British Columbia Study Underscores Need for Mental Health Services for HIV-Positive People
- B.C. researchers compared health records of HIV-positive and HIV-negative patients.
- HIV-positive patients were twice as likely to be diagnosed with a mood disorder.
- Age, sexuality and injection drug use were associated with mental health diagnoses.
At least several studies have found that mental health conditions are more common among HIV-positive people than HIV-negative people. Some of these conditions include the following:
- bipolar depression
- schizoaffective disorders
- post-traumatic stress disorders
It is possible that biological, psychological and/or socio-economic factors play a role in the heightened risk for at least some of these mental health conditions. If mental health conditions are left undiagnosed, untreated or poorly managed, they can degrade overall health, quality of life and, in some cases, the ability to take HIV treatment (ART) exactly as directed.
Researchers at the BC Centre for Excellence in HIV/AIDS and at the University of British Columbia and Simon Fraser University collaborated in a study to compare rates of mental health conditions (also called major mood disorders) between HIV-positive and HIV-negative people. They found that, overall, rates of diagnosed mental health conditions were twice as high among HIV-positive people. The researchers found that HIV-positive people who had milder forms of mental health conditions and/or substance use were likely to subsequently develop more serious mental health problems. The researchers stated that these and other findings from their study "highlight the need for comprehensive and holistic HIV and mental health care."
The researchers accessed several databases that collected health-related information from HIV-positive and HIV-negative people, particularly one called the Comparative Outcomes and Service Utilization Trends (COAST). They focused on the diagnoses of new mood disorders among adults between 1998 and 2012, using data from a large group of HIV-positive people (6,546) and a representative sample of HIV-negative people (485,250).
All participants were in their mid-to-late 30s when they entered the study. All HIV-positive people had been prescribed ART.
Over the 14 years of the study, the proportions of people diagnosed with new mood disorders were distributed as follows:
- HIV-positive people -- 24%
- HIV-negative people -- 12%
This difference was statistically significant; that is, not likely due to chance alone.
The proportions of different people having mental health and associated issues were distributed as follows:
New mental health diagnoses by gender:
- HIV-positive -- 24%
- HIV-negative -- 16%
- HIV-positive -- 24%
- HIV-negative -- 9%
New mental health diagnoses and a history of injecting street drugs:
- HIV-positive -- 52%
- HIV-negative -- 1%
- HIV-positive -- 28%
- HIV-negative -- 2%
Focus on HIV-Positive People
Researchers found the following trends among HIV-positive people:
- Although there were no statistically significant differences in of rates of mental health diagnoses between HIV-positive men and HIV-positive women, one finding that did stand out was that a history of injecting street drugs was more common among women than men.
- People older than 60 years were less likely to develop a new mental health condition compared to people aged 19 to 29.
- Gay, bisexual and other men who have sex with men had higher rates of mental health diagnoses than heterosexual men.
Adherence and health
- People who were diagnosed with mental health conditions were more likely to miss refilling their prescriptions for ART and more likely to have lower CD4+ cell counts and higher viral loads than HIV-positive people who did not have these diagnoses.
Milder to more serious forms of illness
- People who developed initially milder forms of mental health disorders were at increased risk for subsequently developing more severe mental health diagnoses.
Bear in Mind
About 25% of HIV-positive participants were diagnosed with a mental health condition during the study. This is a large percentage of people and this finding caused the researchers to reflect on the mental and general health milieu of HIV-positive people in B.C. As a result of this reflection and after assessing results from other studies, the researchers made the following statements:
- Further research is needed "to explore gendered factors contributing to elevated incidence of mental health disorders, such as depression, experienced by women living with HIV who face multiple intersecting inequities and barriers to both HIV and mental health care. ... Critical efforts and research are needed to promote improved uptake and rollout of integrated mental health services for women living with HIV in B.C."
- "The combination of clinical symptoms, treatment side effects, addictions, stigma, discrimination and criminalization faced by [HIV-positive people] may mask symptoms of depression and create barriers to accessing mental health services, making identifying and diagnosing mental health conditions difficult for health care providers. Untreated mental health conditions have been associated with increased substance use, suicide, reduced adherence to ART and poorer treatment outcomes [in previous studies]."
- The findings from this study "indicate that milder forms of depression, generalized anxiety and problematic substance use are likely predictors of more serious forms of depression and bipolar disorders."
- "Efforts should be taken to address and identify mental health concerns and substance use early on, in order to improve treatment outcomes and the overall well-being of [HIV-positive people] as well as individuals living in the general B.C. population."
- "Increasing access to mental health and addiction services among [HIV-positive people] has been shown to be a cost-effective strategy and an important intervention for improving treatment outcomes and overall [survival].
In summarizing the implications of their findings, the researchers issued the following call: "Comprehensive mental health, addiction and concurrent infectious disease treatment should be included as standard care within the treatment of HIV in B.C., Canada and globally."
Large study finds mental health issues common among HIV-positive people -- TreatmentUpdate 219
Detectable viral loads linked to smoking and mental health issues -- TreatmentUpdate 219
Pushing back against challenges to mental health and emotional wellness -- TreatmentUpdate 204
- Closson K, Osborne C, Smith DM, et al. Factors associated with mood disorder diagnosis among a population-based cohort of men and women living with and without HIV in British Columbia between 1998 and 2012. AIDS and Behavior. 2018 May;22(5):1530-1540.
- Pence BW, Mills JC, Bengtson AM, et al. Association of increased chronicity of depression with HIV appointment attendance, treatment failure, and mortality among HIV-infected adults in the United States. JAMA Psychiatry. 2018 Apr 1;75(4):379-385.
- Sillman B, Woldstad C, Mcmillan J, et al. Neuropathogenesis of human immunodeficiency virus infection. Handbook of Clinical Neurology. 2018;152:21-40.
- Nanni MG, Caruso R, Mitchell AJ, et al. Depression in HIV-infected patients: a review. Current Psychiatry Reports. 2015 Jan;17(1):530.
- Yehia BR, Cui W, Thompson WW, et al. HIV testing among adults with mental illness in the United States. AIDS Patient Care and STD. 2014 Dec;28(12):628-34.
- George Dalmida S, Kraemer KR, Ungvary S, et al. The psychosocial and clinical well-being of women living with Human Immunodeficiency Virus/AIDS. Nursing Clinics of North America. 2018 Jun;53(2):203-225.
- Chaponda M, Aldhouse N, Kroes M, et al. Systematic review of the prevalence of psychiatric illness and sleep disturbance as co-morbidities of HIV infection in the UK. International Journal of STD and AIDS. 2018 Jun;29(7):704-713.
- Bengtson AM, Pence BW, Powers KA, et al. Trajectories of depressive symptoms among a population of HIV-infected men and women in routine HIV care in the United States. AIDS and Behavior. 2018 Oct;22(10):3176-3187.
- Rahimy E, Li FY, Hagberg L, et al. Blood-brain barrier disruption is initiated during primary HIV infection and not rapidly altered by antiretroviral therapy. Journal of Infectious Diseases. 2017 Apr 1;215(7):1132-1140.
- Choi SK, Boyle E, Cairney J, et al. Prevalence, recurrence, and incidence of current depressive symptoms among people living with HIV in Ontario, Canada: Results from the Ontario HIV Treatment Network Cohort Study. PLoS One. 2016 Nov 1;11(11):e0165816.
- Bengtson AM, Pence BW, Gaynes BN, et al. Improving depression among HIV-infected adults: Transporting the effect of a depression treatment intervention to routine care. Journal of Acquired Immune Deficiency Syndromes. 2016 Dec 1;73(4):482-488.
- Helleberg M, Pedersen MG, Pedersen CB, et al. Associations between HIV and schizophrenia and their effect on HIV treatment outcomes: a nationwide population-based cohort study in Denmark. Lancet HIV. 2015 Aug;2(8):e344-50.
- Nurutdinova D, Chrusciel T, Zeringue A, et al. Mental health disorders and the risk of AIDS-defining illness and death in HIV-infected veterans. AIDS. 2012 Jan 14;26(2):229-34.
- Hammond ER, Crum RM, Treisman GJ, et al. Persistent CSF but not plasma HIV RNA is associated with increased risk of new-onset moderate-to-severe depressive symptoms; a prospective cohort study. Journal of Neurovirology. 2016 Aug;22(4):479-87.
- Jallow A, Ljunggren G, Wändell P, et al. HIV infection and psychiatric illnesses -- A double-edged sword that threatens the vision of a contained epidemic: The Greater Stockholm HIV Cohort Study. Journal of Infection. 2017 Jan;74(1):22-28.
- Treisman GJ, Angelino AF, Hutton HE. Psychiatric issues in the management of patients with HIV infection. JAMA. 2001 Dec 12;286(22):2857-64.
[Note from TheBodyPRO: This article was originally published by CATIE on Oct. 9, 2018. We have cross-posted it with their permission.]