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Petroll AE, Quinn KG, John SA, Nigogosyan Z, Walsh JL. Factors associated with lack of care engagement among older, rural-dwelling adults living with HIV in the United States. J Rural Health 2023; 39:477-487. [PMID: 36482508 PMCID: PMC10038837 DOI: 10.1111/jrh.12732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50. METHODS We conducted a cross-sectional study to evaluate the association between patient-level factors and a combined outcome variable encompassing multiple aspects of care engagement. FINDINGS Either online or on paper, 446 participants completed our survey. One-third of the participants (33%) were from the southern United States; one-third were women; one-third were non-White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care. CONCLUSIONS Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH.
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Affiliation(s)
- Andrew E. Petroll
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zack Nigogosyan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer L. Walsh
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Walsh JL, John SA, Quinn KG, Hirshfield S, O’Neil A, Petroll AE. Factors associated with quality of life, depressive symptoms, and perceived stress among rural older adults living with HIV in the United States. J Rural Health 2023; 39:488-498. [PMID: 36510755 PMCID: PMC10038895 DOI: 10.1111/jrh.12730] [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: 12/14/2022]
Abstract
PURPOSE Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population-especially modifiable factors-could inform future interventions. METHODS Online or on paper, we surveyed 446 PLH aged 50+ residing in rural counties across the United States (Mage = 56, 67% male, 67% White, and 23% Black). Associations between social support, HIV stigma, satisfaction with medical care, discrimination in health care settings, and structural barriers and health-related QOL, depressive symptoms, and perceived stress were assessed using multiple linear regressions. FINDINGS Controlling for demographics, greater social support was associated with better QOL, fewer depressive symptoms, and less stress. Greater HIV stigma was associated with more depressive symptoms and stress. Satisfaction with care was associated with better QOL and less stress. Discrimination in medical settings was associated with lower QOL and more depressive symptoms and stress. Finally, experiencing more structural barriers was associated with lower QOL and more depressive symptoms and stress. CONCLUSIONS In addition to engagement in care and viral suppression, QOL and mental health are also critical considerations for rural older PLH. Increasing social support, reducing or providing skills to cope with HIV stigma, improving quality of care, reducing discrimination and stigma in medical settings, and reducing or mitigating the impact of structural barriers present potential targets for interventions aiming to improve the well-being of older rural PLH.
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Affiliation(s)
- Jennifer L. Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Andrew O’Neil
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Kang CR, Yang SJ. Risk factors for depressive symptoms by age group among human immunodeficiency virus-infected adults in Korea. AIDS Care 2022; 34:1522-1529. [PMID: 34612099 DOI: 10.1080/09540121.2021.1981225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We identified factors associated with depressive symptoms according to age group. We used data from a city-wide, cross-sectional survey conducted by the Seoul Metropolitan Government in 2014. Multivariable logistic regression analyses were performed to explore factors related to depressive symptoms. Depressive symptoms were assessed using a single item from the Korea National Health and Nutrition Examination Survey. Of the 370 subjects, 37.3% had depressive symptoms during the past 12 months. Compared to an age of ≥50 years, being 20-39 (adjusted odds ratio, 2.45; 95% confidence interval, 1.26-4.75) or 40-49 years (2.58; 1.32-5.06) of age was positively associated with depressive symptoms. In addition, a history of acquired immune deficiency syndrome-defining opportunistic disease (3.29; 1.09-9.92) and perceived discrimination (1.93; 1.16-3.20) in subjects aged 20-39 years, and poor subjective health (4.97; 1.42-17.32) in subjects aged 40-49 years, were associated with depressive symptoms, but no factor exhibited a significant association in subjects aged ≥ 50 years. In conclusion, a screening program that considers the factors identified in this study to prioritize patients with depression should be implemented.
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Affiliation(s)
- Cho Ryok Kang
- Division of Nursing Science, Ewha Womans University, Seoul, Korea.,Infectious Disease Control Division, Seoul Metropolitan Government, Seoul, Korea
| | - Sook Ja Yang
- Division of Nursing Science, Ewha Womans University, Seoul, Korea
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Tang C, Goldsamt L, Meng J, Xiao X, Zhang L, Williams AB, Wang H. Global estimate of the prevalence of post-traumatic stress disorder among adults living with HIV: a systematic review and meta-analysis. BMJ Open 2020; 10:e032435. [PMID: 32345695 PMCID: PMC7213849 DOI: 10.1136/bmjopen-2019-032435] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Although people living with HIV (PLWH) have been disproportionately affected by post-traumatic stress disorder (PTSD), the global prevalence of PTSD among PLWH is unknown. This study aimed to systematically review the prevalence of PTSD among PLWH worldwide and explore variation in prevalence across sociodemographic and methodological factors. DESIGN A meta-analysis using a random-effects model was conducted to pool the prevalence estimated from individual studies, and subgroup analyses were used to analyse heterogeneities. SETTING, PARTICIPANTS AND MEASURES Observational studies providing PTSD prevalence data in an adult HIV population were searched from January 2000 to November 2019. Measurements were not restricted, although the definition of PTSD had to align with the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases diagnostic criteria. RESULTS A total of 38 articles were included among 2406 records identified initially. The estimated global prevalence of PTSD in PLWH was 28% (95% CI 24% to 33%). Significant heterogeneity was detected in the proportion of PLWH who reported PTSD across studies, which was partially explained by geographic area, population group, measurement and sampling method (p<0.05). CONCLUSION PTSD among PLWH is common worldwide. This review highlights that PTSD should be routinely screened for and that more effective prevention strategies and treatment packages targeting PTSD are needed in PLWH.
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Affiliation(s)
- Chulei Tang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Lloyd Goldsamt
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | - Jingjing Meng
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Xueling Xiao
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Li Zhang
- New York University Rory Meyers College of Nursing, New York, New York, USA
| | | | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
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Dopaminergic impact of cART and anti-depressants on HIV neuropathogenesis in older adults. Brain Res 2019; 1723:146398. [PMID: 31442412 DOI: 10.1016/j.brainres.2019.146398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 01/21/2023]
Abstract
The success of combination antiretroviral therapy (cART) has transformed HIV infection into a chronic condition, resulting in an increase in the number of older, cART-treated adults living with HIV. This has increased the incidence of age-related, non-AIDS comorbidities in this population. One of the most common comorbidities is depression, which is also associated with cognitive impairment and a number of neuropathologies. In older people living with HIV, treating these overlapping disorders is complex, often creating pill burden or adverse drug-drug interactions that can exacerbate these neurologic disorders. Depression, NeuroHIV and many of the neuropsychiatric therapeutics used to treat them impact the dopaminergic system, suggesting that dopaminergic dysfunction may be a common factor in the development of these disorders. Further, changes in dopamine can influence the development of inflammation and the regulation of immune function, which are also implicated in the progression of NeuroHIV and depression. Little is known about the optimal clinical management of drug-drug interactions between cART drugs and antidepressants, particularly in regard to dopamine in older people living with HIV. This review will discuss those interactions, first examining the etiology of NeuroHIV and depression in older adults, then discussing the interrelated effects of dopamine and inflammation on these disorders, and finally reviewing the activity and interactions of cART drugs and antidepressants on each of these factors. Developing better strategies to manage these comorbidities is critical to the health of the aging, HIV-infected population, as the older population may be particularly vulnerable to drug-drug interactions affecting dopamine.
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Depression and aging with HIV: Associations with health-related quality of life and positive psychological factors. J Affect Disord 2019; 251:1-7. [PMID: 30884371 PMCID: PMC6705595 DOI: 10.1016/j.jad.2019.03.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/31/2018] [Accepted: 03/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Depression is prevalent among persons living with HIV (PLWH). This study investigated the relationships between depressive symptomatology, health-related quality of life (HRQoL), and positive psychological factors in PLWH and age-matched HIV-individuals. METHODS One hundred twenty-two PLWH and 94 HIV- individuals, recruited in three age cohorts (36-45, 46-55, 56-65 years old), completed self-report questionnaires on depressive symptoms (CES-D), HRQoL, and positive psychological factors (resilience, grit, and self-rated successful aging [SRSA]). Participants were classified based on HIV status (H+ vs H-) and elevated depressive symptoms (D+ vs D-) into four groups (H+/D+; H-/D+; H+/D-; H-/D-). RESULTS Fifty-eight percent of PLWH had elevated depressive scores, compared to 33% of HIV- individuals (p < 0.001). The proportion of individuals reporting elevated depressive symptoms only differed among individuals 36-45 years old (H+: 61.5%; H-: 17.9%; p < 0.001). Individuals in the H+/D+ group reported the lowest HRQoL, resilience, grit, and SRSA across age cohorts. However, there were no differences on HRQoL or positive psychological factors between H+/D- and H-/D- groups; in fact, individuals 56-65 years in the H+/D- group endorsed aging the most successfully. LIMITATIONS Small sample size within the groups and the cross-sectional nature of the analysis limit the ability to address onset of depressive symptoms in relation to HRQoL or positive psychological factors. CONCLUSIONS Among PLWH depressive symptoms show a strong association with HRQoL and positive psychological factors compared to HIV- individuals. In the absence of elevated depressive symptoms, however, PLWH report similar HRQoL and positive psychological factors to HIV- individuals.
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Mannes ZL, Bryant VE, Burrell LE, Lu H, Ferguson EG, Zhou Z, Cook RL, Ennis N. The prevalence and patterns of substance use by birth cohort among HIV-positive adults in Florida. Aging Ment Health 2019; 23:515-523. [PMID: 29436844 PMCID: PMC6286223 DOI: 10.1080/13607863.2018.1430740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Antiretroviral therapy is affording longer lifespans for people living with HIV (PLWH), yet factors such as substance use play an increasing role in morbidity and mortality in this population. Though previous studies have examined substance use differences between age cohorts of PLWH, no study has examined the influence of birth cohort on current substance use patterns. Thus, this study investigated the prevalence of past 12-month self-reported substance use between four birth cohorts, <1970 (M age = 54.1), 1970s (M age = 41.5), 1980s (M age = 31.3 years old), and 1990s (M age = 23.2 years old) of PLWH in Florida. METHODS PLWH (N = 934) recruited from community health clinics in Florida completed a questionnaire assessing sociodemographics, health status, and substance use. Multivariate logistic regressions utilizing the <1970 cohort as the referent group examined the relationship between birth cohort and substance use. RESULTS The 1980s cohort had significantly greater odds of marijuana use compared to the oldest cohort (<1970s), while the three younger cohorts (1970s, 1980s, and 1990s) evidenced a significantly greater odds of ecstasy use compared to the oldest group. Contrastingly, the three younger birth cohorts reported significantly less crack use than the oldest cohort, while the youngest group (1990s) also demonstrated an 80% reduction in injection drug use compared to the oldest group. CONCLUSION The older cohort evidenced significantly greater crack and injection drug use, while the younger cohorts evidenced greater marijuana and ecstasy use. Therefore, it is important to develop age-specific substance use interventions among PLWH.
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Affiliation(s)
- Zachary L. Mannes
- Corresponding Author: Zachary L. Mannes, NIDA Predoctoral Fellow, Department of Clinical & Health Psychology College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL 32610-0165, Phone: +1-(352)-273-6617,
| | - Vaughn E. Bryant
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, ,+1-(352)-273-6617
| | - Larry E. Burrell
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, ,+1-(352)-273-6617
| | - Huiyin Lu
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, P.O. Box 117450, 2004 Mowry Road, 5th Floor CTRB, Gainesville, Florida, 32611-7450, United States, , (352)-294-5770
| | - Erin G. Ferguson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, ,+1-(352)-273-6617
| | - Zhi Zhou
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, P.O. Box 100231, 2004 Mowry Road, Gainesville, FL 32610, United States, , (352) 294-5949
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, P.O. Box 100231, 2004 Mowry Road, Gainesville, FL 32610, United States, , (352) 273-5869
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States, , +1-(352)-273-6617
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Jiang H, Chen S, Huang X, Huang R, Lin P, Cheng W, Xu M, Yang F, Liu J, Li Y, Gao Y, Yang Y. Prevalence of and factors associated with major depressive disorder among HIV-positive individuals in Guangdong, China. J Affect Disord 2019; 246:474-479. [PMID: 30599371 DOI: 10.1016/j.jad.2018.12.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/03/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND People living with HIV may suffer from mental disorders. We aimed to explore the prevalence of and factors associated with major depressive disorder (MDD) among HIV-positive individuals in Guangdong, China, about which little is known. METHODS A cross-sectional study was conducted to recruit HIV-positive individuals from the Centers for Disease Prevention and Control of Guangzhou, Zhongshan, and Yangjiang from September 2007 to September 2008. Data were collected by questionnaires. MDD was diagnosed and assessed by two psychiatrists using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P) based on the DSM-IV criteria. Multiple logistic regression analyses were conducted to explore the factors associated with MDD. RESULTS The prevalences of lifetime MDD and current MDD among the 339 included participants were 22.71% (95% confidence interval [CI]: 18.25-27.17%) and 12.09% (95%CI: 8.62%-15.57%), respectively. The results of multiple logistic regression showed that patients with AIDS had a higher risk of lifetime MDD (odds ratio [OR] = 2.69, 95%CI: 1.38-5.26) and current MDD (OR = 3.51, 95%CI: 1.59-7.75) than HIV-infected individuals. Participants with more number of negative life events were more likely to have lifetime MDD (OR = 2.33, 95%CI: 1.34-4.06) and current MDD (OR = 3.77, 95%CI: 1.76-8.09) than individuals with fewer negative life events. Individuals with higher score of social support were less likely to have lifetime MDD (OR = 0.45, 95%CI: 0.26-0.80) and current MDD (OR = 0.46, 95%CI: 0.21-0.97) than individuals with less social support. CONCLUSIONS The prevalence of MDD was high among HIV-positive individuals in China. AIDS diagnosis, decreased social support, and an increased number of negative life events were risk factors for MDD.
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Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Shuyi Chen
- The Second People's Hospital of Bao'an District (Group) General Hospital, Shenzhen, China
| | | | - Ruoyan Huang
- Guangzhou Psychiatric Hospital, Guangzhou, China
| | - Peng Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Weibin Cheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Meizhen Xu
- Haizhu District Center for Disease Control and Prevention, Guangzhou, China
| | - Fang Yang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jun Liu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yan Li
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yanhui Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China.
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China.
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De Francesco D, Underwood J, Bagkeris E, Boffito M, Post FA, Mallon P, Vera JH, Williams I, Anderson J, Johnson M, Sabin CA, Winston A. Depression, lifestyle factors and cognitive function in people living with HIV and comparable HIV-negative controls. HIV Med 2019; 20:274-285. [PMID: 30734983 PMCID: PMC6593457 DOI: 10.1111/hiv.12714] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 01/16/2023]
Abstract
Objectives We investigated whether differences in cognitive performance between people living with HIV (PLWH) and comparable HIV‐negative people were mediated or moderated by depressive symptoms and lifestyle factors. Methods A cross‐sectional study of 637 ‘older’ PLWH aged ≥ 50 years, 340 ‘younger’ PLWH aged < 50 years and 276 demographically matched HIV‐negative controls aged ≥ 50 years enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study was performed. Cognitive function was assessed using a computerized battery (CogState). Scores were standardized into Z‐scores [mean = 0; standard deviation (SD) = 1] and averaged to obtain a global Z‐score. Depressive symptoms were evaluated via the Patient Health Questionnaire (PHQ‐9). Differences between the three groups and the effects of depression, sociodemographic factors and lifestyle factors on cognitive performance were evaluated using median regression. All analyses accounted for age, gender, ethnicity and level of education. Results After adjustment for sociodemographic factors, older and younger PLWH had poorer overall cognitive scores than older HIV‐negative controls (P < 0.001 and P = 0.006, respectively). Moderate or severe depressive symptoms were more prevalent in both older (27%; P < 0.001) and younger (21%; P < 0.001) PLWH compared with controls (8%). Depressive symptoms (P < 0.001) and use of hashish (P = 0.01) were associated with lower cognitive function; alcohol consumption (P = 0.02) was associated with better cognitive scores. After further adjustment for these factors, the difference between older PLWH and HIV‐negative controls was no longer significant (P = 0.08), while that between younger PLWH and older HIV‐negative controls remained significant (P = 0.01). Conclusions Poorer cognitive performances in PLWH compared with HIV‐negative individuals were, in part, mediated by the greater prevalence of depressive symptoms and recreational drug use reported by PLWH.
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Affiliation(s)
- D De Francesco
- Institute for Global Health, University College London, London, UK
| | - J Underwood
- Division of Infectious Diseases, Imperial College London, London, UK
| | - E Bagkeris
- Institute for Global Health, University College London, London, UK
| | - M Boffito
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - F A Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - Pwg Mallon
- University College Dublin School of Medicine, Dublin, Ireland
| | - J H Vera
- Brighton and Sussex Medical School, Brighton, UK
| | - I Williams
- Mortimer Market Centre, University College London, London, UK
| | - J Anderson
- Homerton University Hospital, London, UK
| | - M Johnson
- Royal Free Hospital NHS Trust, London, UK
| | - C A Sabin
- Institute for Global Health, University College London, London, UK
| | - A Winston
- Division of Infectious Diseases, Imperial College London, London, UK
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De Francesco D, Winston A, Underwood J, Cresswell FV, Anderson J, Post FA, Williams I, Mallon PW, Sachikonye M, Babalis D, Vera JH, Bagkeris E, Milinkovic A, Sabin CA. Cognitive function, depressive symptoms and syphilis in HIV-positive and HIV-negative individuals. Int J STD AIDS 2019; 30:440-446. [PMID: 30999830 DOI: 10.1177/0956462418817612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated associations between history of syphilis infection and both cognitive function and depressive symptoms in people living with HIV (PLHIV) and comparable HIV-negative controls. Syphilis serological tests, cognitive function and depression were assessed in PLHIV and controls participating in the Pharmacokinetic and Clinical Observations in People Over Fifty study. Cognitive test scores were converted to demographically adjusted T-scores (mean = 50, SD = 10) and then averaged to obtain a global T-score. Severity of depressive symptoms was assessed via the Patient Health Questionnaire-9. Associations of syphilis with global T-scores and depression were assessed using median regression. The 623 PLHIV and 246 HIV-negative controls were predominantly male (89.3% and 66.5%) with median age (interquartile range [IQR]) of 57 (53-63) and 58 (53-63) years, respectively. PLHIV had lower global cognitive T-scores (median [IQR] 48.7 [45.1, 52.1] versus 50.5 [47.0, 53.9], p < 0.001), more severe depressive symptoms (median [IQR] 4 [1, 10] versus 1 [0, 3], p < 0.001) and were more likely to report history of syphilis infection (22.0% versus 8.1%) than controls. There was no significant association between history of syphilis and global cognitive function in either PLHIV (p = 0.69) or controls (p = 0.10). Participants with a history of syphilis had more severe depressive symptoms (median [IQR] 4 [1, 9] versus 2 [0, 8], p = 0.03); however, the association became non-significant (p = 0.62) after adjusting for HIV status and potential confounders. Despite the higher prevalence of syphilis infection in PLHIV, there was no evidence of an association between history of syphilis infection and impaired cognitive function nor depressive symptoms after accounting for potential confounders.
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Affiliation(s)
| | - Alan Winston
- 2 Division of Infectious Diseases, Imperial College London, London, UK
| | | | - Fiona V Cresswell
- 3 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,4 Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Frank A Post
- 6 King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Daphne Babalis
- 10 Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Jaime H Vera
- 3 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,11 Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | - Ana Milinkovic
- 12 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
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A Biopsychosocial Approach to Managing HIV-Related Pain and Associated Substance Abuse in Older Adults: a Review. AGEING INTERNATIONAL 2018. [DOI: 10.1007/s12126-018-9333-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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12
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Moore RC, Marquine MJ, Straus E, Depp CA, Moore DJ, Schiehser DM, Richtand NM, Jeste DV, Eyler LT. Predictors and Barriers to Mental Health Treatment Utilization Among Older Veterans Living With HIV. Prim Care Companion CNS Disord 2017; 19. [PMID: 28157277 DOI: 10.4088/pcc.16m02059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022] Open
Abstract
Objective To identify key mood, social, and functional correlates of current participation in mental health treatment and barriers to participation in mental health treatment among older HIV infected (HIV+) veterans. Methods HIV+ veterans (N = 150) aged ≥ 50 years receiving HIV-related medical care at the VA San Diego Healthcare System, San Diego, California, anonymously completed a survey assessing current self-reported mood, social support, daily functioning problems, mental health service utilization, and barriers to participating in mental health services. Veterans also completed the 2-item Patient Health Questionnaire (PHQ-2), a validated depression screening instrument frequently used in primary care settings. Data were collected from February 2014 to May 2014. Results Overall, 44% of participants screened positive for depressive symptomatology on the PHQ-2; 55% of those who screened positive were participating in mental health treatment. Of the 45% of veterans who screened positive on the PHQ-2 and were not in treatment, two-thirds (66%) stated they had been offered services; however, they were not engaging in or accepting the services. Regardless of PHQ-2 status, current self-reported depressive symptoms emerged as an independent, significant positive predictor of participation in mental health treatment (odds ratio = 5.98; 95% CI, 1.16-30.72; P = .03), whereas anxiety, HIV-related stigma, sufficiency of social support, and daily functioning problems were not associated with mental health treatment utilization. Primary reported barriers to mental health treatment included scheduling/availability, travel time and transportation, and discomfort with group settings. Conclusions Results of this study suggest there may be a need to better engage older HIV+ veterans in depression-related treatment. The use of telehealth technology, such as teletherapy, electronic devices, and cell phone-based programs, may be beneficial in helping older HIV+ veterans overcome many barriers that restrict their participation in mental health treatment.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Drive, St B (8231), San Diego, CA 92103-8231. .,VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - Elizabeth Straus
- California School of Professional Psychology, Alliant International University, San Diego, California, USA
| | - Colin A Depp
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Dawn M Schiehser
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Neil M Richtand
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - Lisa T Eyler
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,The Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
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13
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Milanini B, Catella S, Perkovich B, Esmaeili-Firidouni P, Wendelken L, Paul R, Greene M, Ketelle R, Valcour V. Psychiatric symptom burden in older people living with HIV with and without cognitive impairment: the UCSF HIV over 60 cohort study. AIDS Care 2017; 29:1178-1185. [PMID: 28127989 DOI: 10.1080/09540121.2017.1281877] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Psychiatric comorbidities are common in people living with HIV (PLWH) and adversely affect life satisfaction, treatment adherence and disease progression. There are few data to inform the burden of psychiatric symptoms in older PLWH, a rapidly growing demographic in the U.S. We performed a cross-sectional analysis to understand the degree to which symptom burden was associated with cognitive disorders in PLWH over age 60. Participants completed a standardized neuropsychological battery and were assigned cognitive diagnoses using Frascati criteria. We captured psychiatric symptom burden using the Geriatric Depression Scale (GDS) and proxy-informed Neuropsychiatric Inventory-Questionnaire (NPI-Q). Those diagnosed with HIV-associated neurocognitive disorders (HAND, n = 39) were similar to those without HAND (n = 35) by age (median = 67 years for each group, p = 0.696), education (mean = 16 years vs. 17 years, p = 0.096), CD4+ T-lymphocyte counts (mean = 520 vs. 579, p = 0.240), duration of HIV (median = 21 years for each group, p = 0.911) and sex (92% male in HAND vs. 97% in non-HAND, p = 0.617). Our findings showed similarities in HAND and non-HAND groups on both NPI-Q (items and clusters) and GDS scores. However, there was a greater overall symptom burden in HIV compared to healthy elder controls (n = 236, p < 0.05), with more frequent agitation, depression, anxiety, apathy, irritability and nighttime behavior disturbances (p < 0.05). Our findings demonstrate no differences in psychiatric comorbidity by HAND status in older HIV participants; but confirm a substantial neurobehavioral burden in this older HIV-infected population.
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Affiliation(s)
- Benedetta Milanini
- a Memory and Aging Center , University of California, San Francisco , San Francisco , CA , USA
| | - Stephanie Catella
- a Memory and Aging Center , University of California, San Francisco , San Francisco , CA , USA
| | - Brandon Perkovich
- b School of Medicine , University of California, San Francisco , San Francisco , CA , USA
| | | | - Lauren Wendelken
- a Memory and Aging Center , University of California, San Francisco , San Francisco , CA , USA
| | - Robert Paul
- c Department of Psychology , University of Missouri-St. Louis , St. Louis , MO , USA
| | - Meredith Greene
- d Division of Geriatrics, Department of Medicine , University of California, San Francisco , San Francisco , CA , USA.,e San Francisco Veterans Affairs Medical Center , San Francisco , CA , USA
| | - Robin Ketelle
- a Memory and Aging Center , University of California, San Francisco , San Francisco , CA , USA
| | - Victor Valcour
- a Memory and Aging Center , University of California, San Francisco , San Francisco , CA , USA
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14
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The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study. BMC FAMILY PRACTICE 2016; 17:38. [PMID: 27036116 PMCID: PMC4815064 DOI: 10.1186/s12875-016-0440-0] [Citation(s) in RCA: 500] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022]
Abstract
Background Canadians’ health care-seeking behaviour for physical and mental health issues was examined using the international Quality and Cost of Primary Care (QUALICOPC) survey that was conducted in 2013 in Canada. Method This study used the cross-sectional Patient Experiences Survey collected from 7260 patients in 759 practices across 10 Canadian provinces as part of the QUALICOPC study. A Responsive Care Scale (RCS) was constructed to reflect the degree of health care-seeking behaviour across 11 health conditions. Using several patient characteristics as independent variables, four multiple regression analyses were conducted. Results Patients’ self-reports indicated that there were gender differences in health care-seeking behaviour, with women reporting they visited their primary care provider to a greater extent than did men for both physical and mental health concerns. Overall, patients were less likely to seek care for mental health concerns in comparison to physical health concerns. For both women and men, the results of the regressions indicated that age, illness prevention, trust in physicians and chronic conditions were important factors when explaining health care-seeking behaviours for mental health concerns. Conclusion This study confirms the gender differences in health care-seeking behaviour advances previous research by exploring in detail the variables predicting differences in health care-seeking behaviour for men and women. The variables were better predictors of health care-seeking behaviour in response to mental health concerns than physical health concerns, likely reflecting greater variation among those seeking mental health care. This study has implications for those working to improve barriers to health care access by identifying those more likely to engage in health care-seeking behaviours and the variables predicting health care-seeking. Consequently, those who are not accessing primary care can be targeted and policies can be developed and put in place to promote their health care-seeking behavior.
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15
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Montoya JL, Cattie J, Morgan E, Woods SP, Cherner M, Moore DJ, Atkinson JH, Grant I. The impact of age, HIV serostatus and seroconversion on methamphetamine use. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:168-77. [PMID: 26837461 DOI: 10.3109/00952990.2015.1114625] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Characterizing methamphetamine use in relation to age, HIV serostatus and seroconversion is pertinent given the increasingly older age of the population with HIV and the intertwined epidemics of methamphetamine use and HIV. OBJECTIVES Study aims were to investigate whether (i) methamphetamine use differs by age and HIV serostatus, and (ii) receiving an HIV diagnosis impacts methamphetamine use among younger and older persons with HIV. METHODS This study examined methamphetamine use characteristics among 217 individuals with a lifetime methamphetamine dependence diagnosis who completed an in-person study assessment. RESULTS Multivariable regressions revealed that HIV serostatus uniquely attenuates methamphetamine use, such that persons with HIV report a smaller cumulative quantity (β = -0.16, p = 0.01) and a fewer number of days (β = -0.18, p = 0.004) of methamphetamine use than persons without HIV. Among the HIV+ sample, all participants persisted in methamphetamine use after receiving an HIV diagnosis, with about 20% initiating use after seroconversion. Repeated measures analysis of variance indicated that density of methamphetamine use (i.e. grams per day used) was greater among the younger, relative to the older, HIV+ group (p = 0.02), and increased for both age groups following seroconversion (p < 0.001). CONCLUSION These analyses indicate that although HIV serostatus may attenuate methamphetamine use behaviors, many people with HIV initiate, or persist in, methamphetamine use after receiving an HIV diagnosis. These findings raise the question of whether tailoring of prevention and intervention strategies might reduce the impact of methamphetamine and HIV across the age continuum.
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Affiliation(s)
- Jessica L Montoya
- a Clinical Psychology, San Diego State University/University of California, San Diego Joint Doctoral Program , San Diego , CA , USA
| | - Jordan Cattie
- a Clinical Psychology, San Diego State University/University of California, San Diego Joint Doctoral Program , San Diego , CA , USA
| | - Erin Morgan
- b Translational Methamphetamine AIDS Research Center, Department of Psychiatry , School of Medicine, University of California, San Diego , La Jolla , CA , USA
| | - Steven Paul Woods
- b Translational Methamphetamine AIDS Research Center, Department of Psychiatry , School of Medicine, University of California, San Diego , La Jolla , CA , USA
| | - Mariana Cherner
- b Translational Methamphetamine AIDS Research Center, Department of Psychiatry , School of Medicine, University of California, San Diego , La Jolla , CA , USA
| | - David J Moore
- b Translational Methamphetamine AIDS Research Center, Department of Psychiatry , School of Medicine, University of California, San Diego , La Jolla , CA , USA
| | - J Hampton Atkinson
- b Translational Methamphetamine AIDS Research Center, Department of Psychiatry , School of Medicine, University of California, San Diego , La Jolla , CA , USA.,c VA San Diego Healthcare System , San Diego , CA , USA
| | - Igor Grant
- b Translational Methamphetamine AIDS Research Center, Department of Psychiatry , School of Medicine, University of California, San Diego , La Jolla , CA , USA
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- c VA San Diego Healthcare System , San Diego , CA , USA
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16
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Hammond ER, Crum RM, Treisman GJ, Mehta SH, Clifford DB, Ellis RJ, Gelman BB, Grant I, Letendre SL, Marra CM, Morgello S, Simpson DM, Mcarthur JC. Persistent CSF but not plasma HIV RNA is associated with increased risk of new-onset moderate-to-severe depressive symptoms; a prospective cohort study. J Neurovirol 2016; 22:479-87. [PMID: 26727907 DOI: 10.1007/s13365-015-0416-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/04/2015] [Accepted: 12/09/2015] [Indexed: 12/21/2022]
Abstract
Major depressive disorder is the most common neuropsychiatric complication in human immunodeficiency virus (HIV) infections and is associated with worse clinical outcomes. We determined if detectable cerebrospinal fluid (CSF) HIV ribonucleic acid (RNA) at threshold ≥50 copies/ml is associated with increased risk of depression. The CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) cohort is a six-center US-based prospective cohort with bi-annual follow-up of 674 participants. We fit linear mixed models (N = 233) and discrete-time survival models (N = 154; 832 observations) to evaluate trajectories of Beck Depression Inventory (BDI) II scores and the incidence of new-onset moderate-to-severe depressive symptoms (BDI ≥ 17) among participants on combination antiretroviral therapy (cART), who were free of depression at study entry and received a minimum of three CSF examinations over 2496 person-months follow-up. Detectable CSF HIV RNA (threshold ≥50 copies/ml) at any visit was associated with a 4.7-fold increase in new-onset depression at subsequent visits adjusted for plasma HIV RNA and treatment adherence; hazard ratio (HR) = 4.76, (95 % CI 1.58-14.3); P = 0.006. Depression (BDI) scores were 2.53 points higher (95 % CI 0.47-4.60; P = 0.02) over 6 months if CSF HIV RNA was detectable at a prior study visit in fully adjusted models including age, sex, race, education, plasma HIV RNA, duration and adherence of CART, and lifetime depression diagnosis by Diagnostic Statistical Manual (DSM-IV) criteria. Persistent CSF but not plasma HIV RNA is associated with an increased risk for new-onset depression. Further research evaluating the role of immune activation and inflammatory markers may improve our understanding of this association.
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Affiliation(s)
- Edward R Hammond
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | - Rosa M Crum
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Glenn J Treisman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.,Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David B Clifford
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Ronald J Ellis
- Department of Neurology, University of California, San Diego, CA, USA
| | - Benjamin B Gelman
- Department of Pathology, University of Texas, Medical Branch, Galveston, TX, USA
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Scott L Letendre
- Department of Medicine, University of California, San Diego, CA, USA
| | | | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David M Simpson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Justin C Mcarthur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Departments of Neurology and Pathology, Johns Hopkins University, Baltimore, MD, USA
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17
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Heckman TG, Heckman BD, Anderson T, Bianco JA, Sutton M, Lovejoy TI. Common Factors and Depressive Symptom Relief Trajectories in Group Teletherapy for Persons Ageing with HIV. Clin Psychol Psychother 2015; 24:139-148. [PMID: 26538241 DOI: 10.1002/cpp.1989] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 11/08/2022]
Abstract
Telepsychology research has focused primarily on treatment efficacy, with far less attention devoted to how common factors relate to teletherapy outcomes. This research identified trajectories of depressive symptom relief in 105 older people living with HIV with elevated depressive symptoms enrolled in a randomized clinical trial testing two 12-session group teletherapies and compared common factors (e.g., therapeutic alliance and group cohesion) across depressive symptom trajectory groups. Growth mixture modelling of weekly depression scores identified three depressive symptom change groups: (1) 'early improvers' (31%) who reported reductions in depressive symptoms by Session 4; (2) 'delayed improvers' (16%) whose symptoms improved after Session 5 and (3) 'non-improvers' (53%). Therapeutic alliance was unrelated to treatment outcome group. Group cohesion was greater in early improvers than non-improvers. Group cohesion was unexpectedly lower, and group member similarity was greater in delayed improvers than non-improvers. Early improvers had been living with HIV/AIDS for fewer years than non-improvers. In group teletherapy, group cohesion and group member similarity are more important than client-therapist alliance. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE In group teletherapy with older people living with HIV (OPLWHIV), three latent outcome trajectory groups emerged over the 12-week treatment period: (1) non-improvers (53%); (2) early improvers (31%) and (3) delayed improvers (16%). In group teletherapy with OPLWHIV, group cohesion is a stronger predictor of depressive symptom relief than is client-therapist alliance. OPLWHIV in group teletherapy who do not respond to treatment until the latter therapy sessions can still experience depressive symptom relief comparable with early responders.
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Affiliation(s)
- Timothy G Heckman
- College of Public Health, Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | | | | | - Joseph A Bianco
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Mark Sutton
- College of Public Health, Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Travis I Lovejoy
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
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18
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Heckman BD, Lovejoy TI, Heckman TG, Anderson T, Grimes T, Sutton M, Bianco JA. The moderating role of sexual identity in group teletherapy for adults aging with HIV. Behav Med 2015; 40:134-42. [PMID: 25090366 DOI: 10.1080/08964289.2014.925417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Older adults living with HIV/AIDS experience high rates of depression and suicidal ideation but are less likely than their younger counterparts to seek psychological services. HIV continues to disproportionately impact older men who have sex with men (MSM), many of whom were infected in their 20s and 30s. This study examined whether therapy attendance rates and the efficacies of two group-format teletherapies for the treatment of depression (coping effectiveness group training and supportive-expressive group therapy) were comparable for older MSM and older heterosexuals living with HIV. Intervention-outcome analyses found that older MSM and older heterosexuals living with HIV attended comparable numbers of teletherapy sessions. Older heterosexuals living with HIV who received telephone-administered supportive-expressive group therapy reported significantly greater reductions in depressive symptoms than SOC controls. A similar pattern was not found in older MSM. More research is needed to personalize and tailor group teletherapies for older MSM living with HIV.
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19
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Halkitis PN, Perez-Figueroa RE, Carreiro T, Kingdon MJ, Kupprat SA, Eddy J. Psychosocial burdens negatively impact HIV antiretroviral adherence in gay, bisexual, and other men who have sex with men aged 50 and older. AIDS Care 2014; 26:1426-34. [PMID: 24865599 DOI: 10.1080/09540121.2014.921276] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We sought to characterize HIV antiretroviral therapy (ART) adherence and psychosocial correlates of adherence in a sample of gay, bisexual, and other non-gay or -bisexual identified men who have sex with men aged 50 and over. As part of a cross-sectional study we recruited a community-based sample of 199 men and assessed adherence to current ART medications along four domains: (1) missing doses in the past 4 days, (2) taking doses on the specified schedule in the past 4 days, (3) following instructions about how to take the medications (e.g., to take medications with food), and (4) missing doses in the last weekend. A total adherence score was also computed. Bivariable analyses indicated negative associations between depression, sexual compulsivity, and HIV-related stigma with each of the individual adherence variables and the composite adherence score, while an older age was found to be protective. In multivariable analyses, controlling for age and educational attainment, a higher likelihood of missing doses and failing to follow instructions were related to higher levels of HIV-related stigma, while dosing off-schedule and missing doses on weekends was associated with higher levels of sexual compulsivity. These results indicate that psychosocial burdens undermine the adherence behaviors of older HIV-positive sexual minority men. Programming and services to address this compromising health behavior must embrace a holistic approach to health as informed by syndemics theory, while attending to the developmental and age-specific needs of older men.
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Affiliation(s)
- Perry N Halkitis
- a Department of Applied Psychology , New York University , New York , NY , USA
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20
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Psychosocial and demographic correlates of drug use in a sample of HIV-positive adults ages 50 and older. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2014; 14:618-27. [PMID: 23408281 DOI: 10.1007/s11121-012-0338-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The prevalence of HIV among adults 50 and older in the USA is increasing as a result of improvements in treatment and detection of HIV infection. Substance use by this population has implications for physical and mental health outcomes. We examined patterns of demographics, mental health, and recent substance use in a diverse sample of heterosexual, bisexual, and gay adults 50 and older living with HIV/AIDS (PLWHA) in New York City. The most commonly used substances were cigarettes or alcohol; however, the majority of the sample did not report recent use of marijuana, poppers, or hard drugs (crystal methamphetamine, cocaine, crack, heroin, ecstasy, GHB, ketamine, and LSD or PCP). Statistically significant associations between substance use and psychological states (well-being and loneliness) were generally weak, and depression scores were not significantly related to use; instead, drug use was associated with gender/sexual orientation. The study observations support addressing substance use specific to subpopulations within PLWHA.
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21
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Elliott JC, Aharonovich E, O’Leary A, Wainberg M, Hasin D. Drinking motives as prospective predictors of outcome in an intervention trial with heavily drinking HIV patients. Drug Alcohol Depend 2014; 134:290-295. [PMID: 24286967 PMCID: PMC3908664 DOI: 10.1016/j.drugalcdep.2013.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 10/22/2013] [Accepted: 10/22/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Heavy alcohol consumption in HIV patients is an increasing health concern. Applying the drinking motivational model to HIV primary care patients, drinking motives (drinking to cope with negative affect, for social facilitation, and in response to social pressure) were associated with alcohol consumption at a baseline interview. However, whether these motives predict continued heavy drinking or alcohol dependence in this population is unknown. METHODS Participants were 254 heavy-drinking urban HIV primary care patients (78.0% male; 94.5% African American or Hispanic) participating in a randomized trial of brief drinking-reduction interventions. Drinking motive scales, as well as measures of alcohol consumption and alcohol dependence, were administered at baseline. Consumption and dependence measures were re-administered at the end of treatment two months later. Regression analyses tested whether baseline drinking motive scale scores predicted continued heavy drinking and alcohol dependence status at the end of treatment, and whether motives interacted with treatment condition. RESULTS Baseline drinking to cope with negative affect predicted continued heavy drinking (p<0.05) and alcohol dependence, the latter in both in the full sample (adjusted odds ratio [AOR]=2.14) and among those with baseline dependence (AOR=2.52). Motives did not interact with treatment condition in predicting alcohol outcomes. CONCLUSIONS Drinking to cope with negative affect may identify HIV patients needing targeted intervention to reduce drinking, and may inform development of more effective interventions addressing ways other than heavy drinking to cope with negative affect.
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Affiliation(s)
- Jennifer C. Elliott
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032
| | - Efrat Aharonovich
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 180 Ft. Washington Avenue, New York, NY 10032,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Ann O’Leary
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333
| | - Milton Wainberg
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 180 Ft. Washington Avenue, New York, NY 10032,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 180 Ft. Washington Avenue, New York, NY 10032,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
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22
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Price CJ, Diana TM, Smith-Dijulio KL, Voss JG. Developing Compassionate Self-care Skills in Persons Living with HIV: a Pilot Study to Examine Mindful Awareness in Body-oriented Therapy Feasibility and Acceptability. Int J Ther Massage Bodywork 2013; 6:9-19. [PMID: 23730396 PMCID: PMC3666600 DOI: 10.3822/ijtmb.v6i2.197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Self-care skills for persons living with HIV (PLWH) are needed to better cope with the common symptoms and emotional challenges of living with this chronic illness. Purpose The purpose of this study was to examine the feasibility and acceptability of Mindful Awareness in Body-oriented Therapy (MABT) for individuals receiving medical management for HIV at an outpatient program. Setting A nonprofit outpatient day program that provided medical management to low-income individuals with HIV. Research Design A one group pre–post study design, nine participants were recruited to receive eight weekly MABT sessions of 1.25 hours each. Intervention MABT is designed to facilitate emotion regulation through teaching somatically-based self-care skills to respond to daily stressors. Main Outcome Measures To assess participant characteristics and study feasibility, a battery of health questionnaires and one week of wrist actigraphy was administered pre- and postintervention. A satisfaction survey and written questionnaire was administered postintervention to assess MABT acceptability. Results The results demonstrated recruitment and retention feasibility. The sample had psychological and physical health symptoms that are characteristic of PLWH. MABT acceptability was high, and participants perceived that they learned new mind-body self-care skills that improved HIV symptoms and their ability to manage symptoms. Conclusion The positive findings support a larger future study to examine MABT efficacy to improve coping with HIV symptoms among PLWH.
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Affiliation(s)
- Cynthia J Price
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
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23
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Major depressive disorder, cognitive symptoms, and neuropsychological performance among ethnically diverse HIV+ men and women. J Int Neuropsychol Soc 2013; 19:216-25. [PMID: 23290446 PMCID: PMC3785228 DOI: 10.1017/s1355617712001245] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Major depressive disorder (MDD), cognitive symptoms, and mild cognitive deficits commonly occur in HIV-infected individuals, despite highly active antiretroviral therapies. In this study, we compared neuropsychological performance and cognitive symptoms of 191 HIV-infected participants. Results indicated that participants with a formal diagnosis of current MDD performed significantly worse than participants without MDD in all seven neuropsychological domains evaluated, with the largest effect sizes in information processing speed, learning, and memory. In addition, a brief assessment of cognitive symptoms, derived from a comprehensive neuromedical interview, correlated significantly with neurocognitive functioning. Participants with MDD reported more cognitive symptoms and showed greater neurocognitive deficits than participants without MDD. These findings indicate that HIV-infected adults with MDD have more cognitive symptoms and worse neuropsychological performance than HIV-infected individuals without MDD. The results of this study have important implications for the diagnosis of HIV-associated neurocognitive disorders (HAND).
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Watkins CC, Treisman GJ. Neuropsychiatric complications of aging with HIV. J Neurovirol 2012; 18:277-90. [PMID: 22644745 DOI: 10.1007/s13365-012-0108-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/23/2012] [Accepted: 04/26/2012] [Indexed: 01/28/2023]
Abstract
Persons over age 50 are not only aging with human immunodeficiency virus (HIV) infection but also represent a high proportion of new HIV infections. Neuropsychiatric symptoms, including depression, cognitive impairment, and substance abuse, are very common in individuals infected with HIV. However, there is little understanding of the relationship between these HIV-related comorbid conditions in newly infected elderly patients compared to uninfected elderly and those who have survived after 20 years of HIV/AIDS. We summarize the current theories and research that link aging and HIV with psychiatric illnesses and identify emerging areas for improved research, treatment, and patient care.
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Affiliation(s)
- Crystal C Watkins
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Havlik RJ, Brennan M, Karpiak SE. Comorbidities and depression in older adults with HIV. Sex Health 2011; 8:551-9. [DOI: 10.1071/sh11017] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 05/24/2011] [Indexed: 12/14/2022]
Abstract
Objective
To investigate whether the high rates of depression found in older adults living with HIV are associated with the number and types of comorbidities. Methods: The Research on Older Adults with HIV (ROAH) study collected self-reported health data on ~1000 New York City HIV-positive men and women aged 50 years and older. Participants provided data on health problems experienced in the past year and depressive symptomatology (Center for Epidemiological Studies Depression Scale (CES-D)). Data were analysed using a non-parametric test of association and multiple regression analysis. Results: The correlation between CES-D scores and number of comorbidities was significant (r = 0.24). In multivariate analyses, depression remained a significant covariate of the number of comorbid conditions, in addition to female gender, inadequate income, history of drug and alcohol use, AIDS diagnosis and self-rated health. Correlations of depression with specific comorbidities varied. Significant correlations with sensory loss and dermatological problems were observed. Significant correlations existed with heart and respiratory conditions as well as fractures, but the directionality of these cross-sectional relationships is uncertain. Conclusions: The findings suggest the need for further longitudinal research to understand how high rates of depressive symptoms are related to comorbidities. Focussed clinical care that strives to prevent the collapse of the immune system must evolve into an effective treatment strategy for multimorbidities, where HIV is but one of many other chronic illnesses. If the management of depression continues to be a low priority, the older person with HIV may experience an avoidable reduction in life expectancy.
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Green TC, Kershaw T, Lin H, Heimer R, Goulet JL, Kraemer KL, Gordon AJ, Maisto SA, Day NL, Bryant K, Fiellin DA, Justice AC. Patterns of drug use and abuse among aging adults with and without HIV: a latent class analysis of a US Veteran cohort. Drug Alcohol Depend 2010; 110:208-20. [PMID: 20395074 PMCID: PMC3087206 DOI: 10.1016/j.drugalcdep.2010.02.020] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 02/23/2010] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
Abstract
This study characterized the extent and patterns of self-reported drug use among aging adults with and without HIV, assessed differences in patterns by HIV status, and examined pattern correlates. Data derived from 6351 HIV-infected and uninfected adults enrolled in an eight-site matched cohort, the Veterans Aging Cohort Study (VACS). Using clinical variables from electronic medical records and socio-demographics, drug use consequences, and frequency of drug use from baseline surveys, we performed latent class analyses (LCA) stratified by HIV status and adjusted for clinical and socio-demographic covariates. Participants were, on average, age 50 (range 22-86), primarily male (95%) and African-American (64%). Five distinct patterns emerged: non-users, past primarily marijuana users, past multidrug users, current high consequence multidrug users, and current low consequence primarily marijuana users. HIV status strongly influenced class membership. Non-users were most prevalent among HIV uninfected (36.4%) and current high consequence multidrug users (25.5%) were most prevalent among HIV-infected. While problems of obesity marked those not currently using drugs, current users experienced higher prevalences of medical or mental health disorders. Multimorbidity was highest among past and current multidrug users. HIV-infected participants were more likely than HIV-uninfected participants to be current low consequence primarily marijuana users. In this sample, active drug use and abuse were common. HIV-infected and uninfected Veterans differed on extent and patterns of drug use and on important characteristics within identified classes. Findings have the potential to inform screening and intervention efforts in aging drug users with and without HIV.
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Affiliation(s)
- Traci C Green
- Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States.
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Psychological well-being among individuals aging with HIV: the value of social relationships. J Acquir Immune Defic Syndr 2009; 51:91-8. [PMID: 19282781 DOI: 10.1097/qai.0b013e318199069b] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Utilizing a heterogenous sample of adults diagnosed with HIV infection, the current study sought to explore associations among age, various dimensions of social support, and psychological and functional well-being. METHODS Cross-sectional data capturing subjective and instrumental support, social interaction, behavioral health service utilization, and psychological well-being (ie, positive affect and depressive symptomatology), and physical functioning, were collected from 109 men and women living with HIV. To explore age group differences, participants were stratified by age (<54 vs. 55+ years). RESULTS Despite endorsing greater medical comorbidity, older adults reported significantly lower depressive symptomatology and greater positive affect and were less likely to report seeing a behavioral health specialist than their younger counterparts. No age group differences emerged for instrumental support or amount of social interaction. However, older adults reported higher subjective support, which in turn was associated with lower depressive symptomatology, greater positive affect, and nonutilization of behavioral health services. CONCLUSIONS More attention should be paid to the social environment of individuals diagnosed with HIV as the quality of social relationships may be particularly important for successful psychological adaptation to HIV.
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