DID YOU KNOW?

In approximately one-half of people living with HIV/AIDS who have depression, the depression is both undiagnosed and untreated.11

A significant percentage of patients who commit suicide see their primary care clinician in the month before their suicide.12

U.S. Department of Health and Human Services
Health Resources and Services Administration

MENTAL HEALTH MATTERS

We found substantial and consistent evidence that chronic depression, stressful events, and trauma may negatively affect HIV disease progression.1

—Jane Leserman, University of North Carolina, Chapel Hill

Diagnosis and treatment of mental health issues are essential to the physical health and quality of life of people living with HIV/AIDS (PLWHA). Psychiatric disorders are a barrier to medical care and adherence to medications, and several studies have found that depression, stress, and trauma can lead to disease progression and increased mortality.2,3,4,5 The power of mental health treatment to reduce depression and anxiety, improve adherence and HIV health outcomes and, in turn, reduce the likelihood of death from AIDS-related causes speaks to the vital role of mental health care in the web of HIV care.6,7,8,9

The HIV Costs and Services Utilization Study (HCSUS) found that nearly 50 percent of adults being treated for HIV also have symptoms of a psychiatric disorder—prevalence that is 4 to 8 times higher than in the general population. Nineteen percent of patients studied showed signs of substance abuse, and 13 percent had co-occurring mental illness and substance abuse disorders.10

A more recent study of more than 1,000 PLWHA in North Carolina found even higher rates: 60 percent of study participants reported symptoms of mental illness, 32 percent reported substance use problems, and nearly 25 percent identified both symptoms of mental illness and substance use problems.13 High rates of depression and anxiety have been identified in PLWHA regardless of race, gender, or sexual orientation.14

People with serious mental illness are particularly vulnerable to HIV infection as a result of the higher prevalence among this group of a variety of factors, including poverty, homelessness, high-risk sexual activities, drug abuse, sexual abuse, and social marginalization. Estimates of HIV infection rates among people with mental illness vary widely from 3 percent to 23 percent; the average is about 7 percent. Their health outcomes remain poor.15

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REFERENCES
  1. Lesser J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70:539–45.
  2. Treisman GJ, Angelino AF, Hutton HE. Psychiatric issues in the management of patients with HIV infection. JAMA. 2001;286:2857–64. 3Lesser, 2008.
  3. Lesser, 2008.
  4. Starace F, Ammassari A, Trotta MP, et al. Depression is a risk factor for suboptimal adherence to highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31(Suppl 3):S136–9.
  5. Whetten K, Reif S, Whetten R, et al. Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care. Psychosom Med. 2008;70:531–8.
  6. Cook JA, Grey D, Burke J, et al. Depressive symptoms and AIDS-related mortality among a multisite cohort of HIV-positive women. Am J Public Health. 2004;94:1133–40.
  7. Kalichman SC. Co-occurrence of treatment nonadherence and continued HIV transmission risk behaviors: implications for positive prevention interventions. Psychosom Med. 2008;70:593–7.
  8. Carrico AW, Antoni MH. Effects of psychological interventions on neuroendocrine hormone regulation and immune status in HIV-positive persons: a review of randomized controlled trials. Psychosom Med. 2008;70:575–84.
  9. Horberg MA, Silverberg MJ, Hurley LB, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy on clinical outcomes in HIV-infected patients. J Acquir Immun Defic Syndr. 2008;47:384–90.
  10. Bing EG, Burnam A, Longshore D, et al. Psychiatric disorders and drug use among HIV-infected adults in the US. Arch Gen Psychiatry. 2001;58:721–8.
  11. Lesser, 2008.
  12. New York State Department of Health. Suicidality and violence in patients with HIV/AIDS. 2007. Accessed October 30, 2008.
  13. Whetten K, Reif S, Napravnik S, et al. Substance abuse and symptoms of mental illness among HIV-positive persons in the Southeast. South Med J. 2005;98:9–14.
  14. Whetten et al, 2008.
  15. Weiser SD, Wolfe WR, Bangsberg DR. The HIV epidemic among individuals with mental illness in the United States. Curr Infect Dis Rep. 2004;6:404–10.
  16. National Alliance of State and Territorial AIDS Directors. Mental Health Issue Brief: HIV and mental health: the challenges of dual diagnosis. 2005. Accessed October 15, 2008.
  17. Treisman et al, 2001.
  18. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158:725–30.
  19. Horberg et al, 2008.
  20. Horberg et al, 2008.
  21. Treisman et al, 2001.
  22. Clare DM, Kissane DW. Demoralization: its phenomenology and importance. Aust NZ J Psychiatry. 2002;36:733–42.
  23. Treisman et al, 2001.
  24. HIV/AIDS Bureau, Health Resources and Services Bureau. Tools for grantees: The Client Diagnostic Questionnaire (CDQ). n.d. Accessed October 21, 2008.
  25. Pence BW, Gaynes BN, Whetten K, et al. Validation of a brief screening instrument for substance abuse and mental illness in HIV-positive patients. J Aquir Immune Defic Syndr. 2005;40:434–44.
  26. Pence et al, 2005.
  27. RAND Corporation. Mental health and substance abuse among people with HIV: lessons from HCSUS. Santa Monica, CA: Author; 2007. Accessed October 15, 2008.
  28. RAND Corporation, 2007.
  29. Whetten et al., 2005.
  30. New York State Department of Health. Mental health care for people with HIV Infection: HIV clinical guidelines for the primary care practitioner. Table 1-1: crisis points for HIV-infected persons. 2001.
  31. Personal communication, Armando Smith, Chief Program Officer, Vital Bridges, October 2008.
  32. New York State Department of Health. The role of the primary care practitioner in assessing and treating mental health in persons with HIV. 2001 Accessed November 3, 2008.
  33. National Institute of Mental Health. Depression. 2007. Accessed November 3, 2008.
  34. National Institute of Mental Health. Anxiety disorders. 2008. Accessed November 3, 2008.
  35. Clare & Kissane, 2002.
  36. New York State Department of Health. Cognitive disorders and HIV/AIDS: minor cognitive disorder, HIV-associated dementia, and delirium. 2007. Accessed November 3, 2008.
  37. Coffey, S, Ed. AIDS Education and Training Centers National Resource Center. Clinical manual for management of the HIV-infected adult. 2006. Accessed November 3, 2008.
  38. Mental Health America. Fact sheet: personality disorders. 2006. Accessed November 3, 2008.
  39. AllPsych Online. Psychiatric disorders: substance related disorders. Accessed November 3, 2008.
  40. Smith, personal communication, 2008.
  41. New York/New Jersey AETC. Psychiatric medications and HIV antiretrovirals: a guide to interactions for clinicians. 2008. Accessed November 3, 2008.
  42. Emlet CA. An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS. Health Soc Work. 2006;31:299–308.
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