Psychiatric considerations in the diagnosis, treatment, and prevention of HIV/AIDS

Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease

OBJECTIVE

The psychological and coping responses of the noninfected community towards infectious disease outbreaks are relatively understudied. This cross-sectional study sought to determine the prevalence of severe acute respiratory syndrome (SARS)-related psychiatric and posttraumatic morbidities and associated coping styles within the general population visiting community health care services.

METHODS

It was conducted on individuals attending community polyclinics in Singapore within the first week of July 2003, 16 weeks after the first national outbreak of SARS. The General Health Questionnaire-28, Impact of Event Scale-Revised, and Brief COPE were used to determine the prevalence rates of psychiatric and posttraumatic morbidities and employed coping strategies respectively.

RESULTS

The overall response rate was 78.0%. Of the 415 community health care setting respondents, we found significant rates of SARS-related psychiatric (22.9%) and posttraumatic morbidities (25.8%). The presence of psychiatric morbidity was associated with the presence of high level of posttraumatic symptoms [adjusted odds ratio (OR) 2.26, 95% confidence interval (CI) 1.24-4.13, P=.008]. Psychiatric morbidity was further associated with being seen at fever stations (adjusted OR 1.90, 95% CI 1.08-3.34, P=.026), younger age (adjusted OR 0.97, 95% CI 0.94-0.98, P=.021), increased self blame (adjusted OR 1.67, 95% CI 1.22-2.28, P=.001), less substance use (adjusted OR 0.74, 95% CI 0.56-0.98, P=.034) and posttraumatic morbidity was associated with increased use of denial (adjusted OR 1.31, 95% CI 1.04-1.67, P=.024), and planning (adjusted OR 1.51, 95% CI 1.16-1.95, P=.002) as coping measures.

CONCLUSION

These findings could potentially inform the development of practical community mental health programs for future infectious disease outbreaks.

The Need for Sociocultural Awareness to Maximize Treatment Acceptance and Adherence in Individuals Initiating HIV Therapy

Despite major advances in the long-term treatment of patients with HIV infection, there still exist sociocultural barriers to care. This article will focus on recognizing and understanding the cultural factors that affect treatment in patients starting antiretroviral therapy, most important the factors that can contribute to poor, as well as favorable, treatment adherence in diverse individuals. These factors include cultural and religious stigma; domestic violence; socioeconomic constraints, including literacy, living conditions, presence or absence of family, and social support networks; psychiatric disorders; and pregnancy. The authors also discuss ways in which clinicians can prepare patients for treatment initiation and improve their ongoing adherence by incorporating knowledge of these sociocultural differences into and modifying plans for patient care accordingly.