design: United Kingdom Semistructured Interview Study. JMIR Form Res 2024; 8:e48881. [PMID: 38393760 PMCID: PMC10924263 DOI: 10.2196/48881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/07/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Mental health care provision in the United Kingdom is overwhelmed by a high demand for services. There are high rates of under-, over-, and misdiagnosis of common mental health disorders in primary care and delays in accessing secondary care. This negatively affects patient functioning and outcomes. Digital tools may offer a time-efficient avenue for the remote assessment and triage of mental health disorders that can be integrated directly into existing care pathways to support clinicians. However, despite the potential of digital tools in the field of mental health, there remain gaps in our understanding of how the intended user base, people with lived experiences of mental health concerns, perceive these technologies. OBJECTIVE This study explores the perspectives and attitudes of individuals with lived experiences of mental health concerns on mental health apps that are designed to support self-assessment and triage. METHODS A semistructured interview approach was used to explore the perspectives of the interviewees using 5 open-ended questions. Interviews were transcribed verbatim from audio data recordings. The average interview lasted 46 minutes (rounded to the nearest min; SD 12.93 min). A thematic analysis was conducted. RESULTS Overall, 16 individuals were interviewed in this study. The average age was 42.25 (SD 15.18) years, half of the interviewees identified as women (8/16, 50%), and all were White (16/16, 100%). The thematic analysis revealed six major themes: (1) availability and accessibility, (2) quality, (3) attitudes, (4) safety, (5) impact, and (6) functionality. CONCLUSIONS Engaging in clear communication regarding data security and privacy policies, adopting a consent-driven approach to data sharing, and identifying gaps in the app marketplace to foster the inclusion of a range of mental health conditions and avoid oversaturation of apps for common mental health disorders (eg, depression and anxiety) were identified as priorities from interviewees' comments. Furthermore, reputation was identified as a driver of uptake and engagement, with endorsement from a respected source (ie, health care provider, academic institution) or direct recommendation from a trusted health care professional associated with increased interest and trust. Furthermore, there was an interest in the role that co-designed digital self-assessments could play in existing care pathways, particularly in terms of facilitating informed discussions with health care professionals during appointments and by signposting individuals to the most appropriate services. In addition, interviewees discussed the potential of mental health apps to provide waiting list support to individuals awaiting treatment by providing personalized psychoeducation, self-help tips, and sources of help. However, concerns regarding the quality of care being affected because of digital delivery have been reported; therefore, frequent monitoring of patient acceptability and care outcomes is warranted. In addition, communicating the rationale and benefits of digitizing services will likely be important for securing interest and uptake from health care service users.
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Affiliation(s)
- Erin L Funnell
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Cambridge, United Kingdom
- Psyomics Ltd, Cambridge, United Kingdom
| | - Benedetta Spadaro
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Nayra A Martin-Key
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Jiri Benacek
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Sabine Bahn
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Cambridge, United Kingdom
- Psyomics Ltd, Cambridge, United Kingdom
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Ninnoni JP, Nsatimba F, Agyemang SO, Commey IT, Bennin L, Agyare E, Gyimah L, Senya K, Baddoo NA, Obiri-Yeboah D. An exploratory qualitative study of the psychological effects of HIV diagnosis; the need for early involvement of mental health professionals to improve linkage to care. BMC Public Health 2023; 23:2518. [PMID: 38102628 PMCID: PMC10724895 DOI: 10.1186/s12889-023-17449-y] [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] [Received: 04/16/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Diagnosing a life-threatening disease like the human immunodeficiency virus (HIV) can be unbearable to the individual, which has implications for their subsequent care-seeking decision-making. However, an essential element of HIV testing is identifying infected individuals and linking them with adequate care services, thus contributing to the UNAIDS 95-95-95 targets. The attainment of these targets has been particularly challenging for lower and middle-income countries (LMIC). This study explored the psychological reactions to a positive HIV status in a hospital treatment centre to provide insight into mental health interventions' role in improving HIV screening and early antiretroviral therapy (ART) initiation to enhance the quality of life. METHODS An exploratory qualitative study was investigated among adults who were diagnosed as HIV positive. Participants were purposively recruited from an HIV Treatment Centre. Data were collected with semi-structured interviews that explored the interpretations and psychological reactions to their positive HIV status. Overall, 18 participants were interviewed to reach saturation. Data were transcribed verbatim and analysed thematically to produce findings that address the study's objective. RESULTS Following analysis of participants' interpretations, understanding and implications of their HIV-positive diagnosis, two major themes emerged: (1) anxiety regarding the impact of the disease on self, family and society was overwhelming. Participants were anxious because of the stigma, fear, worry, shock, and shame they faced. (2) Participants expressed hopelessness and could not see meaning or purpose in life. Suicidal ideation, suicide plans and self-harm characterised hopelessness. CONCLUSIONS The initial reaction to the diagnosis of HIV in this LMIC context has the potential to impact linkage to care negatively and, thus, the attainment of the global 95-95-95 targets. It is, therefore, essential that mental health and psychological support services are integrated with testing services to manage the initial reactions and support individuals to improve early linkage to care and thus improve overall outcomes for the infected individual and society.
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Affiliation(s)
- Jerry Paul Ninnoni
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana.
| | - Frederick Nsatimba
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Sampson Opoku Agyemang
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Isaac Tetteh Commey
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Lydia Bennin
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Agyare
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Leveana Gyimah
- Communicable and Non-Communicable Diseases cluster, World Health Organisation Country Office, Accra, Ghana
| | - Kafui Senya
- Communicable and Non-Communicable Diseases cluster, World Health Organisation Country Office, Accra, Ghana
| | - Nyonuku Akosua Baddoo
- National AIDS/STIs Control Programme, Accra, Ghana
- Department of Community Health, the University of Ghana Medical School, Accra, Ghana
| | - Dorcas Obiri-Yeboah
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Borchmann O, Weis N, Hansen ABE, Storgaard M, Fetters MD, Chandanabhumma PP, Moseholm E. Patient-reported outcomes in clinical HIV care: protocol for a single-centre, multistage, mixed-methods study in Denmark. BMJ Open 2023; 13:e077303. [PMID: 37709310 PMCID: PMC10503392 DOI: 10.1136/bmjopen-2023-077303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION People with HIV-1 (PWH) have worse health-related quality of life (HRQoL) compared with the general population. Using patient-reported outcomes (PROs) may help reorient the focus of HIV care towards improving HRQoL. This study aims to develop, implement and evaluate the use of PROs in HIV care. METHODS AND ANALYSIS This is a Danish single-centre, multistage mixed-methods study consisting of four substudies (studies I-IV). Study I is a qualitative focus group interview study aiming to identify relevant PRO domains, and barriers and benefits to PRO use. Participants are 5-10 PWH and 5-10 HIV healthcare providers (HCPs). Data are thematically analysed. Results will guide the design of a PRO measure (PROM). Study II is a quantitative study aiming to assess PWH's willingness and ability to engage with PRO. All PWH are consecutively invited to complete the PROMs before their next consultations. Demographic data are collected at enrolment. Differences between PWH who do/do not complete the PROMs are assessed. Study III is a quantitative before-and-after study aiming to assess the impact of PRO use on HCP awareness. Participants are all who complete the PROMs in Study II. In contrast to study II, HCPs are notified of the PROM results. The number of problems documented by the HCP in patients' medical records during studies II and III are compared using χ2 tests. Multiple regression models are used to identify factors associated with HCP awareness. Study IV is a qualitative study aiming to explore PWH and HCP experiences of using PROs. Participants are 15-20 PWH and 10-15 HCP. Data are collected from participant observation of PRO consultations and individual interviews. Data are analysed thematically. ETHICS AND DISSEMINATION This study is approved by the Danish Data Protection Agency. Participants will provide written consent prior to participation. Results will be published in peer-reviewed journals.
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Affiliation(s)
- Olivia Borchmann
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Ann-Brit Eg Hansen
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus Universitetshospital, Aarhus, Denmark
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Mixed Methods Program, University of Michigan, Ann Arbor, Michigan, USA
| | - P Paul Chandanabhumma
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Mixed Methods Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Ellen Moseholm
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
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Crothers K, Nance RM, Whitney BM, Harding BN, Heckbert SR, Budoff MJ, Mathews WC, Bamford L, Cachay ER, Eron JJ, Napravnik S, Moore RD, Keruly JC, Willig A, Burkholder G, Feinstein MJ, Saag MS, Kitahata MM, Crane HM, Delaney JAC. Chronic obstructive pulmonary disease and the risk for myocardial infarction by type in people with HIV. AIDS 2023; 37:745-752. [PMID: 36728918 PMCID: PMC10041661 DOI: 10.1097/qad.0000000000003465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The relationship between chronic obstructive pulmonary disease (COPD) and cardiovascular disease in people with HIV (PWH) is incompletely understood. We determined whether COPD is associated with risk of myocardial infarction (MI) among PWH, and if this differs for type 1 (T1MI) and type 2 (T2MI). DESIGN We utilized data from five sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort, a multisite observational study. METHODS Our primary outcome was an adjudicated MI, classified as T1MI or T2MI. We defined COPD based on a validated algorithm requiring COPD diagnosis codes and at least 90-day continuous supply of inhalers. We conducted time-to-event analyses to first MI and used multivariable Cox proportional hazards models to measure associations between COPD and MI. RESULTS Among 12 046 PWH, 945 had COPD. Overall, 309 PWH had an MI: 58% had T1MI ( N = 178) and 42% T2MI ( N = 131). In adjusted models, COPD was associated with a significantly increased risk of all MI [adjusted hazard ratio (aHR) 2.68 (95% confidence interval (CI) 1.99-3.60)] even after including self-reported smoking [aHR 2.40 (95% CI 1.76-3.26)]. COPD was also associated with significantly increased risk of T1MI and T2MI individually, and with sepsis and non-sepsis causes of T2MI. Associations were generally minimally changed adjusting for substance use. CONCLUSION COPD is associated with a substantially increased risk for MI, including both T1MI and T2MI, among PWH. Given the association with both T1MI and T2MI, diverse mechanistic pathways are involved. Future strategies to decrease risk of T1MI and T2MI in PWH who have COPD are needed.
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Affiliation(s)
| | - Robin M Nance
- Department of Medicine
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | | | - Barbara N Harding
- Barcelona Institute of Global Health (ISGlobal) and Universitat Pompeu Fabra (UPF), Barcelona
- CIBER Epidemiolog ia y Salud Publica (CIBERESP), Madrid, Spain
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Matthew J Budoff
- Lundquist Institute at Harbor-University of California, Los Angeles (UCLA), Torrance
| | - William C Mathews
- Department of Medicine, University of California San Diego, California
| | - Laura Bamford
- Department of Medicine, University of California San Diego, California
| | - Edward R Cachay
- Department of Medicine, University of California San Diego, California
| | - Joseph J Eron
- University of North Carolina, Chapel Hill, North Carolina
| | | | - Richard D Moore
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jeanne C Keruly
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Amanda Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Greer Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Matthew J Feinstein
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Joseph A C Delaney
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
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Shin HD, Durocher K, Sequeira L, Zaheer J, Torous J, Strudwick G. Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review. BMC Health Serv Res 2023; 23:281. [PMID: 36959599 PMCID: PMC10037806 DOI: 10.1186/s12913-023-09254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on ICT-based interventions for suicide prevention implemented in clinical settings and then to identify and characterize implementation barriers and facilitators, as well as evaluation outcomes, and measures. METHODS We conducted this review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was applied to the following six databases between August 17-20, 2021: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Library, Information Science and Technology Abstracts. We also supplemented our search with Google searches and hand-searching reference lists of relevant reviews. To be included in this review, studies must include ICT-based interventions for any spectrum of suicide-related thoughts and behaviours including non-suicidal self-injury. Additionally, these ICTs must be implemented in clinical settings, such as emergency department and in-patient units. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to prepare this full report. RESULTS This review included a total of 75 citations, describing 70 studies and 66 ICT-based interventions for suicide prevention implemented in clinical settings. The majority of ICTs were computerized interventions and/or applications (n = 55). These ICTs were commonly used as indicated strategies (n = 49) targeting patients who were actively presenting with suicide risk. The three most common suicide prevention intervention categories identified were post-discharge follow-up (n = 27), screening and/or assessment (n = 22), and safety planning (n = 20). A paucity of reported information was identified related to implementation strategies, barriers and facilitators. The most reported implementation strategies included training, education, and collaborative initiatives. Barriers and facilitators of implementation included the need for resource supports, knowledge, skills, motivation as well as engagement with clinicians with research teams. Studies included outcomes at patient, clinician, and health system levels, and implementation outcomes included acceptability, feasibility, fidelity, and penetration. CONCLUSION This review presents several trends of the ICT-based interventions for suicide prevention implemented in clinical settings and identifies a need for future research to strengthen the evidence base for improving implementation. More effort is required to better understand and support the implementation and sustainability of ICTs in clinical settings. The findings can also serve as a future resource for researchers seeking to evaluate the impact and implementation of ICTs.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- School of Health, Community Service & Creative Design, Lambton College, Sarnia, Ontario, Canada
| | - Lydia Sequeira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Tsai YT, K. M. SP, Ku HC, Wu YL, Ko NY. Global overview of suicidal behavior and associated risk factors among people living with human immunodeficiency virus: A scoping review. PLoS One 2023; 18:e0269489. [PMID: 36940193 PMCID: PMC10029973 DOI: 10.1371/journal.pone.0269489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/22/2022] [Indexed: 03/21/2023] Open
Abstract
Death by suicide is a major public health problem. People living with human immunodeficiency virus (PLHIV) have higher risk of suicidal behavior than the general population. The aim of this review is to summarize suicidal behavior, associated risk factors, and risk populations among PLHIV. Research studies in six databases from January 1, 1988, to July 8, 2021, were searched using keywords that included "HIV," "suicide," and "risk factors." The study design, suicide measurement techniques, risk factors, and study findings were extracted. A total of 193 studies were included. We found that the Americas, Europe, and Asia have the highest rates of suicidal behavior. Suicide risk factors include demographic factors, mental illness, and physiological, psychological, and social support. Depression is the most common risk factor for PLHIV, with suicidal ideation and attempt risk. Drug overdosage is the main cause of suicide death. In conclusion, the current study found that PLHIV had experienced a high level of suicidal status. This review provides an overview of suicidal behavior and its risk factors in PLHIV with the goal of better managing these factors and thus preventing death due to suicide.
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Affiliation(s)
- Yi-Tseng Tsai
- Department of Nursing, An Nan Hospital, China Medical University, Tainan,
Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Sriyani Padmalatha K. M.
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
- Operating Room Department, National Hospital of Sri Lanka, Colombo, Sri
Lanka
| | - Han-Chang Ku
- Department of Nursing, An Nan Hospital, China Medical University, Tainan,
Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Yi-Lin Wu
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
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Tsai YT, Padmalatha S, Ku HC, Wu YL, Yu T, Chen MH, Ko NY. Suicidality Among People Living With HIV From 2010 to 2021: A Systematic Review and a Meta-regression. Psychosom Med 2022; 84:924-939. [PMID: 36162070 PMCID: PMC9553271 DOI: 10.1097/psy.0000000000001127] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 04/11/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The association between human immunodeficiency virus (HIV)/AIDS and suicidality is not well understood, partly because of variability in results. This meta-analysis aimed to investigate the predictive value of HIV/acquired immune deficiency syndrome for incident suicidality. METHODS A literature review was conducted of articles published between January 1, 2010, and October 31, 2021. The following databases were searched: Embase, MEDLINE, CINAHL, Web of Science, and Scopus. The search terms included human immunodeficiency virus (HIV), suicidal behavior, auto mutilation, and self-injurious behavior. Observational studies were screened following a registered protocol, and eligible ones were meta-analyzed and followed by meta-regression. RESULTS A total of 43 studies were included in this systematic review, and a meta-regression included 170,234 participants. The pooled prevalence estimates of suicidal ideation, attempted suicide, and deaths by suicide were 22.3%, 9.6%, and 1.7%, respectively. The following significant risk factors for suicide ideation were found: substance use, depression, low quality of life, low social support, without HIV status disclosure, living alone, low level of memory problems, family history of suicide, and stage III of HIV. Risk factors for suicide attempts were depression and family history of suicide. An elevated risk for suicide-related death was found for people living with HIV (PLHIV) who had a psychiatric disorder and in studies conducted in hospital-based settings (versus national database studies or HIV clinic settings). CONCLUSIONS The risk of suicidality is high among PLHIV within all six World Health Organization regions during the modern antiretroviral therapy era. Assessment of socioeconomic and psychological factors is recommended for further management to prevent suicide among PLHIV. The present findings are useful for design of intervention protocols and development of clinical practice guidelines intended to manage the well-being of PLHIV worldwide.
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Parcesepe AM, Lahuerta M, Lamb MR, Ahoua L, Abacassamo F, Elul B. Prevalence and psychosocial factors associated with self-injurious thoughts among people living with HIV presenting for HIV testing in Mozambique. AIDS Care 2022; 34:771-775. [PMID: 33749451 PMCID: PMC8452792 DOI: 10.1080/09540121.2021.1902930] [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] [Received: 07/01/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Self-injurious thoughts have been associated with psychiatric morbidity and suicide. Little is known about psychosocial factors associated with self-injurious thoughts among people newly diagnosed with HIV in sub-Saharan Africa. This study examined whether food insufficiency, mental health symptoms, or social support were associated with recent self-injurious thoughts among people newly diagnosed with HIV in Mozambique. The sample included 2001 PLWH aged ≥ 18 newly diagnosed with HIV at 10 health clinics in Mozambique between April 2013 and June 2015. Data were collected at time of HIV diagnosis. Multivariable logistic regression modeled the association of social support, affective mental health symptom severity, somatic mental health symptom severity, and food insufficiency on recent self-injurious thoughts. Ten percent of respondents reported recent self-injurious thoughts, which was higher among women than men (11% vs 7%). In multivariable analyses, food insufficiency [adjusted odds ratio (aOR) 1.7 (95% CI 1.3, 2.2)], and low [aORvs no = 4.8, 95% CI 1.7, 13.4) and moderate/high affective symptom severity [aORvs no = 8.7, 95% CI 2.8, 27.6) were associated with greater odds of self-injurious thoughts. Interventions to address self-injurious thoughts should consider accompanying psychosocial stressors. Longitudinal research to examine mechanisms through which psychosocial stressors are associated with self-injurious thoughts is warranted.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maria Lahuerta
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matthew R Lamb
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Laurence Ahoua
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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A comprehensive analysis of excess depressive disorder in women and men living with HIV in France compared to the general population. Sci Rep 2022; 12:6364. [PMID: 35430622 PMCID: PMC9013369 DOI: 10.1038/s41598-022-10263-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/30/2022] [Indexed: 01/14/2023] Open
Abstract
AbstractWe aimed to estimate the prevalence of depressive disorder in people living with HIV (PLWH) and evaluate its association with non-HIV-specific and HIV-specific factors in PLWH and in PLWH compared to the general population (GP). We used cross-sectional data from the QuAliV study, conducted within the ANRS-CO3 Aquitaine-AQUIVIH-NA cohort of PLWH in Nouvelle-Aquitaine (2018–2020), and a nationally-representative survey in the GP (EHIS-ESPS, 2014–2015), we included all participants aged ≥ 18 years old who had completed the Patient Health Questionnaire-8 (PHQ-8). Depressive disorder was defined as Patient Health Questionnaire-8 score greater or equal to 10. Its association with non-HIV-specific (demographic, socio-economic, behavioral, health status), HIV-specific factors (immuno-viral markers, antiretrovirals, level of perceived HIV-stigma), and HIV-status was assessed using Poisson regression models with robust variance in women and men separately. We included 914 PLWH (683 men/231 women). More than one in five PLWH had depressive disorder. It was strongly associated with being younger and experiencing severe pain in both sexes. Unemployment in women, being single, and lack of family ties in men were also associated with depressive disorder. More than 30% of our sample reported HIV-stigma, with a dose–response relationship between level of perceived HIV-stigma and depressive disorder. The crude prevalence of depressive disorder was 2.49 (95%CI 1.92–3.22) and 4.20 (95%CI 3.48–5.05) times higher in women and men living with HIV respectively compared to GP counterparts and 1.46 (95%CI 1.09–1.95) and 2.45 (95%CI 1.93–3.09) times higher after adjustment for non-HIV specific factors. The adjusted prevalence ratio of depressive disorder was not significantly different in HIV-stigma free women, but remained twice as high in HIV-stigma free men. The prevalence of depressive disorder compared to the GP tended to decrease with age in PLWH. Excess depressive disorder remains a major concern in PLWH. Our findings reaffirm the importance of regular screening. Tackling social inequalities and HIV-stigma should be prioritized to ensure that PLWH achieve good mental as well as physical health outcomes.
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Crane HM, Nance R, Whitney BM, Ruderman S, Tsui JI, Chander G, McCaul ME, Lau B, Mayer KH, Batey DS, Safren SA, Moore RD, Eron JJ, Napravnik S, Mathews WC, Fredericksen RJ, Hahn AW, Mugavero MJ, Lober WB, Saag MS, Kitahata MM, Delaney JAC. Drug and alcohol use among people living with HIV in care in the United States by geographic region. AIDS Care 2021; 33:1569-1576. [PMID: 33486978 PMCID: PMC9104760 DOI: 10.1080/09540121.2021.1874274] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Substance use in the U.S. varies by geographic region. Opioid prescribing practices and marijuana, heroin, and methamphetamine availability are evolving differently across regions. We examined self-reported substance use among people living with HIV (PLWH) in care at seven sites from 2017-2019 to understand current regional substance use patterns. We calculated the percentage and standardized percentage of PLWH reporting current drug use and at-risk and binge alcohol use by U.S. Census Bureau geographic region and examined associations in adjusted logistic regression analyses. Among 7,686 PLWH, marijuana use was the most prevalent drug (30%), followed by methamphetamine/crystal (8%), cocaine/crack (7%), and illicit opioids (3%). One-third reported binge alcohol use (32%). Differences in percent of current use by region were seen for marijuana (24-41%) and methamphetamine/crystal (2-15%), with more use in the West and Northeast, and binge alcohol use (26-40%). In adjusted analyses, PLWH in the Midwest were significantly less likely to use methamphetamine/crystal (aOR: 0.13;0.06-0.25) or illicit opioids (aOR:0.16;0.05-0.53), and PLWH in the Northeast were more likely to use cocaine/crack (aOR:1.59;1.16-2.17), compared to PLWH in the West. Understanding differences in substance use patterns in the current era, as policies continue to evolve, will enable more targeted interventions in clinical settings among PLWH.
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Robin Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Judith I. Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Kenneth H. Mayer
- Fenway Institute and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - D Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami FL, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - W Chris Mathews
- Department of Medicine, University of California at San Diego, San Diego, CA, USA
| | | | - Andrew W Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William B Lober
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Joseph AC Delaney
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Manitoba, Manitoba, Canada
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Jabour SM, Chander G, Riekert KA, Keruly JC, Herne K, Hutton H, Beach MC, Lau B, Moore RD, Monroe AK. The Patient Reported Outcomes as a Clinical Tool (PROACT) Pilot Study: What Can be Gained by Sharing Computerized Patient-Reported Mental Health and Substance Use Symptoms with Providers in HIV Care? AIDS Behav 2021; 25:2963-2972. [PMID: 33559775 DOI: 10.1007/s10461-021-03175-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
Substance use and mental health (SU/MH) disorders are insufficiently recognized in HIV care. We examined whether conveying SU/MH screening results to patients and providers increased SU/MH discussions and action plans. Intervention participants completed a computerized patient-reported questionnaire before their HIV visit; screened positive on ≥ 1 measure: depression, anxiety, PTSD symptoms, at-risk alcohol use, or drug use; and reviewed screening results to decide which to prioritize with their provider. Screening results and clinical recommendations were conveyed to providers via medical record. A historic control included patients with positive screens but no conveyance to patient or provider. The patient-provider encounter was audio-recorded, transcribed, and coded. For the overall sample (n = 70; 38 control, 32 intervention), mean age (SD) was 51.8 (10.3), 61.4% were male, and 82.9% were Black. Overall, 93.8% raised SU/MH in the intervention compared to 50.0% in the control (p < 0.001). Action plans were made for 40.0% of intervention and 10.5% of control encounters (p = 0.049). Conveying screening results with clinical recommendations increased SU/MH action plans, warranting further research on this intervention to address SU/MH needs.
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14
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Pei JH, Pei YX, Ma T, Du YH, Wang XL, Zhong JP, Xie Q, Zhang LH, Yan LX, Dou XM. Prevalence of suicidal ideation, suicide attempt, and suicide plan among HIV/AIDS: A systematic review and meta-analysis. J Affect Disord 2021; 292:295-304. [PMID: 34134028 DOI: 10.1016/j.jad.2021.05.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 05/09/2021] [Accepted: 05/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Suicidality is common in people living with HIV/AIDS. However, the prevalence estimates of the suicidality vary between studies. Here, we performed a systematic review and estimated the prevalence of suicidal behavior in this population. METHODS Systematic search of PubMed, Embase, Web of Science, CINAHL, Scopus and PsycINFO for relevant studies published before August 29, 2020. A random-effects model was used to pool the estimates of the prevalence of suicidal ideation, attempts and plans, which were also stratified by continent or region and screening instrument from the studies included in this meta-analysis. RESULTS Suicide prevalence data were extracted from 36 studies(n=32,818) from 15 countries. The overall pooled crude prevalence estimates of suicidal ideation, plans, and attempts were 20.9% [95% confidence interval (CI) 16.5-21.6%],8.1% (95% CI 5.4-11.3%), and 7.5% (95% CI 5.7-9.5%), respectively. For lifetime suicidal ideation and attempts prevalence, this was 22.4% (95% CI 15.9-29.8%), and 12.0% (95% CI 6.9- 18.1%), respectively. Summary prevalence estimates ranged across assessment modalities from 6.5% to 33.7%. Pooled estimates were generally higher for females, as compared with males (risk ratios in the range 1.48-1.85). The leave-one-out analysis showed that no single study significantly affected the final pooled results.
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Affiliation(s)
- Ju-Hong Pei
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Yi-Xuan Pei
- Performance Operation Office, The Second People's Hospital of Gansu Province, Lanzhou, Gansu, People's Republic of China
| | - Tong Ma
- Department of Spine Minimally Invasive Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Gansu, People's Republic of China
| | - Ye-Hui Du
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Xing-Lei Wang
- Department of liver diseases branch, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Juan-Ping Zhong
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Qi Xie
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Li-Hong Zhang
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China
| | - Li-Xin Yan
- Second Department of Mental Health, Lanzhou University Second Hospital, Lanzhou, Gansu
| | - Xin-Man Dou
- School of Nursing, Lanzhou university, Lanzhou, Gansu, People's Republic of China;; Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
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15
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Progovac AM, Tran NM, Mullin BO, De Mello Libardi Maia J, Creedon TB, Dunham E, Reisner SL, McDowell A, Bird N, Sánchez Román MJ, Dunn M, Telingator C, Lu F, Breslow AS, Forstein M, Cook BL. Elevated Rates of Violence Victimization and Suicide Attempt Among Transgender and Gender Diverse Patients in an Urban, Safety Net Health System. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Pittman JOE, Lindamer L, Afari N, Depp C, Villodas M, Hamilton A, Kim B, Mor MK, Almklov E, Gault J, Rabin B. Implementing eScreening for suicide prevention in VA post-9/11 transition programs using a stepped-wedge, mixed-method, hybrid type-II implementation trial: a study protocol. Implement Sci Commun 2021; 2:46. [PMID: 33926577 PMCID: PMC8082763 DOI: 10.1186/s43058-021-00142-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Post-9/11 veterans who enroll in VA health care frequently present with suicidal ideation and/or recent suicidal behavior. Most of these veterans are not screened on their day of enrollment and their risk goes undetected. Screening for suicide risk, and associated mental health factors, can lead to early detection and referral to effective treatment, thereby decreasing suicide risk. eScreening is an innovative Gold Standard Practice with evidence to support its effectiveness and implementation potential in transition and care management (TCM) programs. We will evaluate the impact of eScreening to improve the rate and speed of suicide risk screening and referral to mental health care compared to current screening methods used by transition care managers. We will also evaluate the impact of an innovative, multicomponent implementation strategy (MCIS) on the reach, adoption, implementation, and sustained use of eScreening. METHODS This is an eight-site 4-year, stepped-wedge, mixed-method, hybrid type-II implementation trial comparing eScreening to screening as usual while also evaluating the potential impact of the MCIS focusing on external facilitation and Lean/SixSigma rapid process improvement workshops in TCM. The aims will address: 1) whether using eScreening compared to oral and/or paper-based methods in TCM programs is associated with improved rates and speed of PTSD, depression, alcohol, and suicide screening & evaluation, and increased referral to mental health treatment; 2) whether and to what degree our MCIS is feasible, acceptable, and has the potential to impact adoption, implementation, and maintenance of eScreening; and 3) how contextual factors influence the implementation of eScreening between high- and low-eScreening adopting sites. We will use a mixed methods approach guided by the RE-AIM outcomes of the Practical Robust Implementation and Sustainability Model (PRISM). Data to address Aim 1 will be collected via medical record query while data for Aims 2 and 3 will be collected from TCM staff questionnaires and qualitative interviews. DISCUSSION The results of this study will help identify best practices for screening in suicide prevention for Post-9/11 veterans enrolling in VA health care and will provide information on how best to implement technology-based screening into real-world clinical care programs. TRIAL REGISTRATION ClinicalTrials.gov : NCT04506164; date registered: August 20, 2020; retrospectively registered.
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Affiliation(s)
- James O E Pittman
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA.
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA.
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA.
| | - Laurie Lindamer
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Colin Depp
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Miguel Villodas
- San Diego State University, 5500 Campanile Dr, San Diego, CA, USA
| | - Alison Hamilton
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, USA
| | - Bo Kim
- HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA
| | - Maria K Mor
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- VA Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erin Almklov
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
| | - John Gault
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA
| | - Borsika Rabin
- VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA
- UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
- UC San Diego Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA
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Gizachew KD, Chekol YA, Basha EA, Mamuye SA, Wubetu AD. Suicidal ideation and attempt among people living with HIV/AIDS in selected public hospitals: Central Ethiopia. Ann Gen Psychiatry 2021; 20:15. [PMID: 33608017 PMCID: PMC7896396 DOI: 10.1186/s12991-021-00335-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is the act of intentionally causing one's own death. HIV/AIDS continues to be associated with an under-recognized risk for suicidal behavior. Suicidal behavior among people living with HIV/AIDS is not only a predictor of future attempted suicide and completed suicide, but it is also associated with poor quality of life and poor adherence with antiretroviral therapy. OBJECTIVE The aim of this study was to assess the prevalence of suicidal ideation and attempt and associated factors among people living with HIV/AIDS in selected public hospitals of Amhara region, central Ethiopia. METHODS Institutional based cross-sectional study design was employed. The study was conducted in four public hospitals in North Shewa Zone from May to December 2017. Study population comprised all HIV-infected individuals from Antiretroviral Therapy (ART) clinic. A total of 348 study subjects were recruited using systematic random sampling and 326 completed the interview. Suicidality module from Composite International Diagnostic Interview (CIDI) was modified to assess suicidal behavior. Crude and adjusted OR was analyzed using logistic regression and the level of significance of association was determined at P value < 0.05. RESULT A total of 326 (93.7%) study subjects were interviewed. The magnitude of suicidal ideation and attempt was found to be 16% and 7.1%, respectively. Low monthly income, living alone, suicidal thought before knowing seropositive status, family history of suicide, experiencing mild and moderate-to-severe depression and anxiety symptoms, being gossiped sometimes in the last 12 months of the study period due to HIV status and ever use of khat (a psychoactive substance) was statistically significant associated factor with suicidal ideation. And low monthly income, experiencing mild and moderate-to-severe depression and anxiety symptoms, being gossiped sometimes and often in the previous 12 months of the study period due to HIV status and using alcohol currently were significantly associated factors with suicidal attempt. CONCLUSION Suicidal ideation and attempt among people living with HIV/AIDS (PLWHA) in this study were higher than prevalence in the general population. This shows suicidal ideation and attempt is a mental health concern of PLWHA and it needs great attention in Ethiopia.
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Affiliation(s)
- Kefyalew Dagne Gizachew
- Department of Psychiatry, College of Health Sciences and Medicine, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia. .,Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Yigrem Ali Chekol
- Department of Psychiatry, College of Health Sciences, Dilla University, Dilla, Ethiopia
| | - Elyas Admasu Basha
- Department of Psychiatry, College of Health Sciences and Medicine, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia
| | - Shiferaw Abeway Mamuye
- School of Nursing and Midwifery, Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abate Dargie Wubetu
- Department of Psychiatry, College of Health Sciences and Medicine, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia
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Fredericksen RJ, Gibbons LE, Fitzsimmons E, Nance RM, Schafer KR, Batey DS, Loo S, Dougherty S, Mathews WC, Christopoulos K, Mayer KH, Mugavero MJ, Kitahata MM, Crane PK, Crane HM. Impact and correlates of sub-optimal social support among patients in HIV care. AIDS Care 2021; 33:1178-1188. [PMID: 33443445 DOI: 10.1080/09540121.2020.1853660] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Social support (SS) predicts health outcomes among patients living with HIV. We administered a brief, validated measure of SS, the Multifactoral Assessment of Perceived Social Support, within a patient-reported outcomes assessment of health domains in HIV care at 4 U.S. clinics in English and Spanish (n = 708). In univariate analysis, low SS was associated with poorer engagement in care, antiretroviral adherence, and health-related quality of life; current methamphetamine/crystal use, depression, anxiety, and HIV stigma (all p < 0.001); any use of either methamphetamines/crystal, illicit opioids, or cocaine/crack (p = 0.001), current marijuana use (p = 0.012), nicotine use (p = 0.005), and concern for sexually transmitted infection exposure (p = 0.001). High SS was associated with undetectable viral load (p = 0.031). Multivariate analyses found low SS independently associated with depression (risk ratio (RR) 3.72, 95% CI 2.93-4.72), lower adherence (RR 0.76, 95% CI 0.64-0.89), poor engagement in care (RR 2.05, 95% CI 1.44-2.96), and having more symptoms (RR 2.29, 95% CI 1.92-2.75). Medium SS was independently associated with depression (RR 2.59, 95% CI 2.00-3.36), poor engagement in care (RR 1.62, 95% CI 1.15-2.29) and having more symptoms (RR 1.75, 95% CI 1.44-2.13). SS assessment may help identify patients at risk for these outcomes.
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Affiliation(s)
| | - L E Gibbons
- Medicine, University of Washington, Seattle, WA, USA
| | - E Fitzsimmons
- Medicine, University of Washington, Seattle, WA, USA
| | - R M Nance
- Medicine, University of Washington, Seattle, WA, USA
| | - K R Schafer
- Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - D S Batey
- Medicine, University of Alabama, Birmingham, AL, USA
| | - S Loo
- Fenway Community Health, Boston, MA, USA
| | - S Dougherty
- Medicine, University of Alabama, Birmingham, AL, USA
| | - W C Mathews
- Medicine, University of California, San Diego, CA, USA
| | | | - K H Mayer
- Fenway Community Health, Boston, MA, USA
| | - M J Mugavero
- Medicine, University of Alabama, Birmingham, AL, USA
| | - M M Kitahata
- Medicine, University of Washington, Seattle, WA, USA
| | - P K Crane
- Medicine, University of Washington, Seattle, WA, USA
| | - H M Crane
- Medicine, University of Washington, Seattle, WA, USA
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Suicidal ideation, psychopathology and associated factors among HIV-infected adults in Indonesia. BMC Psychiatry 2020; 20:255. [PMID: 32448151 PMCID: PMC7245986 DOI: 10.1186/s12888-020-02666-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Suicidal behavior is a prevalent psychiatric emergency in HIV-infected adults. Detection of suicidal ideation is important in planning early psychiatric intervention and optimizing HIV/AIDS management. Characterization of suicidal ideation among HIV-infected adults is crucial; however, practically there is no data in Indonesia, the country with the second largest burden of HIV/AIDS epidemic in Asia. This study aims to identify suicidal ideation and analyze the associated psychopathology and determining factors among HIV-infected adults in Indonesia. METHODS An observational cross-sectional study was conducted among HIV-infected adults aged 18-65 years old receiving antiretroviral therapy (ART). Measurement using Symptom Checklist-90 (SCL-90) was performed to assess the existing psychopathology. Firth's penalized logistic regression analysis was performed to identify factors associated with suicidal ideation. RESULTS A total of 86 subjects were recruited. Most subjects were male (65.1%), median age was 35 years, and median latest CD4 count was 463 cells/μl. Lifetime suicidal ideation was identified in 20 subjects (23.3%). Mean SCL-90 T-score for depressive and anxiety symptoms were both significantly higher among subjects with suicidal ideation (M = 60.75, SD = 12.0, p = 0.000 and M = 57.9, SD = 2.8, p = 0.001, respectively) compared to those without. Bivariate analyses showed that lifetime suicidal ideation was associated with depressive and anxiety symptoms, non-marital status, CD4 count < 500 cells/μl, and efavirenz use. Multivariate analysis identified that a single-point increase in SCL-90 depression symptoms score (AOR 1.16, 95% CI 4.5-123.6, p = 0.000) and efavirenz use (AOR 5.00, 95% CI 1.02-24.6, p = 0.048) were significant independent factors related to suicidal ideation. CONCLUSION Suicidal ideation is commonly found among Indonesian HIV-infected adults on ART. Depressive symptoms and efavirenz use are independent factors related to the presence of suicidal ideation. Thus, early screening of psychopathology as well as substitution of efavirenz with other ART regiment are recommended to prevent suicide and improve HIV/AIDS management outcome.
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20
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Davison B, Liddle R, Fitz J, Singh GR. Computerised emotional well-being and substance use questionnaires in young Indigenous and non-Indigenous Australian adults. SAGE Open Med 2020; 8:2050312120906042. [PMID: 32095239 PMCID: PMC7011318 DOI: 10.1177/2050312120906042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 12/27/2019] [Indexed: 11/15/2022] Open
Abstract
Background: Mental health disorders rank among the most substantial causes of morbidity
and mortality worldwide. Almost half of Australian adults experience mental
illness at some point in their lifetime, with Indigenous Australians
disproportionally affected. Thus, it is imperative that effective,
acceptable screening tools are used, which are tailored to the target
population. Objectives: This research investigates the methodology of computerised questionnaires in
assessing the emotional well-being and substance use in Indigenous and
non-Indigenous young adults. Methods: Cross-sectional data from young adults (21–28 years) in the Life Course
Program, Northern Territory, Australia, are presented. Through an extensive
consultation process, validated questionnaires were adapted to a
computerised format suitable for both remote and urban residing Indigenous
and non-Indigenous adults. Results: Of the 576 participants (459 Indigenous, 117 non-Indigenous) available for
assessment, high consent rates were seen, with completion rates >86%. One
in three young adults in this cohort were highlighted as ‘at risk’ of
psychological distress, and one in five as ‘at risk’ of suicidal ideation or
self-harm. Conclusion: The target population of this study were at a critical age with high levels
of psychological distress and suicidal ideation reported, particularly in
Indigenous young adults. This simple, user-friendly, pictorial programme
allowed assessment of a sensitive topic anonymously, while simultaneously
collating data and identifying those at high risk, irrespective of literacy
level or cultural background.
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Affiliation(s)
- Belinda Davison
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Robyn Liddle
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Joseph Fitz
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Gurmeet R Singh
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Northern Territory Medical Program, Flinders University, Darwin, NT, Australia
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Johnson MO, Neilands TB, Koester KA, Wood T, Sauceda JA, Dilworth SE, Mugavero MJ, Crane HM, Fredericksen RJ, Mayer KH, Mathews WC, Moore RD, Napravnik S, Christopoulos KA. Detecting Disengagement From HIV Care Before It Is Too Late: Development and Preliminary Validation of a Novel Index of Engagement in HIV Care. J Acquir Immune Defic Syndr 2019; 81:145-152. [PMID: 30865180 PMCID: PMC6522296 DOI: 10.1097/qai.0000000000002000] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Engagement in care is critical to achieving and sustaining optimal benefits of efficacious antiretroviral therapies for HIV infection. Current metrics of engagement in care, including problematic patterns of retention in care, adherence to treatment, and viral suppression, are often detected late in the disengagement process. We sought to develop and validate a patient-centered screener of engagement in care that can be used to identify deficits in patient perceptions of engagement before the development of poor outcomes, including loss to follow-up, treatment nonadherence, virologic failure, and the resulting increased likelihood of HIV-associated morbidity and mortality and onward transmission of HIV. SETTING AND METHODS Using input from patients, providers, and researchers through in-person focus groups and an online Delphi process, we developed a self-report measure of engagement in care that was validated with 3296 patients from 7 clinics across the United States. RESULTS Results supported a single dimension of engagement in care measured by 10 items. Lower scores on the HIV Index were related to higher depression and anxiety symptoms, greater use of alcohol and stimulants, and increased likelihood of reporting internalized HIV stigma. Higher Index scores were positively associated with self-report measures of antiretroviral therapy adherence, corroborative clinic records documenting appointment attendance, and increased likelihood of recent viral load suppression. CONCLUSIONS The HIV Index offers promise as a patient-centered diagnostic and prognostic screener for engagement in care that can be used to trigger interventions to promote better clinical outcomes for persons living with HIV.
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Affiliation(s)
| | | | | | - Troy Wood
- Department of Medicine, University of California, San Francisco, CA
| | - John A Sauceda
- Department of Medicine, University of California, San Francisco, CA
| | | | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Kenneth H Mayer
- Fenway Health and Department of Medicine, The Fenway Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - William C Mathews
- Department of Medicine, University of California, San Diego, San Diego, CA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Katerina A Christopoulos
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
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22
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Shim EJ, Lee SH, Kim NJ, Kim ES, Bang JH, Sohn BK, Park HY, Son KL, Hwang H, Lee KM, Hahm BJ. Suicide Risk in Persons with HIV/AIDS in South Korea: a Partial Test of the Interpersonal Theory of Suicide. Int J Behav Med 2019; 26:38-49. [PMID: 30255219 DOI: 10.1007/s12529-018-9749-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The high disease burden associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is linked to the elevated suicide risk in this population. Informed by the interpersonal theory of suicide, this study examined how and under which conditions depression is related to suicide risk in people living with HIV/AIDS. METHODS A total of 202 outpatients with HIV/AIDS participated in a cross-sectional and multi-center survey involving four university hospitals in South Korea. This self-reported survey included the Hospital Anxiety and Depression Scale, Interpersonal Needs Questionnaire, and Mini-International Neuropsychiatric Interview suicidality module. RESULTS Participants' mean age was 48.6 (SD = 13.4) and the majority was male (89.1%). The proportions of those at high, medium, and low suicide risk were 18.5%, 20%, and 15.4%, respectively. Depression was associated with suicide risk directly and indirectly by increasing perceived burdensomeness (PB) and the indirect effect of depression on suicide risk mediated by PB was contingent on the level of thwarted belongingness (TB). PB was associated with suicide risk even after controlling for depression, suggesting its independent effect on suicide risk. CONCLUSIONS PB and TB are potential mechanisms through which depression is associated with suicide risk, supporting the applicability of the interpersonal theory of suicide to understanding a complex interplay of risk factors in people with HIV/AIDS. Moreover, given the independent association of PB with suicide risk, as well as a protective effect of TB in suicide risk, monitoring and management of these factors should be included in the care of people with HIV/AIDS.
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Affiliation(s)
- Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, South Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Bo Kyung Sohn
- Department of Psychiatry, Sanggye Paik Hospital, Seoul, South Korea.,Department of Psychiatry, Inje University College of Medicine, Busan, South Korea
| | - Hye Youn Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Lak Son
- Department of Psychiatry, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Heesung Hwang
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang-Min Lee
- Public Health and Medical Service, Seoul National University Hospital, Seoul, South Korea
| | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea.
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23
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Lu HF, Sheng WH, Liao SC, Chang NT, Wu PY, Yang YL, Hsiao FH. The changes and the predictors of suicide ideation and suicide attempt among HIV-positive patients at 6-12 months post diagnosis: A longitudinal study. J Adv Nurs 2018; 75:573-584. [PMID: 30334591 DOI: 10.1111/jan.13883] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/19/2018] [Accepted: 09/13/2018] [Indexed: 02/05/2023]
Abstract
AIMS This study examined the changes and the predictors of suicide ideation/suicide attempt and the moderating effects of psychosocial factors on the suicide ideation/suicide attempts among human immunodeficiency virus (HIV)-positive patients at 6-12 months post-diagnosis. BACKGROUND Suicide behaviours are prevalent among newly diagnosed HIV-positive patients, but the changes in suicide behaviours after diagnosis and the role of psychosocial factors in these behaviours are not well studied. DESIGN This study used a prospective longitudinal design. METHODS A total of 113 participants diagnosed as HIV-positive for 6-12 months were recruited from the outpatient department. Data were collected from June 2015 - October 2016. They were asked to complete Beck's Scale for Suicide Ideation, the Beck Depression Inventory-II, the Body Image Scale, the Meaning in Life Questionnaire and the Multidimensional Scale of Perceived Social Support at baseline, the third month and the sixth month. RESULTS The results showed the high occurrence rates for suicide ideation ranging from 27.2%, 21.6%, and 25.8% and suicide attempt ranging from 14.7%, 8.6%, and 13.3% at the baseline, the third month and the sixth month, respectively. The education level, social support from family and depressive symptoms were the predictors of suicide ideation. The history of depression disorders, depressive symptoms and social support from friends significantly predicted suicide attempt. Meaning in life-presence moderated the relationship between depressive symptoms and suicide ideation. CONCLUSIONS After diagnosed for 6-12 months, HIV-positive patients remain the high-risk group for suicide ideation and attempt. Suicide intervention targeting the risk and protective factors are required for HIV-positive patients.
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Affiliation(s)
- Hsing-Fei Lu
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Nien-Tzu Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Ying Wu
- Department of Infectious disease, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Ling Yang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fei-Hsiu Hsiao
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Nursing Department, National Taiwan University Hospital, Taipei, Taiwan
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24
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Nance RM, Delaney JAC, Simoni JM, Wilson IB, Mayer KH, Whitney BM, Aunon FM, Safren SA, Mugavero MJ, Mathews WC, Christopoulos KA, Eron JJ, Napravnik S, Moore RD, Rodriguez B, Lau B, Fredericksen RJ, Saag MS, Kitahata MM, Crane HM. HIV Viral Suppression Trends Over Time Among HIV-Infected Patients Receiving Care in the United States, 1997 to 2015: A Cohort Study. Ann Intern Med 2018; 169:376-384. [PMID: 30140916 PMCID: PMC6388406 DOI: 10.7326/m17-2242] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Because HIV viral suppression is essential for optimal outcomes and prevention efforts, understanding trends and predictors is imperative to inform public health policy. OBJECTIVE To evaluate viral suppression trends in people living with HIV (PLWH), including the relationship of associated factors, such as demographic characteristics and integrase strand transfer inhibitor (ISTI) use. DESIGN Longitudinal observational cohort study. SETTING 8 HIV clinics across the United States. PARTICIPANTS PLWH receiving clinical care. MEASUREMENTS To understand trends in viral suppression (≤400 copies/mL), annual viral suppression rates from 1997 to 2015 were determined. Analyses were repeated with tests limited to 1 random test per person per year and using inverse probability of censoring weights to address loss to follow-up. Joint longitudinal and survival models and linear mixed models of PLWH receiving antiretroviral therapy (ART) were used to examine associations between viral suppression or continuous viral load (VL) levels and demographic factors, substance use, adherence, and ISTI use. RESULTS Viral suppression increased from 32% in 1997 to 86% in 2015 on the basis of all tests among 31 930 PLWH. In adjusted analyses, being older (odds ratio [OR], 0.76 per decade [95% CI, 0.74 to 0.78]) and using an ISTI-based regimen (OR, 0.54 [CI, 0.51 to 0.57]) were associated with lower odds of having a detectable VL, and black race was associated with higher odds (OR, 1.68 [CI, 1.57 to 1.80]) (P < 0.001 for each). Similar patterns were seen with continuous VL levels; when analyses were limited to 2010 to 2015; and with adjustment for adherence, substance use, or depression. LIMITATION Results are limited to PLWH receiving clinical care. CONCLUSION HIV viral suppression rates have improved dramatically across the United States, which is likely partially attributable to improved ART, including ISTI-based regimens. However, disparities among younger and black PLWH merit attention. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Robin M Nance
- University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., F.M.A., R.J.F., M.M.K., H.M.C.)
| | - J A Chris Delaney
- University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., F.M.A., R.J.F., M.M.K., H.M.C.)
| | - Jane M Simoni
- University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., F.M.A., R.J.F., M.M.K., H.M.C.)
| | - Ira B Wilson
- Brown University, Providence, Rhode Island (I.B.W.)
| | - Kenneth H Mayer
- Harvard Medical School and Fenway Institute, Boston, Massachusetts (K.H.M.)
| | - Bridget M Whitney
- University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., F.M.A., R.J.F., M.M.K., H.M.C.)
| | - Frances M Aunon
- University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., F.M.A., R.J.F., M.M.K., H.M.C.)
| | - Steven A Safren
- University of Miami, Miami, Florida, and Fenway Institute, Boston, Massachusetts (S.A.S.)
| | - Michael J Mugavero
- University of Alabama at Birmingham, Birmingham, Alabama (M.J.M., M.S.S.)
| | | | | | - Joseph J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.J.E., S.N.)
| | - Sonia Napravnik
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.J.E., S.N.)
| | - Richard D Moore
- Johns Hopkins University, Baltimore, Maryland (R.D.M., B.L.)
| | | | - Bryan Lau
- Johns Hopkins University, Baltimore, Maryland (R.D.M., B.L.)
| | - Rob J Fredericksen
- University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., F.M.A., R.J.F., M.M.K., H.M.C.)
| | - Michael S Saag
- University of Alabama at Birmingham, Birmingham, Alabama (M.J.M., M.S.S.)
| | - Mari M Kitahata
- University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., F.M.A., R.J.F., M.M.K., H.M.C.)
| | - Heidi M Crane
- University of Washington, Seattle, Washington (R.M.N., J.C.D., J.M.S., B.M.W., F.M.A., R.J.F., M.M.K., H.M.C.)
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25
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Aboumrad M, Fuld A, Soncrant C, Neily J, Paull D, Watts BV. Root Cause Analysis of Oncology Adverse Events in the Veterans Health Administration. J Oncol Pract 2018; 14:e579-e590. [PMID: 30110226 DOI: 10.1200/jop.18.00159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Oncology providers are leaders in patient safety. Despite their efforts, oncology-related medical errors still occur, sometimes resulting in patient injury or death. The Veterans Health Administration (VHA) National Center of Patient Safety used data obtained from root cause analysis (RCA) to determine how and why these adverse events occurred in the VHA, and how to prevent future reoccurrence. This study details the types of oncology adverse events reported in VHA hospitals and their root causes and suggests actions for prevention and improvement. METHODS We searched the National Center for Patient Safety adverse event reporting database for RCA related to oncology care from October 1, 2013, to September 8, 2017, to identify event types, root causes, severity of outcomes, care processes, and suggested actions. Two independent reviewers coded these variables, and inter-rater agreement was calculated by κ statistic. Variables were evaluated using descriptive statistics. RESULTS We identified 48 RCA reports that specifically involved an oncology provider. Event types included care delays (39.5% [n = 19]), issues with chemotherapy (25% [n = 12]) and radiation (12.5% [n = 6]), other (12.5% [n = 6]), and suicide (10.5% [n = 5]). Of the 48 events, 27.1% (n = 13) resulted in death, 4.2% (n = 2) in severe harm, 18.8% (n = 9) in temporary harm, 20.8% (n = 10) in minimal harm, and 2.1% (n = 1) in no harm. The majority of root causes identified a need to improve care processes and policies, interdisciplinary communication, and care coordination. CONCLUSION This analysis highlights an opportunity to implement system-wide changes to prevent similar events from reoccurring. These actions include comprehensive cancer clinics, usability testing of medical equipment, and standardization of processes and policies. Additional studies are necessary to assess oncologic adverse events across specialties.
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Affiliation(s)
- Maya Aboumrad
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Alexander Fuld
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Christina Soncrant
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Julia Neily
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Douglas Paull
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Bradley V Watts
- National Center for Patient Safety; White River Junction VA Medical Center, White River Junction, VT; The National Center for Patient Safety, Ann Arbor, MI; and Geisel School of Medicine at Dartmouth, Hanover, NH
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26
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Barger D, Leleux O, Conte V, Sapparrart V, Gapillout M, Crespel I, Erramouspe M, Delveaux S, Dabis F, Bonnet F. Integrating Electronic Patient-Reported Outcome Measures into Routine HIV Care and the ANRS CO3 Aquitaine Cohort's Data Capture and Visualization System (QuAliV): Protocol for a Formative Research Study. JMIR Res Protoc 2018; 7:e147. [PMID: 29880467 PMCID: PMC6013715 DOI: 10.2196/resprot.9439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Effective antiretroviral therapy has greatly reduced HIV-related morbidity and mortality, dramatically changing the demographics of the population of people living with HIV. The majority of people living with HIV in France are well cared for insofar as their HIV infection is concerned but remain at risk for age-associated comorbidities. Their long-term, potentially complex, and growing care needs make the routine, longitudinal assessment of health-related quality of life and other patient-reported outcomes of relevance in the current treatment era. OBJECTIVE We aim to describe the development of a Web-based electronic patient-reported outcomes system for people living with HIV linked to the ANRS CO3 Aquitaine cohort's data capture and visualization system (ARPEGE) and designed to facilitate the electronic collection of patient-reported data and ultimately promote better patient-physician communication and quality of care (both patient satisfaction and health outcomes). METHODS Participants who meet the eligibility criteria will be invited to engage with the Web-based electronic patient-reported outcomes system and provided with the information necessary to create a personal patient account. They will then be able to access the electronic patient-reported outcomes system and complete a set of standardized validated questionnaires covering health-related quality of life (World Health Organization's Quality of Life Instrument in HIV infection, named WHOQOL-HIV BREF) and other patient-reported outcomes. The information provided via questionnaires will ultimately be presented in a summary format for clinicians, together with the patient's HIV care history. RESULTS The prototype of the Web-based electronic patient-reported outcome system will be finalized and the first 2 formative research phases of the study (prototyping and usability testing) will be conducted from December 2017 to May 2018. We describe the sequential processes planned to ensure that the proposed electronic patient-reported outcome system is ready for formal pilot testing, referred to herein as phases 1a and 1b. We also describe the planned pilot-testing designed to evaluate the acceptability and use of the system from the patient's perspective (phase 2). CONCLUSIONS As the underlying information technology solution, ARPEGE, has being developed in-house, should the feasibility study presented here yield promising results, the panel of services provided via the proposed portal could ultimately be expanded and used to experiment with health-promoting interventions in aging people living with HIV in hospital-based care or adapted for use in other patient populations. TRIAL REGISTRATION ClinicalTrials.gov NCT03296202; https://clinicaltrials.gov/ct2/show/NCT03296202 (Archived by WebCite at http://www.webcitation.org/6zgOBArps). REGISTERED REPORT IDENTIFIER RR1-10.2196/9439.
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Affiliation(s)
- Diana Barger
- University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, F-33000, Bordeaux, France
| | - Olivier Leleux
- University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, F-33000, Bordeaux, France
| | - Valérie Conte
- Centre de Recherche et Développement en Informatique Médicale, University of Bordeaux, Bordeaux, France
| | - Vincent Sapparrart
- Centre de Recherche et Développement en Informatique Médicale, University of Bordeaux, Bordeaux, France
| | - Marie Gapillout
- Centre de Recherche et Développement en Informatique Médicale, University of Bordeaux, Bordeaux, France
| | | | | | | | - Francois Dabis
- University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, F-33000, Bordeaux, France.,CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France
| | - Fabrice Bonnet
- University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, F-33000, Bordeaux, France.,CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France.,CHU de Bordeaux, Saint-André Hospital, Bordeaux, France
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27
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Ospina-Pinillos L, Davenport TA, Ricci CS, Milton AC, Scott EM, Hickie IB. Developing a Mental Health eClinic to Improve Access to and Quality of Mental Health Care for Young People: Using Participatory Design as Research Methodologies. J Med Internet Res 2018; 20:e188. [PMID: 29807878 PMCID: PMC5996175 DOI: 10.2196/jmir.9716] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/17/2018] [Accepted: 03/22/2018] [Indexed: 01/18/2023] Open
Abstract
Background Each year, many young Australians aged between 16 and 25 years experience a mental health disorder, yet only a small proportion access services and even fewer receive timely and evidence-based treatments. Today, with ever-increasing access to the Internet and use of technology, the potential to provide all young people with access (24 hours a day, 7 days a week) to the support they require to improve their mental health and well-being is promising. Objective The aim of this study was to use participatory design (PD) as research methodologies with end users (young people aged between 16 and 25 years and youth health professionals) and our research team to develop the Mental Health eClinic (a Web-based mental health clinic) to improve timely access to, and better quality, mental health care for young people across Australia. Methods A research and development (R&D) cycle for the codesign and build of the Mental Health eClinic included several iterative PD phases: PD workshops; translation of knowledge and ideas generated during workshops to produce mockups of webpages either as hand-drawn sketches or as wireframes (simple layout of a webpage before visual design and content is added); rapid prototyping; and one-on-one consultations with end users to assess the usability of the alpha build of the Mental Health eClinic. Results Four PD workshops were held with 28 end users (young people n=18, youth health professionals n=10) and our research team (n=8). Each PD workshop was followed by a knowledge translation session. At the conclusion of this cycle, the alpha prototype was built, and one round of one-on-one end user consultation sessions was conducted (n=6; all new participants, young people n=4, youth health professionals n=2). The R&D cycle revealed the importance of five key components for the Mental Health eClinic: a home page with a visible triage system for those requiring urgent help; a comprehensive online physical and mental health assessment; a detailed dashboard of results; a booking and videoconferencing system to enable video visits; and the generation of a personalized well-being plan that includes links to evidence-based, and health professional–recommended, apps and etools. Conclusions The Mental Health eClinic provides health promotion, triage protocols, screening, assessment, a video visit system, the development of personalized well-being plans, and self-directed mental health support for young people. It presents a technologically advanced and clinically efficient system that can be adapted to suit a variety of settings in which there is an opportunity to connect with young people. This will enable all young people, and especially those currently not able or willing to connect with face-to-face services, to receive best practice clinical services by breaking down traditional barriers to care and making health care more personalized, accessible, affordable, and available.
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Affiliation(s)
| | | | - Cristina S Ricci
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Alyssa C Milton
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Rudolph JE, Cole SR, Edwards JK, Moore R, O'Cleirigh C, Mathews WC, Christopoulos K. At-Risk Alcohol Use Among HIV-Positive Patients and the Completion of Patient-Reported Outcomes. AIDS Behav 2018. [PMID: 28620802 DOI: 10.1007/s10461-017-1824-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Heavy drinking is prevalent among people living with HIV. Studies use tools like patient-reported outcomes (PROs) to quantify alcohol use in a detailed, timely manner. However, if alcohol misuse influences PRO completion, selection bias may result. Our study included 14,145 adult HIV patients (133,036 visits) from CNICS who were eligible to complete PROs at an HIV primary care visit. We compared PRO completion proportions between patients with and without a clinical diagnosis of at-risk alcohol use in the prior year. We accounted for confounding by baseline and visit-specific covariates. PROs were completed at 20.8% of assessed visits. The adjusted difference in PRO completion proportions was -3.2% (95% CI -5.6 to -0.8%). The small association between receipt of an at-risk alcohol use diagnosis and decreased PRO completion suggests there could be modest selection bias in studies using the PRO alcohol measure.
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Affiliation(s)
- Jacqueline E Rudolph
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 2101 McGavran Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA.
| | - Stephen R Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 2101 McGavran Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 2101 McGavran Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA
| | - Richard Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Katerina Christopoulos
- Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
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The Impact of Perceived Stigma, Quality of Life, and Spiritual Beliefs on Suicidal Ideations among HIV-Positive Patients. AIDS Res Treat 2018; 2018:6120127. [PMID: 30356375 PMCID: PMC6176316 DOI: 10.1155/2018/6120127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/30/2018] [Accepted: 02/19/2018] [Indexed: 01/23/2023] Open
Abstract
Background Suicidal ideation is considered a major health problem associated with HIV/AIDS. Suicide rates among people living with HIV/AIDS (PLHA) are more than three times higher in the general population and that is a significant difference. This study aimed at investigating the related factors of suicidal ideations among HIV-positive patients in Southwest Iran. Study Design A cross-sectional study. Methods 351 adult volunteer HIV-infected patients that referred to the Voluntary Counseling and Testing (VCT) center in the south of Iran were evaluated based on convenience sampling. Data was collected utilizing a structured questionnaire from March to August 2015. Results Over the six months prior to the study, 15.4% of the entire sample had been diagnosed with suicidal ideation. There was a significant correlation between the quality of life, spiritual beliefs, perceived stigma, and age with suicidal ideation. Suicidal ideation is significantly different in terms of gender and marital status. Perceived stigma and spiritual beliefs showed the highest effect on suicidal ideations, respectively. Conclusions Having religious beliefs due to accelerating psychological adaptation can motivate HIV patients to survive and have also been considered effective in preventing women from suicide. Perceived stigma and quality of life are other factors that should be taken into consideration as key elements in suicide preventive programs.
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Wang W, Xiao C, Yao X, Yang Y, Yan H, Li S. Psychosocial health and suicidal ideation among people living with HIV/AIDS: A cross-sectional study in Nanjing, China. PLoS One 2018; 13:e0192940. [PMID: 29470532 PMCID: PMC5823403 DOI: 10.1371/journal.pone.0192940] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 01/18/2018] [Indexed: 01/28/2023] Open
Abstract
Background Suicide is a serious cause of mortality worldwide and is considered as a psychiatric emergency. People living with HIV/AIDS (PLWHA) have higher rates of suicidal behavior than the general population. This study assessed the prevalence and verified the syndemic effect of psychosocial health conditions on suicidal ideation among PLWHA in China. Methods An institutional-based cross-sectional study was conducted from July to August 2016 in Nanjing, China, using a self-report questionnaire. Sociodemographic characteristics, infection status, psychosocial variables and suicide ideation reports of participants were collected. Logistic regressions were used to identify potential factors associated with suicidal ideation and to verify the syndemic effect of psychosocial factors. Additionally, odds ratios (ORs) with 95% confidence intervals (95% CI) were computed. Results In total, four hundred sixty-five PLWHA participated, 31.6% (n = 147) of whom had suicidal ideation. The results from univariate analysis showed that older age, low education level, being married, having children, and psychosocial variables (high perceived stigma, depression, low self-esteem, social support and resilience) were significantly associated with increased suicidal ideation. Multiple logistic regression models revealed that depression (OR = 2.70, 95%CI = 1.62–4.51), perceived stigma (OR = 1.97, 95%CI = 1.17–3.32), and low social support (OR = 1.85, 95%CI = 1.08–3.20) and self-esteem (OR = 4.11, 95%CI = 2.06–8.16) were statistically significant. PLWHA with at least two psychosocial health problems were nearly 5 times more likely (OR = 4.72, 95% CI 3.11–7.17) to have had suicidal ideation. Conclusions Suicidal ideation is frequent among PLWHA in China and is consistent with prevalence estimates from abroad. Psychosocial health problems were the determining factors associated with suicidal ideation, and a syndemic effect of psychosocial health conditions was confirmed in predicting suicidal ideation. Therefore, early screening of high-risk groups for suicidal ideation and more psychosocial health care among PLWHA are needed.
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Affiliation(s)
- Wei Wang
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
- Department of Epidemiology, University of Florida, Gainesville, FL, United States of America
| | - Chenchang Xiao
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
- Wuhan University of Science and Technology City College, Wuhan, P.R. China
| | - Xing Yao
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
| | - Yinmei Yang
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
| | - Hong Yan
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
| | - Shiyue Li
- School of Health Sciences, Wuhan University, Wuhan, P.R. China
- * E-mail:
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Iorfino F, Davenport TA, Ospina-Pinillos L, Hermens DF, Cross S, Burns J, Hickie IB. Using New and Emerging Technologies to Identify and Respond to Suicidality Among Help-Seeking Young People: A Cross-Sectional Study. J Med Internet Res 2017; 19:e247. [PMID: 28701290 PMCID: PMC5529742 DOI: 10.2196/jmir.7897] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Suicidal thoughts are common among young people presenting to face-to-face and online mental health services. The early detection and rapid response to these suicidal thoughts and other suicidal behaviors is a priority for suicide prevention and early intervention efforts internationally. Establishing how best to use new and emerging technologies to facilitate person-centered systematic assessment and early intervention for suicidality is crucial to these efforts. OBJECTIVE The aim of this study was to examine the use of a suicidality escalation protocol to respond to suicidality among help-seeking young people. METHODS A total of 232 young people in the age range of 16-25 years were recruited from either a primary mental health care service or online in the community. Each young person used the Synergy Online System and completed an initial clinical assessment online before their face-to-face or online clinical appointment. A suicidality escalation protocol was used to identify and respond to current and previous suicidal thoughts and behaviors. RESULTS A total of 153 young people (66%, 153/232) reported some degree of suicidality and were provided with a real-time alert online. Further levels of escalation (email or phone contact and clinical review) were initiated for the 35 young people (15%, 35/232) reporting high suicidality. Higher levels of psychological distress (P<.001) and a current alcohol or substance use problem (P=.02) predicted any level of suicidality compared with no suicidality. Furthermore, predictors of high suicidality compared with low suicidality were higher levels of psychological distress (P=.01), psychosis-like symptoms in the last 12 months (P=.01), a previous mental health problem (P=.01), and a history of suicide planning or attempts (P=.001). CONCLUSIONS This study demonstrates the use of new and emerging technologies to facilitate the systematic assessment and detection of help-seeking young people presenting with suicidality. This protocol empowered the young person by suggesting pathways to care that were based on their current needs. The protocol also enabled an appropriate and timely response from service providers for young people reporting high suicidality that was associated with additional comorbid issues, including psychosis-like symptoms, and a history of suicide plans and attempts.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | | | - Daniel F Hermens
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Shane Cross
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Jane Burns
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Quinlivan EB, Gaynes BN, Lee JS, Heine AD, Shirey K, Edwards M, Modi R, Willig J, Pence BW. Suicidal Ideation is Associated with Limited Engagement in HIV Care. AIDS Behav 2017; 21:1699-1708. [PMID: 27380390 DOI: 10.1007/s10461-016-1469-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PHQ-9 data from persons living with HIV (PLWH, n = 4099) being screened for depression in three clinics in the southeastern USA were used to determine the prevalence of suicidal ideation (SI). SI was reported by 352 (8.6 %); associated with <3 years since HIV diagnosis (1.69; 95 %CI 1.35, 2.13), and HIV RNA >50 copies/ml (1.70, 95 %CI 1.35, 2.14). Data from PLWH enrolled in a depression treatment study were used to determine the association between moderate-to-high risk SI (severity) and SI frequency reported on PHQ-9 screening. Over forty percent of persons reporting that SI occurred on "more than half the days" (by the PHQ-9) were assessed as having a moderate-to-high risk for suicide completion during the Mini International Neuropsychiatric Interview. SI, including moderate-to-high risk SI, remains a significant comorbid problem for PLWH who are not fully stabilized in care (as indicated by detectable HIV RNA or HIV diagnosis for less than 3 years).
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Affiliation(s)
- E Byrd Quinlivan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA.
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA.
| | - Bradley N Gaynes
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Lee
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy D Heine
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
| | - Kristen Shirey
- Departments of Psychiatry and Behavioral Sciences and Medicine, Duke University, Durham, NC, USA
| | - Malaika Edwards
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
| | - Riddhi Modi
- Department of Medicine, University of Alabama - Birmingham, Birmingham, AL, USA
| | - James Willig
- Department of Medicine, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Brian W Pence
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Prevalence and Associated Factors of Suicidal Ideation and Attempt among People Living with HIV/AIDS at Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study. PSYCHIATRY JOURNAL 2017; 2017:2301524. [PMID: 28491869 PMCID: PMC5405386 DOI: 10.1155/2017/2301524] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 02/21/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
Abstract
Background. Human Immune Deficiency Virus (HIV/AIDS) continues to be an underrecognized risk for suicidal ideation, suicidal attempt, and completion of suicide. Suicidal ideation and attempt in HIV/AIDS is not only a predictor of future attempted suicide and completed suicide. Methods. An institution based cross-sectional study was conducted among HIV-positive patients attending HIV care at Zewditu Memorial Hospital. Systematic random sampling technique was used to recruit 423 participants from April to May 2014. Composite International Diagnostic Interview was used to collect data. Multivariable logistic regression was computed to assess factors associated with suicidal ideation and attempt. Result. Suicidal ideation and suicidal attempt were found to be 22.5% and 13.9%, respectively. WHO clinical stage of HIV, not being on HAART, depression, family history of suicidal attempt, and perceived stigma were associated with suicidal ideation. WHO clinical stage, being female, not being on HAART, use of substance, and depression were associated with suicidal attempt. Conclusion. Early diagnosis and treatment of opportunistic infections, depression, and early initiation of ART need to be encouraged in HIV-positive adults. Furthermore, counseling on substance use and its consequences and early identification of HIV-positive people with family history of suicidal ideation have to be considered.
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Gibbons LE, Fredericksen R, Batey DS, Dant L, Edwards TC, Mayer KH, Mathews WC, Morales LS, Mugavero MJ, Yang FM, Paez E, Kitahata MM, Patrick DL, Crane HM, Crane PK. Validity assessment of the PROMIS fatigue domain among people living with HIV. AIDS Res Ther 2017; 14:21. [PMID: 28400850 PMCID: PMC5387298 DOI: 10.1186/s12981-017-0146-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/19/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate psychometric characteristics and cross-sectional and longitudinal validity of the 7-item PROMIS® Fatigue Short Form and additional fatigue items among people living with HIV (PLWH) in a nationally distributed network of clinics collecting patient reported data at the time of routine clinical care. Methods Cross-sectional and longitudinal fatigue data were collected from September 2012 through April 2013 across clinics participating in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). We analyzed data regarding psychometric characteristics including simulated computerized adaptive testing and differential item functioning, and regarding associations with clinical characteristics. Results We analyzed data from 1597 PLWH. Fatigue was common in this cohort. Scores from the PROMIS® Fatigue Short Form and from the item bank had acceptable psychometric characteristics and strong evidence for validity, but neither performed better than shorter instruments already integrated in CNICS. Conclusions The PROMIS® Fatigue Item Bank is a valid approach to measuring fatigue in clinical care settings among PLWH, but in our analyses did not perform better than instruments associated with less respondent burden. Electronic supplementary material The online version of this article (doi:10.1186/s12981-017-0146-y) contains supplementary material, which is available to authorized users.
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A Comparison of Adherence Timeframes Using Missed Dose Items and Their Associations with Viral Load in Routine Clinical Care: Is Longer Better? AIDS Behav 2017; 21:470-480. [PMID: 27714525 DOI: 10.1007/s10461-016-1566-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Questions remain regarding optimal timeframes for asking about adherence in clinical care. We compared 4-, 7-, 14-, 30-, and 60-day timeframe missed dose items with viral load levels among 1099 patients on antiretroviral therapy in routine care. We conducted logistic and linear regression analyses examining associations between different timeframes and viral load using Bayesian model averaging (BMA). We conducted sensitivity analyses with subgroups at increased risk for suboptimal adherence (e.g. patients with depression, substance use). The 14-day timeframe had the largest mean difference in adherence levels among those with detectable and undetectable viral loads. BMA estimates suggested the 14-day timeframe was strongest overall and for most subgroups although findings differed somewhat for hazardous alcohol users and those with current depression. Adherence measured by all missed dose timeframes correlated with viral load. Adherence calculated from intermediate timeframes (e.g. 14-day) appeared best able to capture adherence behavior as measured by viral load.
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Cholera R, Pence BW, Bengtson AM, Crane HM, Christopoulos K, Cole SR, Fredericksen R, Gaynes BN, Heine A, Mathews WC, Mimiaga MJ, Moore R, Napravnik S, O’Clerigh C, Safren S, Mugavero MJ. Mind the Gap: Gaps in Antidepressant Treatment, Treatment Adjustments, and Outcomes among Patients in Routine HIV Care in a Multisite U.S. Clinical Cohort. PLoS One 2017; 12:e0166435. [PMID: 28125593 PMCID: PMC5268441 DOI: 10.1371/journal.pone.0166435] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 10/28/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Depression affects 20-30% of HIV-infected patients and is associated with worse HIV outcomes. Although effective depression treatment is available, depression is largely untreated or undertreated in this population. METHODS We quantified gaps in antidepressant treatment, treatment adjustments, and outcomes among US patients in routine HIV care in the nationally distributed CNICS observational clinical cohort. This cohort combines detailed clinical data with regular, self-reported depressive severity assessments (Patient Health Questionnaire-9, PHQ-9). We considered whether participants with likely depression received antidepressants, whether participants on antidepressants with persistently high depressive symptoms received timely dose adjustments, and whether participants achieved depression remission. We considered a cross-sectional analysis (6,219 participants in care in 2011-2012) and a prospective analysis (2,936 participants newly initiating CNICS care when PHQ-9 screening was active). RESULTS The cross-sectional sample was 87% male, 53% Caucasian, 25% African American, and 18% Hispanic; the prospective sample was similar. In both samples, 39-44% had likely depression, with 44-60% of those receiving antidepressants. Of participants receiving antidepressants, 20-26% experienced persistently high depressive symptoms; only a small minority of those received antidepressant dose adjustments. Overall, 35-40% of participants on antidepressants achieved full depression remission. Remission among participants with persistently high depressive symptoms was rare regardless of dose adjustments. CONCLUSIONS In this large, diverse cohort of US patients engaged in routine HIV care, we observed large gaps in antidepressant treatment, timely dose adjustment to address persistently high depressive symptoms, and antidepressant treatment outcomes. These results highlight the importance of more effective pharmacologic depression treatment models for HIV-infected patients.
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Affiliation(s)
- Rushina Cholera
- UNC School of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill NC, United States of America
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill NC, United States of America
| | - Angela M. Bengtson
- Department of Epidemiology, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill NC, United States of America
| | - Heidi M. Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Katerina Christopoulos
- HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States of America
| | - Steven R. Cole
- Department of Epidemiology, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill NC, United States of America
| | - Rob Fredericksen
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Bradley N. Gaynes
- Department of Psychiatry, School of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill NC, United States of America
| | - Amy Heine
- Division of Infectious Diseases, Department of Medicine, School of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill NC, United States of America
| | - W. Christopher Mathews
- UCSD, Department of Medicine, School of Medicine, University of California, San Diego, San Diego, CA, United States of America
| | - Matthew J. Mimiaga
- Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America
- The Fenway Institute, Fenway Health, Boston, MA, United States of America
- Harvard School of Public Health, Department of Epidemiology, Boston, MA, United States of America
| | - Richard Moore
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Sonia Napravnik
- Department of Epidemiology, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill NC, United States of America
- Division of Infectious Diseases, Department of Medicine, School of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill NC, United States of America
| | - Conall O’Clerigh
- Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America
- The Fenway Institute, Fenway Health, Boston, MA, United States of America
| | - Steven Safren
- Department of Psychology, University of Miami, Miami FL, United States of America
| | - Michael J. Mugavero
- Department of Medicine and UAB Center for AIDS Research, University of Alabama at Birmingham, Birmingham AL, United States of America
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Cigarette Smokers are Less Likely to Have Undetectable Viral Loads: Results From Four HIV Clinics. J Addict Med 2016; 10:13-9. [PMID: 26656939 DOI: 10.1097/adm.0000000000000172] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of smoking among HIV-infected individuals is 2-3 times that of the general population, increasing the risk of smoking-related morbidity and mortality. We examined characteristics associated with smoking behavior among a large cohort of HIV-infected individuals in care in the United States. METHODS A convenience sample of 2952 HIV-infected patients in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) was assessed during routine clinic visits and was included. Multinomial logistic regression was used to examine the relationship between smoking status, depression/panic symptoms, alcohol/substance use, and demographic and clinical characteristics. RESULTS Compared with never-smokers, current smokers were more likely to have moderate to severe depression (odds ratio [OR] 1.37), endorse current substance use (OR 14.09), and less likely to report low-risk alcohol use on the Alcohol Use Disorders Identification Test (AUDIT-C) (OR 0.73). Current smokers were less likely to have an undetectable viral load (OR 0.75), and more likely to have current substance abuse (OR 2.81) and moderate to severe depression (OR 1.50), relative to smokers who had quit smoking. CONCLUSIONS HIV-infected smokers are less likely to have undetectable viral loads and frequently have psychosocial comorbidities including depression and substance abuse that impact antiretroviral therapy adherence and viral load suppression. To be effective, smoking-cessation interventions need to address the complex underlying concurrent risks in this population.
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Crane HM, Fredericksen RJ, Church A, Harrington A, Ciechanowski P, Magnani J, Nasby K, Brown T, Dhanireddy S, Harrington RD, Lober WB, Simoni J, Safren SA, Edwards TC, Patrick DL, Saag MS, Crane PK, Kitahata MM. A Randomized Controlled Trial Protocol to Evaluate the Effectiveness of an Integrated Care Management Approach to Improve Adherence Among HIV-Infected Patients in Routine Clinical Care: Rationale and Design. JMIR Res Protoc 2016; 5:e156. [PMID: 27707688 PMCID: PMC5071617 DOI: 10.2196/resprot.5492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/28/2016] [Accepted: 05/30/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adherence to antiretroviral medications is a key determinant of clinical outcomes. Many adherence intervention trials investigated the effects of time-intensive or costly interventions that are not feasible in most clinical care settings. OBJECTIVE We set out to evaluate a collaborative care approach as a feasible intervention applicable to patients in clinical care including those with mental illness and/or substance use issues. METHODS We developed a randomized controlled trial (RCT) investigating an integrated, clinic-based care management approach to improve clinical outcomes that could be integrated into the clinical care setting. This is based on the routine integration and systematic follow-up of a clinical assessment of patient-reported outcomes targeting adherence, depression, and substance use, and adapts previously developed and tested care management approaches. The primary health coach or care management role is provided by clinic case managers allowing the intervention to be generalized to other human immunodeficiency virus (HIV) clinics that have case managers. We used a stepped-care approach to target interventions to those at greatest need who are most likely to benefit rather than to everyone to maintain feasibility in a busy clinical care setting. RESULTS The National Institutes of Health funded this study and had no role in study design, data collection, or decisions regarding whether or not to submit manuscripts for publication. This trial is currently underway, enrollment was completed in 2015, and follow-up time still accruing. First results are expected to be ready for publication in early 2017. DISCUSSION This paper describes the protocol for an ongoing clinical trial including the design and the rationale for key methodological decisions. There is a need to identify best practices for implementing evidence-based collaborative care models that are effective and feasible in clinical care. Adherence efficacy trials have not led to sufficient improvements, and there remains little guidance regarding how adherence interventions should be implemented into clinical care. By focusing on improving adherence within care settings using existing staff, routine assessment of key domains, such as depression, adherence, and substance use, and feasible interventions, we propose to evaluate this innovative way to improve clinical outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT01505660; http://clinicaltrials.gov/ct2/show/NCT01505660 (Archived by WebCite at http://www.webcitation/ 6ktOq6Xj7).
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA, United States.
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Meyer D, Abbott JA, Rehm I, Bhar S, Barak A, Deng G, Wallace K, Ogden E, Klein B. Development of a Suicidal Ideation Detection Tool for Primary Healthcare Settings: Using Open Access Online Psychosocial Data. Telemed J E Health 2016; 23:273-281. [PMID: 27662524 DOI: 10.1089/tmj.2016.0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Suicidal patients often visit healthcare professionals in their last month before suicide, but medical practitioners are unlikely to raise the issue of suicide with patients because of time constraints and uncertainty regarding an appropriate approach. INTRODUCTION A brief tool called the e-PASS Suicidal Ideation Detector (eSID) was developed for medical practitioners to help detect the presence of suicidal ideation (SI) in their clients. If SI is detected, the system alerts medical practitioners to address this issue with a client. The eSID tool was developed due to the absence of an easy-to-use, evidence-based SI detection tool for general practice. MATERIAL AND METHODS The tool was developed using binary logistic regression analyses of data provided by clients accessing an online psychological assessment function. Ten primary healthcare professionals provided advice regarding the use of the tool. RESULTS The analysis identified eleven factors in addition to the Kessler-6 for inclusion in the model used to predict the probability of recent SI. The model performed well across gender and age groups 18-64 (AUR 0.834, 95% CI 0.828-0.841, N = 16,703). Healthcare professionals were interviewed; they recommended that the tool be incorporated into existing medical software systems and that additional resources be supplied, tailored to the level of risk identified. CONCLUSION The eSID is expected to trigger risk assessments by healthcare professionals when this is necessary. Initial reactions of healthcare professionals to the tool were favorable, but further testing and in situ development are required.
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Affiliation(s)
- Denny Meyer
- 1 Swinburne University of Technology , Hawthorn, Australia
| | - Jo-Anne Abbott
- 1 Swinburne University of Technology , Hawthorn, Australia
| | - Imogen Rehm
- 1 Swinburne University of Technology , Hawthorn, Australia
| | - Sunil Bhar
- 1 Swinburne University of Technology , Hawthorn, Australia
| | | | - Gary Deng
- 1 Swinburne University of Technology , Hawthorn, Australia
| | - Klaire Wallace
- 1 Swinburne University of Technology , Hawthorn, Australia
| | - Edward Ogden
- 1 Swinburne University of Technology , Hawthorn, Australia
| | - Britt Klein
- 3 Federation University Australia , Ballarat, Australia
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Pala AN, Steca P, Bagrodia R, Helpman L, Colangeli V, Viale P, Wainberg M. Subtypes of depressive symptoms and inflammatory biomarkers: An exploratory study on a sample of HIV-positive patients. Brain Behav Immun 2016; 56:105-13. [PMID: 26883521 PMCID: PMC5553322 DOI: 10.1016/j.bbi.2016.02.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/24/2016] [Accepted: 02/12/2016] [Indexed: 12/27/2022] Open
Abstract
Depressive symptoms cause major impairment and may accelerate HIV progression despite the use of antiretroviral medication. The somatic symptoms criteria for HIV infection and depression partially overlap, which can make differential diagnosis challenging. Because of chronic inflammation caused by HIV infection, HIV-positive patients may develop somatic and affective-cognitive symptoms of depression. Inflammation-related depression is primarily characterized with severe somatic symptoms such as fatigue and sleep disturbance. This study sought to explore the patterns of somatic and cognitive-affective depressive symptoms that characterize HIV-positive patients. Our specific aims were (1) to identify subtypes of depressive symptoms in a sample of HIV-positive patients; and (2) to test the subtypes' difference on inflammatory and HIV disease progression biomarkers. HIV-positive men and women (N=102) with and without depressive symptoms were randomly selected from an Italian HIV clinic. Depressive symptoms (PHQ-9), viral load (VL), CD4+, Il-6, TNF-α, and monocytes were assessed. The three subtypes formed using Latent Class Analysis (LCA) identified patients with (1) severe cognitive-affective and somatic depressive symptoms; (2) severe/moderate somatic symptoms; and (3) absent or low depressive symptoms. The subtype with severe/moderate somatic symptoms was characterized with elevated levels of Il-6 and monocytes. No difference on HIV progression biomarkers was found. The subtypes of depressive symptoms might help differentiating depressive symptoms from HIV- and inflammatory-related somatic symptoms. When present, cognitive-affective and/or somatic symptoms cause significant impairment to patients' lives and thus warrant further assessment and treatment.
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Affiliation(s)
- A. Norcini Pala
- New York State Psychiatric Institute (NYSPI)/Columbia University, New York, NY, USA,Corresponding author at: HIV Center New York State Psychiatric Institute/Columbia Psychiatry, 1051 Riverside Dr, Unit 15, New York, NY 10032, USA. (A. Norcini Pala)
| | - P. Steca
- Milano-Bicocca University, Milan, Italy
| | - R. Bagrodia
- Teachers College, Columbia University, New York, NY, USA
| | - L. Helpman
- New York State Psychiatric Institute (NYSPI)/Columbia University, New York, NY, USA
| | - V. Colangeli
- Institute of Infectious Diseases, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - P. Viale
- Institute of Infectious Diseases, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | - M.L. Wainberg
- New York State Psychiatric Institute (NYSPI)/Columbia University, New York, NY, USA
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Shacham E, Estlund AL, Tanner AE, Presti R. Challenges to HIV management among youth engaged in HIV care. AIDS Care 2016; 29:189-196. [PMID: 27397139 DOI: 10.1080/09540121.2016.1204422] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Regardless of medical advancements, new HIV infections persist. Young adults are most often newly infected, thus research is needed to assess medication adherence barriers specific to young adults with HIV. The data were abstracted from medical charts to include both self-reported behavioral and psychological distress data and HIV parameters in 2013 among patients aged 18-30 years. Descriptive and logistic regression analyses were conducted to identify factors related to viral suppression and sexually transmitted infection (STI) status. A total of 335 individuals presented for care during a 12-month period at a single clinic. The majority were African American and had a mean age of 25.6 years. Nearly all had current prescriptions of antiretroviral therapy (ART). Among those receiving ART, almost three-quarters were virally suppressed, as measured by 200 copies/mL. STI tests are conducted annually and by assessed need; 30% of this sample had at least 1 bacterial STI diagnosis within the last year. Psychological distress symptoms were more common among individuals who were not virally suppressed, compared to those who were virally suppressed. Women and individuals with moderate to severe symptoms of depression had higher odds of having unsuppressed viral loads. The independent factors associated with having any STIs were being African American or other minorities and having two or more sex partners. Our findings related to how young adults are managing their HIV care suggest that increased efforts aimed to prevent additional STIs and manage psychological distress will likely reduce transmission risks.
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Affiliation(s)
- Enbal Shacham
- a Department of Behavioral Science and Health Education , College for Public Health and Social Justice, Saint Louis University , St. Louis , MO , USA
| | - Amy L Estlund
- a Department of Behavioral Science and Health Education , College for Public Health and Social Justice, Saint Louis University , St. Louis , MO , USA
| | - Amanda E Tanner
- b Department of Public Health Education , School of Health & Human Sciences, University of North Carolina Greensboro , Greensboro , NC , USA
| | - Rachel Presti
- c Division of Infectious Diseases, Department of Medicine , Washington University School of Medicine , St. Louis , MO , USA
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Evaluation of quality of life using a tablet PC-based survey in cancer patients treated with radiotherapy: a multi-institutional prospective randomized crossover comparison of paper and tablet PC-based questionnaires (KROG 12-01). Support Care Cancer 2016; 24:4399-406. [PMID: 27220523 DOI: 10.1007/s00520-016-3280-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 05/16/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE This study compared a tablet PC questionnaire with a paper method for reliability and patient preferences in the acquisition of patient-reported outcomes (PROs) for patients treated with radiotherapy. By comparing the two modes of PRO administration, we aimed to evaluate the adequacy of using tablet PC questionnaires in future clinical use. METHODS Patients were randomized in a crossover study design using two different methods for PRO entry. A group of 89 patients answered a paper questionnaire followed by the tablet PC version, whereas 89 patients in another group completed the tablet PC questionnaire followed by the paper version. Surveys were performed four times per patient throughout the course of the radiotherapy. The Korean versions of the M.D. Anderson Symptom Inventory (MDASI-K) and the Brief Fatigue Inventory (BFI-K) were used. The primary endpoint of our current study was an assessment of patient preference for the survey method. The proportions of patients preferring each mode of questionnaire were evaluated. RESULTS The proportion of patients who preferred the tablet PC version, paper form, or who had no preference was 52.2, 22.1, and 25.7 %, respectively. More than half of the patients preferred the tablet PC to the paper version in all four surveys. Age, gender, educational status, prior experience of using a tablet PC, and the order of paper to tablet PC administration did not impact patient preferences. Inter-class correlation coefficients (ICCs) between the modes were 0.92 for MDASI-K and 0.94 for BFI-K and ranged from 0.91 to 0.96 on both instruments during the four surveys. CONCLUSIONS A tablet PC-based PRO is an acceptable and reliable method compared with paper-based data collection for Korean patients receiving radiotherapy.
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Use of Cognitive Interviews to Adapt PROMIS Measurement Items for Spanish Speakers Living with HIV. AIDS Res Treat 2016; 2016:8340863. [PMID: 27022480 PMCID: PMC4789049 DOI: 10.1155/2016/8340863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/28/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose. To use cognitive interviewing techniques to assess comprehension of existing Patient-Reported Outcomes Measurement Information System (PROMIS) items among Latinos living with HIV and then refine items based on participant feedback. Methods. Latino monolingual Spanish speakers living with HIV (n = 56) participated in cognitive interviews. Items from four PROMIS domains, including depression, anxiety, fatigue, and alcohol use, were assessed for comprehension. Audiotaped interviews and handwritten notes were subjected to content analysis to identify problems specific to each instrument for each domain. Results. The assessments from the cognitive interviews identified areas for improvement in each domain. We present data on the type of items that were difficult to comprehend and provide examples for how items were refined based on participants' and PROMIS Statistical Coordinating Center (PSCC) feedback. Six out of 48 depression items, 7 out of the 61 anxiety items, 18 out of 42 fatigue items, and 7 out of 44 alcohol use items were found to have poor comprehension. These items were refined based on participant feedback; the items were then submitted to the PSCC for additional guidance on linguistics and grammar to improve comprehension. Conclusions. Cognitive interviews may be used to enhance comprehension of PROMIS items among Latinos.
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Suicidal Ideation, Attempt, and Determining Factors among HIV/AIDS Patients, Ethiopia. DEPRESSION RESEARCH AND TREATMENT 2016; 2016:8913160. [PMID: 27747101 PMCID: PMC5055996 DOI: 10.1155/2016/8913160] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/28/2016] [Indexed: 11/18/2022]
Abstract
Background. Suicide is a serious cause of mortality worldwide and is considered as a psychiatric emergency. Suicide is more frequent in peoples living with HIV/AIDS than in general population. Objective. To assess the proportion and determining factors of suicidal ideation and attempt among peoples living with HIV/AIDS in Ethiopia. Methods. Institutional based cross-sectional study was conducted from May to June 2015 by selecting 393 participants using systematic random sampling technique. Suicide manual of Composite International Diagnostic Interview (CIDI) was used to collect data. Logistic regression was carried out and odds ratio with 95% confidence intervals was computed. Results. The proportion of suicidal ideation and attempt was 33.6% and 20.1%, respectively. Female sex (AOR = 2.6, 95%CI: 1.27-5.22), marital status (AOR = 13.5, 95%CI: 4.69-39.13), depression (AOR = 17.0, 95%CI: 8.76-33.26), CD4 level (AOR = 2.57, 95%CI: 1.34-4.90), and presence of opportunistic infection (AOR = 5.23, 95%CI: 2.51-10.88) were associated with suicidal ideation, whereas marital status (AOR = 8.44, 95%CI: 3.117-22.84), perceived HIV stigma (AOR = 2.9, 95%CI: 1.45-5.99), opportunistic infection (AOR = 2.37, 95%CI: 1.18-4.76), and poor social support (AOR = 2.9, 95%CI: 1.58-5.41) were significantly associated with suicidal attempt. Conclusion. Suicidal ideation and attempt were high among HIV positive patients. Therefore early screening, treatment, and referral of suicidal patients are necessary in HIV clinics.
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Oladeji BD, Taiwo B, Mosuro O, Fayemiwo SA, Abiona T, Fought AJ, Robertson K, Ogunniyi A, Adewole IF. Suicidal Behavior and Associations with Quality of Life among HIV-Infected Patients in Ibadan, Nigeria. J Int Assoc Provid AIDS Care 2015; 16:376-382. [PMID: 26586788 DOI: 10.1177/2325957415617829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Suicidality has rarely been studied in HIV-infected patients in sub-Saharan Africa. This study explored suicidal behavior in a clinic sample of people living with HIV, in Nigeria. METHODS Consecutive patients were interviewed using the Composite International Diagnostic Interview (CIDI-10.0) and the World Health Organization Quality of Life (WHO-QOL-HIV-BREF). Associations of suicidal behavior were explored using logistic regression models. RESULTS In this sample of 828 patients (71% female, mean age 41.3 ± 10 years), prevalence of suicidal behaviors were 15.1%, 5.8%, and 3.9% for suicidal ideation, plans, and attempts, respectively. Women were more likely than men to report suicidal ideation (odds ratio 1.7; 95% confidence interval 1.05-2.64). Depression and/or anxiety disorder was associated with increased odds of all suicidal behaviors. Suicidal behavior was associated with significantly lower overall and domain scores on the WHO-QOL. CONCLUSION Suicidal behaviors were common and significantly associated with the presence of mental disorders and lower quality of life.
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Affiliation(s)
| | - Babafemi Taiwo
- 2 Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Olushola Mosuro
- 3 Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Samuel A Fayemiwo
- 4 Department of Medical Microbiology, College of Medicine, University of Ibadan, Nigeria
| | - Taiwo Abiona
- 5 Department of Community Medicine, University of Ibadan, Nigeria
| | - Angela J Fought
- 6 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kevin Robertson
- 7 Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Adesola Ogunniyi
- 8 Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Isaac F Adewole
- 9 Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Nigeria
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O'Cleirigh C, Magidson JF, Skeer MR, Mayer KH, Safren SA. Prevalence of Psychiatric and Substance Abuse Symptomatology Among HIV-Infected Gay and Bisexual Men in HIV Primary Care. PSYCHOSOMATICS 2015. [PMID: 25656425 DOI: 10.1017/s0950268814002131.tuberculosis] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND The presence of psychiatric symptoms in gay/bisexual men managing HIV are underidentified and undertreated and can interfere with optimal HIV disease management. There is a paucity of prevalence reports of these symptoms in this group, identified in the primary HIV care setting. Few studies have compared prevalence rates based on empirically supported screening tools in relation to diagnoses made in primary care. OBJECTIVE The purpose of this study was to identify the prevalence of psychiatric symptoms and substance abuse in HIV-infected gay/bisexual men and to estimate the proportion of those who had been diagnosed within their primary medical care setting. METHOD Participants (n = 503) were HIV-infected gay/bisexual men screened for participation in a HIV prevention trial and completed psychosocial assessment. Data were also extracted from patients׳ electronic medical record. RESULTS More than 47% of participants met diagnostic screen-in criteria for any anxiety disorder, of whom approximately one-third were identified in primary care. More than 22% screened in for a depressive mood disorder, approximately 50% of whom had been identified in primary care. A quarter of the sample had elevated substance abuse symptoms, 19.4% of whom were identified in primary care. Of those with symptoms of alcohol abuse (19.9%), 9.0% of those were identified in primary care. CONCLUSION These results provide some evidence suggesting that mood, anxiety, and substance abuse symptomatology are prevalent among HIV-infected gay/bisexual men and are underidentified in primary care. Increased mental health and substance use screening integrated into HIV primary care treatment settings may help to identify more gay/bisexual men in need of treatment.
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Affiliation(s)
- Conall O'Cleirigh
- Fenway Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA (CO, JFM, SAS).
| | - Jessica F Magidson
- Fenway Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA (CO, JFM, SAS)
| | | | - Kenneth H Mayer
- The Fenway Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (KHM)
| | - Steven A Safren
- Fenway Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA (CO, JFM, SAS)
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Serafini G, Montebovi F, Lamis DA, Erbuto D, Girardi P, Amore M, Pompili M. Associations among depression, suicidal behavior, and quality of life in patients with human immunodeficiency virus. World J Virol 2015; 4:303-312. [PMID: 26279991 PMCID: PMC4534821 DOI: 10.5501/wjv.v4.i3.303] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/19/2015] [Accepted: 08/03/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the potential associations among major depression, quality of life, and suicidal behavior in human immunodeficiency virus (HIV) patients.
METHODS: A detailed MEDLINE search was carried out to identify all articles and book chapters in English published from January 1995 to January 2015.
RESULTS: Based on the main findings, the prevalence of major depressive disorder (MDD) ranged from 14.0% to 27.2%. Furthermore, the prevalence of suicidal ideation varied from 13.6% to 31.0% whereas, attempted suicides were reported to range from 3.9% to 32.7%. Interestingly, various associated risk factors for both depression and suicide were identified in HIV patients. Finally, consistent associations were reported among MDD, suicidal ideation, and poor quality of life in individuals living with HIV.
CONCLUSION: Although additional studies are needed to elucidate this complex association, our results suggest the importance of early detection of both MDD and suicidality in patients living with HIV.
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Edwards TC, Fredericksen RJ, Crane HM, Crane PK, Kitahata MM, Mathews WC, Mayer KH, Morales LS, Mugavero MJ, Solorio R, Yang FM, Patrick DL. Content validity of Patient-Reported Outcomes Measurement Information System (PROMIS) items in the context of HIV clinical care. Qual Life Res 2015; 25:293-302. [PMID: 26245710 DOI: 10.1007/s11136-015-1096-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess content validity and patient and provider prioritization of Patient-Reported Outcomes Measurement Information System (PROMIS) depression, anxiety, fatigue, and alcohol use items in the context of clinical care for people living with HIV (PLWH), and to develop and assess new items as needed. METHODS We conducted concept elicitation interviews (n = 161), item pool matching, prioritization focus groups (n = 227 participants), and cognitive interviews (n = 48) with English-speaking (~75 %) and Spanish-speaking (~25 %) PLWH from clinical sites in Seattle, San Diego, Birmingham, and Boston. For each domain we also conducted item review and prioritization with two HIV provider panels of 3-8 members each. RESULTS Among items most highly prioritized by PLWH and providers were those that included information regarding personal impacts of the concept being assessed, in addition to severity level. Items that addressed impact were considered most actionable for clinical care. We developed additional items addressing this. For depression we developed items related to suicide and other forms of self-harm, and for all domains we developed items addressing impacts PLWH and/or providers indicated were particularly relevant to clinical care. Across the 4 domains, 16 new items were retained for further psychometric testing. CONCLUSION PLWH and providers had priorities for what they believed providers should know to provide optimal care for PLWH. Incorporation of these priorities into clinical assessments used in clinical care of PLWH may facilitate patient-centered care.
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Affiliation(s)
- Todd C Edwards
- Department of Health Services, School of Public Health, University of Washington, 1208 NE 43rd St., Seattle, WA, 98195, USA.
| | - Rob J Fredericksen
- Harborview Madison Clinic, School of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Heidi M Crane
- Harborview Madison Clinic, School of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Paul K Crane
- Harborview Madison Clinic, School of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Mari M Kitahata
- Harborview Madison Clinic, School of Medicine, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA
| | - William C Mathews
- Owen Clinic, University of California - San Diego, 4168 Front St, San Diego, CA, 92103, USA
| | - Kenneth H Mayer
- The Fenway Institute, School of Public Health, Harvard University, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Leo S Morales
- Department of Health Services, School of Public Health, University of Washington, 1208 NE 43rd St., Seattle, WA, 98195, USA
| | - Michael J Mugavero
- 1917 Clinic, University of Alabama - Birmingham, 908 20th Street S, Suite 250, Birmingham, AL, 35205, USA
| | - Rosa Solorio
- Department of Health Services, School of Public Health, University of Washington, 1208 NE 43rd St., Seattle, WA, 98195, USA
| | - Frances M Yang
- Georgia Regents University, 1459 Laney Walker Blvd, Augusta, GA, 30901, USA
| | - Donald L Patrick
- Department of Health Services, School of Public Health, University of Washington, 1208 NE 43rd St., Seattle, WA, 98195, USA
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Ho CP, Zinski A, Fogger SA, Peters JD, Westfall AO, Mugavero MJ, Lawrence ST, Nevin CR, Raper JL, Saag MS, Willig JH. Factors Associated with Missed Psychiatry Visits in an Urban HIV Clinic. AIDS Behav 2015; 19:1423-9. [PMID: 25491027 DOI: 10.1007/s10461-014-0967-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Psychiatric co-management is often required in HIV primary care. While rates and clinical impact of linkage and retention in HIV are well explored, fewer investigations focus specifically on linkage to psychiatry. In this investigation, we evaluate factors associated with linkage to psychiatric services using a retrospective cohort study of HIV-infected patients during a two-year observation period. Descriptive statistics depict patient characteristics, and logistic regression models were fit to evaluate factors associated with failure to establish care at the co-located psychiatry clinic following referral from HIV provider. Of 370 referred, 23 % did not attend a scheduled psychiatry appointment within 6 months of initial referral. In multivariable analysis, Non-white race, younger age, non-suppressed viral load, and increased wait time to appointment (in days) were associated with failure to attend. Further exploration of barriers that contribute to disparate linkage to psychiatric care may inform future interventions to improve HIV outcomes in this population.
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Affiliation(s)
- Christina P Ho
- Department of Medicine, University of Alabama at Birmingham, BBRB 206B, 845 19th Street S, Birmingham, AL, 35294, USA
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Dabaghzadeh F, Jabbari F, Khalili H, Abbasian L. Associated Factors of Suicidal Thoughts in HIV-Positive Individuals. IRANIAN JOURNAL OF PSYCHIATRY 2015; 10:185-91. [PMID: 26877752 PMCID: PMC4749688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE As a first study, suicidal ideation and its correlates have been evaluated in Iranian HIV positive population. METHODS One hundred and fifty HIV-positive individuals were recruited in this cross-sectional study. The Hospital Anxiety and Depression Scale (HADS), Positive and Negative Suicide Ideation (PANSI), Pittsburgh Sleep Quality Inventory (PSQI) and Somatization subscale of Symptom Checklist 90 (SCL 90) as self- reported questionnaires were used to assess the patients' anxiety and depression status, suicidal thoughts, sleep quality and physiological factors, respectively. RESULTS Antiretroviral therapy and efavirenz intake did not show any significant effects on the patients' suicidal ideation. Anxiety (p<0.001), depression (p<0.001), poor physical activity (P<0.001) and sleep quality (p<0.001) were significantly associated with the patients' negative suicidal ideation. From the patients' demographic data, unemployment (p = 0.04), living alone (p = 0.01), and lack of family support (p = 0.01) were correlated with the patients' negative suicidal thoughts. CONCLUSION Although hospitals are the main referral centers for providing care for HIV-positive individuals in Tehran, Iran, conducting a multi-center study with sufficient sample size from different areas of our country that include individuals with different behaviors and cultures is essential to confirm the results of this study.
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Affiliation(s)
- Fatemeh Dabaghzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Jabbari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ladan Abbasian
- Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran
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