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Hu FH, Liu P, Jia YJ, Ge MW, Shen LT, Xia XP, Chen HL. Prevalence of mental health problems in people living with HIV: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2025; 30:397-413. [PMID: 39504439 DOI: 10.1080/13548506.2024.2424998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 10/29/2024] [Indexed: 11/08/2024]
Abstract
HIV remains a significant public health concern, with an estimation of 39 million people infected. There is a lack of universally accepted benchmarks for prevalence of mental health problems among people living with HIV. We aimed to compute aggregate estimates of mental health problems among people living with HIV. We conducted a comprehensive literature search in PubMed, Web of Science, and Embase. Our inclusion criteria encompassed peer-reviewed cross-sectional or longitudinal studies conducted in any country that investigated people living with HIV and provided data allowing us to determine the prevalence of mental health problems. We conducted a meta-analysis to determine the combined prevalence of mental health problems among people living with HIV and consider predefined moderators by subgroup meta-analysis and meta-regression analysis. Our initial search identified 31 407 records. After removing the duplication and excluding ineligible records, 240 studies were included in our meta-analysis. Six commonly reported mental health problems were identified (depression, anxiety, suicidal ideation, post-traumatic stress disorder, stigma, and psychological distress). The pooled prevalence was 31% (95% CI 28-34) for depression, 29% (24-34) for anxiety, 20% (17-24) for suicidal ideation, 20% (13-28) for post-traumatic stress disorder, 47% (40-55) for stigma, 44% (31-56) for psychological distress. After considering predefined moderators, the heterogeneity was still observed. A high prevalence of mental health problems was observed among people living with HIV. Effective prevention and treatment programs can alleviate symptoms and promote mental health. This, in turn, can have a positive impact on all aspects of HIV management, leading to improved overall health outcomes for people living with HIV.
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Affiliation(s)
- Fei-Hong Hu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Peng Liu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Yi-Jie Jia
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Lu-Ting Shen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Xiao-Peng Xia
- Department of Orthopaedics, Traditional Chinese Medical Hospital of Nantong City, Nantong, Jiangsu, PR China
| | - Hong-Lin Chen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
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den Boer LXY, Scheuermaier K, Tempelman HA, Barth RE, Devillé WLJM, Coutinho RA, Grobbee DE, Venter F, Vos-Seda AG, Klipstein-Grobusch K. The association of HIV status and depressive symptoms in the Ndlovu Cohort study. Sci Rep 2025; 15:4539. [PMID: 39915535 PMCID: PMC11803091 DOI: 10.1038/s41598-025-85830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 01/06/2025] [Indexed: 02/09/2025] Open
Abstract
HIV majorly contributes to the disease burden in South Africa. Depressive symptoms are common in people living with HIV (PLHIV). Few studies compared depressive symptoms between PLHIV and those without HIV. The aim of the study was to examine the association of HIV status and depressive symptoms. Moreover, the study aimed to explore the comparison between HIV-negative participants and the different HIV-positive sub-groups regarding their depressive symptoms. A cross-sectional analysis was conducted among PLHIV and HIV-negative participants in rural South Africa, using the baseline data of the Ndlovu Cohort study. Data was collected on demographics, socioeconomic status, and depressive symptoms using the PHQ-9 questionnaire. A score of 10 and above indicated depressive symptoms. Logistic regression analysis on the relationship between HIV status and depressive symptoms was used while adjusting for age, sex, level of education, employment status, income, and ever smoking. The study included 1,927 participants; 46% were PLHIV and 239 (12.5%) had depressive symptoms. PLHIV were more likely to have depressive symptoms than HIV-negative participants (OR 1.34, 95% CI 1.01-1.77). This association was not statistically significant after adjusting for confounders (OR 1.22, 95% CI 0.92-1.63). Compared to HIV-negative participants, ART (antiretroviral treatment) naïve participants had statistically significant higher odds of depressive symptoms (OR 1.84, 95% CI 1.20-2.78). This association remained after adjusting for confounders (OR 1.72, 95% CI 1.11-2.61). There was no statistically significant difference in depressive symptoms between HIV-negative participants and those on ART, regardless of treatment regimen. In general, higher odds of depressive symptoms in ART-naïve PLHIV could reflect poor coping with diagnosis of HIV. Future research to investigate the relation between ART regimen and depressive symptoms, to establish causality and to identify changes over time, is warranted.
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Affiliation(s)
- Li Xiang Y den Boer
- Julius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karine Scheuermaier
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Roos E Barth
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Walter L J M Devillé
- Julius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roel A Coutinho
- Julius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- PharmAccess Foundation, Amsterdam, The Netherlands
| | - Diederick E Grobbee
- Julius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alinda G Vos-Seda
- Julius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Rtbey G, Mihertabe M, Andualem F, Melkam M, Takelle GM, Tinsae T, Fentahun S. Anxiety and associated factors among medical and surgical patients in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0306413. [PMID: 39046996 PMCID: PMC11268606 DOI: 10.1371/journal.pone.0306413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Individuals diagnosed with chronic medical conditions and patients appointed to undergo surgery face various degrees of anxiety as a result of doubts related to the outcome of surgery, and the psycho-socioeconomic costs of the medical illness. This can affect the treatment process and even the outcome of patients with medical and surgical cases. Though different studies were conducted on anxiety and associated factors among medical and surgical patients in Ethiopia, the findings were found to be inconsistent and had a wide discrepancy. So, this systematic review and meta-analysis estimated the pooled effect size of anxiety among this population and guides to plan appropriate intervention at a national level. METHODS Studies conducted on anxiety and associated factors among medical and surgical patients in Ethiopia were included. Data was extracted using Microsoft Excel and analyzed using STATA version 11. The random-effects model was used to estimate the pooled effect size of anxiety and its determinants with 95% confidence intervals. Funnel plots and Egger's regression tests were employed to check publication bias. Sub-group and sensitivity analyses were also conducted. RESULTS The pooled prevalence of anxiety among medical and surgical patients in Ethiopia was found to be 48.82% with a 95% CI (42.66, 54.99). Being female[OR = 2.84(2.02, 4.01)], fear of death [OR = 2.93(1.57, 5.50)], and history of surgery[OR = 0.42(0.27, 0.065)], among surgical patients and being female[OR = 2.35(1.94, 2.850], having poor social support[OR = 2.22(1.62, 3.05)], perceived stigma[OR = 4.25(1.97, 9.18)] and family history of mental illness[OR = 1.86(1.21, 2.86)] among medical patients were significantly associated with anxiety in this systematic review and meta-analysis. CONCLUSION AND RECOMMENDATION The pooled prevalence of anxiety among medical and surgical patients in Ethiopia was found to be high. Therefore, it would be good for professionals to screen patients for anxiety besides managing their medical or surgical cases to detect them early and address them.
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Affiliation(s)
- Gidey Rtbey
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Milen Mihertabe
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Setegn Fentahun
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abbas Q, Nisa M, Khan MU, Anwar N, Aljhani S, Ramzan Z, Shahzadi M. Brief cognitive behavior therapy for stigmatization, depression, quality of life, social support and adherence to treatment among patients with HIV/AIDS: a randomized control trial. BMC Psychiatry 2023; 23:539. [PMID: 37491185 PMCID: PMC10367308 DOI: 10.1186/s12888-023-05013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE Individuals living with HIV/AIDs are at a high risk of many problems like depression, stigma, quality of life, decreased adherence to treatment, and lack of social support. The present study aimed to investigate the impact of brief-cognitive behavior therapy (B-CBT) on reducing depression and stigma and improving treatment adherence, quality of life, and social support among patients with HIV/AIDS attending antiretroviral therapy (ART). MATERIALS AND METHODS This randomized clinical trial was conducted at ART Clinic in the Tehsil Headquarters Hospital Shahkot Nankana Sahib from July 2021 to October 2021. After baseline screening, 126 patients met the eligibility criteria and 63 were allocated to the experimental group (EXPg = 63) and 63 to waitlist-control group (WLCg = 63). Participants' age range was from 20 to 55 years. Participants who were taking ART treatment were enrolled for the CBT treatment. Before this, all the participants completed a baseline assessment to ensure a level of severity and diagnosis. A total of eight CBT based therapeutic sessions were conducted individually with EXPg. To assess the outcomes among patients receiving ART, we used Demographic form, Patient health questionnaire, HIV stigma scale, General medication adherence scale, Multidimensional scale of perceived social support, and WHOQOL BREF scale. RESULTS Findings suggest that B-CBT significantly reduced the level of depression (i.e. F (1, 78) = 101.38, p < .000, η2 = .599), and social stigma (i.e. F (1, 78) = 208.47, p < .000, η2 = .787) among patients with HIV/AIDS. Furthermore, CBT substantially improved the level of adherence to treatment (i.e. F(1,78) = 24.75, p < .000, η2 = .503), social support (i.e. F (1, 78) = 128.33, p < .000, η2 = .606), and quality of life (i.e. F (1, 78) = 373.39, p < .000, η2 = .837) among patients with HIV/AIDS. Significant mean difference M(SD) on PHQ at post-analysis in the EXPg vs. WLCg was seen 1.22(0.47) vs. 2.30(0.68) and similarly, on MPSS at a post-analysis in the EXPg vs. WLCg 2.85(0.36) vs. 1.70(0.51) which indicates sound therapeutic outcomes. CONCLUSIONS Cognitive behavioral therapy effectively decreases the level of depression and stigma and enhances the level of social support, quality of life, and adherence to treatment among HIV/AIDS patients. It is concluded that cognitive behavior therapy is an effective treatment approach for patients with HIV/AIDS. TRIAL REGISTRATION Thai clinical trial registry (i.e. TCTR = TCTR20210702002 ).
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Affiliation(s)
- Qasir Abbas
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan.
| | - Mehru Nisa
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan
| | - Muhammad Umar Khan
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan
| | - Nida Anwar
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sumayah Aljhani
- Department of Psychiatry, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Zoobia Ramzan
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mafia Shahzadi
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan
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Davoudi M, Heydari A, Manzari ZS. Psychosocial Interventions by Nurses for Patients with HIV/ AIDS: A Systematic Review. J Caring Sci 2023; 12:94-102. [PMID: 37469749 PMCID: PMC10352634 DOI: 10.34172/jcs.2023.30726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/05/2022] [Indexed: 07/21/2023] Open
Abstract
Introduction Providing psychological support is one of the traditional roles of nurses for patients with HIV/AIDS. Searching the literature showed that various psychological interventions have been performed by nurses to support HIV/AIDS patients; however, no summary of these interventions is available. We aimed to systematically review the interventional studies which investigated the effectiveness of psychosocial interventions delivered by nurses to HIV/AIDS patients. Methods This systematic review was performed based on Cochrane's handbook of systematic reviews of interventional studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were used in this study. The databases of PubMed, Web of Science, Cochrane, Scopus and World Health Organization were searched from January 2009 to December 2022. Based on inclusion criteria, nine studies included in this systematic review. Cochrane data extraction form was used for the systematic review and the article's information was summarized using the modified Jadad scale. Results The interventions provided by the nurses included: virtual and face-to-face educational programs, written information resources, palliative care, motivational interview, case management, home visit, and care services, along with face-to-face and telephone follow-up. These interventions have a significant positive effect on the quality of life and management of high-risk behaviors, disease management, symptoms and complications, adherence to treatment, immune function, and mental health in patients with HIV/AIDS. Conclusion The results of the present study show that despite the fact that the interventions have a purely psychological content and can be done with various methods, they are able to have positive consequences in physical, psychological, behavioral, and laboratory health in HIV/AIDS patients.
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Affiliation(s)
- Malihe Davoudi
- Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sadat Manzari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Lang R, Hogan B, Zhu J, McArthur K, Lee J, Zandi P, Nestadt P, Silverberg MJ, Parcesepe AM, Cook JA, Gill MJ, Grelotti D, Closson K, Lima VD, Goulet J, Horberg MA, Gebo KA, Camoens RM, Rebeiro PF, Nijhawan AE, McGinnis K, Eron J, Althoff KN. The prevalence of mental health disorders in people with HIV and the effects on the HIV care continuum. AIDS 2023; 37:259-269. [PMID: 36541638 PMCID: PMC9782734 DOI: 10.1097/qad.0000000000003420] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe the prevalence of diagnosed depression, anxiety, bipolar disorder, and schizophrenia in people with HIV (PWH) and the differences in HIV care continuum outcomes in those with and without mental health disorders (MHDs). DESIGN Observational study of participants in the North American AIDS Cohort Collaboration on Research and Design. METHODS PWH (≥18 years) contributed data on prevalent schizophrenia, anxiety, depressive, and bipolar disorders from 2008 to 2018 based on International Classification of Diseases code mapping. Mental health (MH) multimorbidity was defined as having two or more MHD. Log binomial models with generalized estimating equations estimated adjusted prevalence ratios (aPR) and 95% confidence intervals for retention in care (≥1 visit/year) and viral suppression (HIV RNA ≤200 copies/ml) by presence vs. absence of each MHD between 2016 and 2018. RESULTS Among 122 896 PWH, 67 643 (55.1%) were diagnosed with one or more MHD: 39% with depressive disorders, 28% with anxiety disorders, 10% with bipolar disorder, and 5% with schizophrenia. The prevalence of depressive and anxiety disorders increased between 2008 and 2018, whereas bipolar disorder and schizophrenia remained stable. MH multimorbidity affected 24% of PWH. From 2016 to 2018 (N = 64 684), retention in care was marginally lower among PWH with depression or anxiety, however those with MH multimorbidity were more likely to be retained in care. PWH with bipolar disorder had marginally lower prevalence of viral suppression (aPR = 0.98 [0.98-0.99]) as did PWH with MH multimorbidity (aPR = 0.99 [0.99-1.00]) compared with PWH without MHD. CONCLUSION The prevalence of MHD among PWH was high, including MH multimorbidity. Although retention and viral suppression were similar to people without MHD, viral suppression was lower in those with bipolar disorder and MH multimorbidity.
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Affiliation(s)
- Raynell Lang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Brenna Hogan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jiafeng Zhu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Kristen McArthur
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Jennifer Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Judith A Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Canada
| | - David Grelotti
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Kalysha Closson
- School of Population and Public Health, University of British Columbia
| | - Viviane D Lima
- University of British Columbia & BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Joseph Goulet
- Yale School of Medicine & VA Connecticut Healthcare System, West Haven, Connecticut
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville
| | - Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Peter F Rebeiro
- Departments of Medicine & Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ank E Nijhawan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathleen McGinnis
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Joseph Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Kaaya S, Siril H, Fawzi MCS, Aloyce Z, Araya R, Kaale A, Kasmani MN, Komba A, Minja A, Mwimba A, Ngakongwa F, Somba M, Sudfeld CR, Larson E. A peer-facilitated psychological group intervention for perinatal women living with HIV and depression in Tanzania-Healthy Options: A cluster-randomized controlled trial. PLoS Med 2022; 19:e1004112. [PMID: 36512631 PMCID: PMC9746973 DOI: 10.1371/journal.pmed.1004112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/16/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Perinatal women living with HIV (PWLH) have a greater risk of depression compared to other women; however, there are limited specialized mental health services available to them. We aimed to determine whether a stepped-care intervention facilitated by trained lay providers can improve mental health outcomes postpartum for PWLH. METHODS AND FINDINGS Healthy Options is a cluster-randomized controlled study conducted in 16 government-managed antenatal care clinics that provided HIV care for pregnant women in urban Tanzania. Recruitment occurred from May 2015 through April 2016, with the final round of data collection completed in October 2017. Participants included a consecutive sample of pregnant women under 30 weeks of gestation, living with HIV and depression, and attending the study clinics. Control sites received enhanced usual care for depression (EUDC). Intervention sites received EUDC plus the Healthy Options intervention, which includes prenatal group sessions of problem-solving therapy (PST) plus cognitive behavioral therapy (CBT) sessions for individuals showing depressive symptoms at 6 weeks postdelivery. We assessed depressive symptoms comparable to major depressive disorder (MDD) using the Patient Health Questionnaire-9 (PHQ-9) with a locally validated cutoff at 9 months and 6 weeks postpartum. The primary time point is 9 months postpartum. We examined differences in outcomes using an intent-to-treat analysis with a complete case approach, meaning those with data at the relevant time point were included in the analysis. We used generalized estimating equations accounting for clustering. Of 818 women screened using the PHQ-9, 742 were determined eligible and enrolled (395 intervention; 347 control); 649 women (87.5%) participated in the first follow-up and 641 women (86.4%) in the second. A majority (270, 74.6%) of women in the intervention arm attended 5 or more PST sessions. Women enrolled in Healthy Options demonstrated a 67% (RR 0.33; 95% CI: 0.22, 0.51; p-value: <0.001; corresponding to a 25.7% difference in absolute risk) lower likelihood of depressive symptoms than women in control clusters at 6 weeks postpartum. At 9 months postpartum, women enrolled in Healthy Options demonstrated a nonsignificant 26% (RR 0.74; 95% CI: 0.42, 1.3; p-value: 0.281; corresponding to a 3.2% difference in absolute risk) lower likelihood of depressive symptoms than women in control clusters. Study limitations include not using diagnostic interviews to measure depression and not blinding data collectors to intervention status during follow-up. CONCLUSIONS The Healthy Options intervention did not demonstrate reduction in depressive symptoms at 9 months postpartum, the primary outcome. Significant reductions were seen in depression symptoms at 6 weeks postpartum, the secondary outcome. Stepped-care interventions may be relevant for improving outcomes in the critical early postpartum window. TRIAL REGISTRATION Clinical Trial registration number (closed to new participants) NCT02039973.
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Affiliation(s)
- Sylvia Kaaya
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hellen Siril
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Mary C. Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Zenaice Aloyce
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Ricardo Araya
- Centre for Global Mental Health, King’s College London, United Kingdom
| | - Anna Kaale
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Muhummed Nadeem Kasmani
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Amina Komba
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Anna Minja
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Angelina Mwimba
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Magreat Somba
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Elysia Larson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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8
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Musisi S, Nakasujja N. Psychiatric Problems in HIV Care. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.106077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Psychiatric problems associated with HIV/AIDS are many, varied and often bidirectional and they are often neglected. Their presence compromises HIV care and prevention efforts. Unaddressed, they compromise treatment outcomes, increase HIV virus–resistant strains, leave pockets of potential HIV spread in the community and lead to poor quality of life and early death of Persons Living With HIV/AIDS. This chapter focuses on specific HIV-associated mental disorders and their management. However, the mental health problems of HIV/AIDS go beyond disorders to include social, family and community problems such as the problems faced by AIDS orphans, widowhood, family disruptions, multiple deaths, bereavements, poverty, stigma, caregiver burden, education and occupational difficulties etc. All these need to be addressed in holistic HIV care. This calls for more research and integration of mental healthcare in all HIV/AIDS treatment and prevention programs.
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Chi D, de Terte I, Gardner D. Posttraumatic Growth and Posttraumatic Stress Symptoms in People with HIV. AIDS Behav 2022; 26:3688-3699. [PMID: 35666361 PMCID: PMC9550787 DOI: 10.1007/s10461-022-03697-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/27/2022]
Abstract
Receiving a diagnosis of HIV can be challenging. People with HIV (PWH) can experience high levels of distress, as well as some positive psychological changes associated with post-traumatic growth. However, the mechanisms which underlying the association of a highly stressful event (i.e., being diagnosed with HIV) and posttraumatic growth (PTG) and posttraumatic stress symptoms (PTSS) are under-explored, and this is the focus of the study. Cross-sectional survey data were provided by 77 PWH living in New Zealand. An analysis examined the roles of deliberate rumination and coping strategies as serial mediators of the associations between event centrality and PTG and PTSSs. The relationships between event centrality and PTG and PTSSs were found to be sequentially mediated by deliberate rumination and avoidance coping, but not by deliberate rumination and active coping. Further analyses explored active coping and deliberate rumination as parallel mediators, with avoidance coping as a subsequent mediator, between event centrality and PTG and PTSSs. However, these analyses were not supported. The findings indicate that the more participants appraised the HIV diagnosis as central, the greater PTG they perceived; however, the more they deliberately ruminated on it, and the more avoidance coping they adopted, the less PTG and greater PTSSs they perceived. Future studies need to explore the relationships of event centrality and coping and their associations with PTG and PTSSs.
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Affiliation(s)
- Danni Chi
- School of Psychology, Massey University, Wellington, New Zealand. .,Clinical Psychology Centre, Ningbo Kangning Hospital, Ningbo, China.
| | - Ian de Terte
- School of Psychology, Massey University, Wellington, New Zealand
| | - Dianne Gardner
- School of Psychology, Massey University, Palmerston North, New Zealand
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Nabunya P, Ssewamala FM, Bahar OS, Michalopoulos LTM, Mugisha J, Neilands TB, Trani JF, McKay MM. Suubi4Stigma study protocol: a pilot cluster randomized controlled trial to address HIV-associated stigma among adolescents living with HIV in Uganda. Pilot Feasibility Stud 2022; 8:95. [PMID: 35488323 PMCID: PMC9052650 DOI: 10.1186/s40814-022-01055-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) is heavily burdened by HIV, with 85% of the global new infections among adolescents happening in the region. With advances in medication and national policies promoting antiretroviral therapy (ART), children < 15 years living with HIV (CLWH) continue to grow with a chronic, highly stigmatized disease. Unfortunately, the stigma they experience results in much lower quality of life, including poor mental health and treatment outcomes. Family members also experience stigma and shame by virtue of their association with an HIV-infected family member. Yet, stigma-reduction interventions targeting CLWH and their families are very limited. The goal of this study is to address HIV-associated stigma among CLWH and their caregivers in Uganda. METHODS This three-arm cluster randomized control trial, known as Suubi4Stigma, will evaluate the feasibility, acceptability, and preliminary impact of two evidence-based interventions: (1) group cognitive behavioral therapy (G-CBT) focused on cognitive restructuring and strengthening coping skills at the individual level and (2) a multiple family group (MFG) intervention that strengthens family relationships to address stigma among CLWH (N = 90, 10-14 years) and their families (dyads) in Uganda. Nine clinics will be randomized to one of three study arms (n = 3 clinics, 30 child-caregiver dyads each): (1) usual care; (2) G-CBT + usual care; and (3) MFG + usual care. Both treatment and control conditions will be delivered over a 3-month period. Data will be collected at baseline (pre-intervention) and at 3 months and 6 months post-intervention initiation. CONCLUSION The primary aim of the proposed project is to address the urgent need for theoretically and empirically informed interventions that seek to reduce HIV-associated stigma and its negative impact on adolescent health and psychosocial well-being. As several countries in SSA grapple with care and support for CLWH, this study will lay the foundation for a larger intervention study investigating how HIV-associated stigma can be reduced to foster healthy child development-especially for CLWH as they transition through adolescence. TRIAL REGISTRATION ClinicalTrials.gov: NCT04528732 ; Registered August 27, 2020.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), St. Louis, USA.
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), St. Louis, USA
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), St. Louis, USA
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Lynn T M Michalopoulos
- The Moving Well Project International, Inc., Silver Spring, USA
- School of Social Work, Columbia University, New York City, USA
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Torsten B Neilands
- Division of Prevention Science, School of Medicine, University of California San Francisco, San Francisco, USA
| | - Jean-Francois Trani
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Mary M McKay
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
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11
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Matshoba T, Mashaphu S, Tomita A, Paruk S. HIV knowledge, attitudes and practices amongst patients with severe mental illnesses and chronic medical illnesses in Durban, South Africa. S Afr J Psychiatr 2021; 27:1586. [PMID: 34230865 PMCID: PMC8252175 DOI: 10.4102/sajpsychiatry.v27i0.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Studies exploring HIV knowledge, attitudes and practices (KAP) of individuals with severe mental illness (SMI) have suggested their poorer knowledge about HIV. In KwaZulu-Natal (KZN) province, South Africa (SA), the epicentre of the country's HIV epidemic, improving KAP is essential for reduce its incidence amongst individuals with SMI. Comparing the KAP related to HIV between those with SMI and chronic medical illnesses (CMI) such as hypertension and diabetes may expose gaps in KAP related to HIV in the mentally ill who are more vulnerable to HIV. AIM This study aimed to compare the KAP related to HIV between people living with SMI and CMI. SETTING Outpatient clinics in Durban, SA. METHODS A cross-sectional structured questionnaire survey was conducted amongst 214 adult outpatients with SMI and CMI attending two general public sector hospitals in Durban, KZN. The KAP questionnaire consisted of three sections: general information, prevention and transmission of HIV. RESULTS Interviews were conducted with 124 patients with SMI and 90 with CMI. Most were female (69.5%), single (57.5%) and unemployed (59.4%). The diagnosis of SMI was associated with poorer general information of HIV (p = 0.02), but not with its prevention and transmission compared with those with CMI. Educational level was associated with poorer performance in all three domains: general information of HIV (p = 0.01), prevention (p = 0.01) and transmission (p = 0.02) amongst all the participants. CONCLUSION Gaps in the KAP of HIV amongst individuals with SMI compared with those with CMI suggested a need to provide focused health promotion regarding sexual health and HIV to the mentally ill at psychiatric facilities.
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Affiliation(s)
- Thembeka Matshoba
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sibongile Mashaphu
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saeeda Paruk
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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12
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Dorney K, Murphy M. Recommendations for the medical work-up of first episode psychosis, including specific relevance to Indigenous Australians: A narrative review. Early Interv Psychiatry 2021; 15:423-438. [PMID: 32543124 DOI: 10.1111/eip.12980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 03/24/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
AIMS To collate existing literature for busy practicing psychiatrists about the medical work-up for first-episode psychosis (FEP). Therefore, (a) to review current guidelines for the medical work-up of first episode psychosis. (b) To examine whether any specific recommendations for Indigenous Australians exist. (c) To produce an easy reference table of evidence based investigations. METHOD A multi-part narrative review process was undertaken. Step 1 "Source identification and summary": identified key existing national and international guidelines and expert opinions related to the medical work-up of FEP and summarised these suggestions. Step 2 "Exploration of each investigation": examined each of the identified investigations for its importance. Step 3 "Relevance to Indigenous Australians": reviewed any particular relevance to the Indigenous Australian population. Step 4 "Clinician guide": involved presenting recommended investigations in a simple table. RESULTS Multiple guidelines were identified. There was clear consensus for many aspects. However, there were also differences in the approach for some investigations. Clinical reasoning for the proposed investigations was commonly absent. There were limited specific recommendations for Indigenous Australians. Evidence and importance was explored for each investigation and auseful table for the practicing psychiatrist was constructed. Investigations were stratified into those considered to be "universal," "low yield," or "unecessary." CONCLUSION A narrative review of multiple guidelines relating to the medical work-up of FEP identified many similarities and some differences to their approach. Little additional information exists for the Indigenous Australian context. A clinician friendly worksheet for everyday use may be helpful to busy clinicians.
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Affiliation(s)
- Kiernan Dorney
- Department of Psychiatry, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael Murphy
- Department of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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13
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Ruffieux Y, Efthimiou O, Van den Heuvel LL, Joska JA, Cornell M, Seedat S, Mouton JP, Prozesky H, Lund C, Maxwell N, Tlali M, Orrell C, Davies MA, Maartens G, Haas AD. The treatment gap for mental disorders in adults enrolled in HIV treatment programmes in South Africa: a cohort study using linked electronic health records. Epidemiol Psychiatr Sci 2021; 30:e37. [PMID: 33993900 PMCID: PMC8157506 DOI: 10.1017/s2045796021000196] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 12/22/2022] Open
Abstract
AIMS Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision of mental health services. METHODS We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15-49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15-49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression. RESULTS In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5-52.9) for patients followed-up in private care, 96.5% (95% CI 95.0-97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5-85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06-0.07), 50 (aRR 0.02, 95% CI 0.01-0.03) and 2.6 (aRR 0.39, 95% CI 0.35-0.43) times lower in public primary care programmes than in the private sector programmes. CONCLUSIONS There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated.
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Affiliation(s)
- Y. Ruffieux
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - O. Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - L. L. Van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - J. A. Joska
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - M. Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - S. Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - J. P. Mouton
- Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - H. Prozesky
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - C. Lund
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, King's Global Health Institute, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - N. Maxwell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - M. Tlali
- Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - C. Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - M.-A. Davies
- Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Western Cape Provincial Department of Health, Cape Town, South Africa
| | - G. Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - A. D. Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Smith HJ, Topp SM, Hoffmann CJ, Ndlovu T, Charalambous S, Murray L, Kane J, Sikazwe I, Muyoyeta M, Herce ME. Addressing Common Mental Health Disorders Among Incarcerated People Living with HIV: Insights from Implementation Science for Service Integration and Delivery. Curr HIV/AIDS Rep 2021; 17:438-449. [PMID: 32779099 DOI: 10.1007/s11904-020-00518-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Despite evidence of disproportionate burden of HIV and mental health disorders among incarcerated people, scarce services exist to address common mental health disorders, including major depressive and anxiety disorders, post-traumatic stress disorder, and substance use disorders, among incarcerated people living with HIV (PLHIV) in sub-Saharan Africa (SSA). This paper aims to summarize current knowledge on mental health interventions of relevance to incarcerated PLHIV and apply implementation science theory to highlight strategies and approaches to deliver mental health services for PLHIV in correctional settings in SSA. RECENT FINDINGS Scarce evidence-based mental health interventions have been rigorously evaluated among incarcerated PLHIV in SSA. Emerging evidence from low- and middle-income countries and correctional settings outside SSA point to a role for cognitive behavioral therapy-based talking and group interventions implemented using task-shifting strategies involving lay health workers and peer educators. Several mental health interventions and implementation strategies hold promise for addressing common mental health disorders among incarcerated PLHIV in SSA. However, to deliver these approaches, there must first be pragmatic efforts to build corrections health system capacity, address human rights abuses that exacerbate HIV and mental health, and re-conceptualize mental health services as integral to quality HIV service delivery and universal access to primary healthcare for all incarcerated people.
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Affiliation(s)
- Helene J Smith
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | | | - Christopher J Hoffmann
- The Aurum Institute, Johannesburg, South Africa
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | | | | | - Izukanji Sikazwe
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Monde Muyoyeta
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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15
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Haas AD, Technau KG, Pahad S, Braithwaite K, Madzivhandila M, Sorour G, Sawry S, Maxwell N, von Groote P, Tlali M, Davies MA, Egger M. Mental health, substance use and viral suppression in adolescents receiving ART at a paediatric HIV clinic in South Africa. J Int AIDS Soc 2020; 23:e25644. [PMID: 33283916 PMCID: PMC7720277 DOI: 10.1002/jia2.25644] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Mental health problems are prevalent in adolescents living with HIV (ALHIV), often remain untreated, and may negatively affect antiretroviral therapy (ART) adherence and viral suppression. We implemented routine mental health screening at a paediatric ART clinic to improve the identification and management of mental health problems in ALHIV. In this report, we examine screening outcomes, associated patient characteristics and the odds of unsuppressed viral load in ALHIV screening positive for mental disorders. METHODS Adolescents aged 10 to 19 years attending Rahima Moosa Hospital in Johannesburg, South Africa between February 1, 2018, and January 1, 2020, were offered mental health screening at each routine HIV care visit. The screening included four pre-screening questions followed by full screening (conditional on positive pre-screening) for depression (Patient Health Questionnaire-9 [PHQ-9]), suicide (Adolescent Innovations Project [AIP]-handbook), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), post-traumatic stress disorder (PTSD) (Primary Care PTSD Screen [PC-PTSD-5]) and substance use (CAGE Adapted to Include Drugs [CAGE-AID]). We assessed screening outcomes and calculated adjusted odds ratios for associations between positive screening tests at the first screen and unsuppressed viral load (>400 copies/mL) at the measurement taken closest to the date of screening, within hundred days before and one day after screening. RESULTS Out of 1203 adolescents who attended the clinic, 1088 (90.4%) were pre-screened of whom 381 (35.0%) underwent full screening, 48 (4.4%) screened positive for depression (PHQ-9 ≥10), 29 (2.8%) for suicidal concern, 24 (2.2%) for anxiety (GAD-7 ≥10), 38 (3.2%) for PTSD (PC-PTSD-5 ≥3), 18 (1.7%) for substance use (CAGE-AID ≥2) and 97 (8.9%) for any of these conditions. Positive screening for depression (aOR 2.39, 95% CI 1.02 to 5.62), PTSD (aOR 3.18, 95% CI 1.11 to 9.07), substance use (aOR 7.13, 95% CI 1.60 to 31.86), or any condition (aOR 2.17, 95% CI 1.17 to 4.02) were strongly associated with unsuppressed viral load. CONCLUSIONS ALHIV affected by mental health problems have increased rates of unsuppressed viral load and need specific clinical attention. The integration of routine mental health screening in paediatric ART programmes is a feasible approach for identifying and referring adolescents with mental health and adherence problems to counselling and psychosocial support services and if needed to psychiatric care.
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Affiliation(s)
- Andreas D Haas
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
| | - Karl-Günter Technau
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shenaaz Pahad
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate Braithwaite
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mampho Madzivhandila
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gillian Sorour
- Empilweni Services and Research Unit, Department of Paediatrics & Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Maxwell
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Per von Groote
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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16
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Effects of Supervised Exercise on Physical Health and Quality of Life Among Older Adults Living With HIV in Hong Kong. J Assoc Nurses AIDS Care 2020; 31:353-358. [PMID: 31094864 DOI: 10.1097/jnc.0000000000000099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abbamonte JM, Sawhney M, Alcaide ML, Weiss SM, Kumar M, Asfar T, Jones DL. The association of HIV and cocaine use to cigarette smoking in the context of depression and perceived stress. AIDS Care 2020; 32:1229-1237. [PMID: 32539456 PMCID: PMC7529880 DOI: 10.1080/09540121.2020.1778627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Mental well-being can contribute to cigarette smoking and negatively impact disease progression among people living with HIV (PLWH). This study examined potential associations between cocaine use (COC), depression, and HIV status in predicting cigarette smoking; hypothesizing that depression would be highest in cocaine users and predict cigarette smoking. An exploratory analysis including stress was also examined as a potential predictor of cigarette use. More than half of the sample (65%) endorsed smoking at some point in the past, and 52% endorsed being current smokers at the time of the study. Smokers were most likely to be cocaine users (87.1%), cocaine using PLWH (74.3%), or PLWH (36.6%). Neither HIV status (χ2(1) = 1.5, p = .221), perceived stress (χ2(1) = 0.75 p = .386), nor depressive symptomatology (χ2(1) = 1.2, p = .274) were related to smoking. Non-cocaine users were approximately 95.4% less likely to smoke than cocaine users, controlling for all other variables. Overall, cocaine use was the greatest predictor of cigarette smoking and quantity of cigarettes smoked. Perceived stress and depression were not associated with cigarette smoking in the sample. Future interventions targeting cigarette use should include a cocaine-related component to encourage smoking cessation among this high-risk group.
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Affiliation(s)
- J M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - M Sawhney
- Liffrig Family School of Education & Behavioral Sciences, University of Mary, Bismarck, ND, USA
| | - M L Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - S M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - M Kumar
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - T Asfar
- Department of Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
| | - D L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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18
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Association Between Magnesium Intake and Depressive Symptoms in People Living With HIV Infection. J Assoc Nurses AIDS Care 2020; 31:255-260. [PMID: 31592801 DOI: 10.1097/jnc.0000000000000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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[Psychiatric aspects in treatment of HIV]. MMW Fortschr Med 2020; 162:34-37. [PMID: 32583251 DOI: 10.1007/s15006-020-0643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Truter I, Gaida R, Grobler C. OUTCOMES OF PEOPLE LIVING WITH HIV IN TWO PUBLIC-SECTOR PSYCHIATRIC FACILITIES IN THE EASTERN CAPE USING EFAVIRENZ-CONTAINING REGIMENS. Afr J Infect Dis 2020; 14:10-15. [PMID: 33884345 PMCID: PMC8047287 DOI: 10.21010/ajid.v14i2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND People with mental disorders are more vulnerable to human immunodeficiency virus (HIV) infection. A part of first-line treatment for HIV, efavirenz, is routinely avoided in patients with mental illness due to the risk of potential aggravation of the mental illness. This study aimed to determine the outcomes of people living with HIV/AIDS who were mental healthcare users admitted to two public-sector psychiatric facilities and who were prescribed an efavirenz-containing regimen. MATERIALS AND METHODS A retrospective drug utilization study was conducted at two public-sector psychiatric hospitals in the Eastern Cape of South Africa. Patients aged 18 years or older living with HIV were included in the study. Follow-up reviews were conducted at four, 12 and 24 weeks. The patients were seen by doctors at the hospital and notes on progress and medication were recorded in medical records. The files were then reviewed. RESULTS A total of 37 patients were enrolled. However, just 26 were reviewed at 24 weeks. A total of 43.2% (n=16) were female patients and the average age of the patients was 39.38±8.76 years. At the baseline, 32.4% (n=12) patients were diagnosed with schizophrenia. A total of 81.08% (n=30) of patients experienced an improvement in psychiatric symptoms after 24 weeks. Of these, 43.3% (n=13) were on an efavirenz-containing regimen. CONCLUSION Majority of the patients demonstrated an improvement in their psychiatric conditions to the extent that they were discharged into the community. This finding suggests that patients with psychiatric disorders on efavirenz can experience stabilisation of their psychiatric symptoms.
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Affiliation(s)
- Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa
| | - Razia Gaida
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa
| | - Christoffel Grobler
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, Eastern Cape, South Africa
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21
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Chong SC, Ibrahim N, Ang JK, Masiran R, Tan KA, Andrew BN, Soh KY, Kumar S. The Role of Depression, Anxiety and Illness Characteristics on Risky Sexual Behaviour among People Living with HIV in A Malaysian Tertiary Reference Hospital. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082215666191022112412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background:
People living with HIV (PLHIV) have a longer lifespan with treatment and
continue to be sexually active. To date, the extent of risky sexual behaviour among local PLHIV
and its associated factors were undetermined.
Objective:
To examine the role of depression, anxiety and illness characteristics on risky sexual
behaviour among PLHIV attending care in a Malaysian tertiary reference hospital (N= 406).
Method:
It was a cross-sectional study. Subjects were recruited by systematic random sampling.
Risky sexual behaviour was determined by using the modified National Youth Risk Behaviour Survey.
PHQ-9 and GAD-7 were used to measure the depressive and anxiety symptoms, respectively.
Chi-square test was used to examine the association between the variables. Multiple logistic regression
was used to examine the predictors of the study. A p value of less than 0.05 was considered
significant and odds ratio was used as the measure of risk association.
Results:
Our study showed that 29.3% had risky sexual behaviour. Meanwhile, 21.9% and 26.4%
had depressive and anxiety symptoms, respectively. Risky sexual behaviour was significantly associated
with age, religion, education level, duration of HIV diagnosis, depressive and anxiety symptoms.
From multivariate logistic regression, duration of HIV diagnosis and anxiety symptoms significantly
predicted risky sexual behaviour.
Conclusion:
This study highlights that a substantial number of PLHIV had risky sexual behaviour
and psychological symptoms. It is important for psychological interventions that reduce risky sexual
behaviour among PLHIV who attend treatment, especially during the early phase.
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Affiliation(s)
- Seng Choi Chong
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Normala Ibrahim
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Jin Kiat Ang
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Ruziana Masiran
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Kit-Aun Tan
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Beatrice Ng Andrew
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Kwong-Yan Soh
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Suresh Kumar
- Department of Medicine, Hospital Sungai Buloh, 47000, Sungai Buloh, Selangor Darul Ehsan, Malaysia
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22
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Nabunya P, Byansi W, Sensoy Bahar O, McKay M, Ssewamala FM, Damulira C. Factors Associated With HIV Disclosure and HIV-Related Stigma Among Adolescents Living With HIV in Southwestern Uganda. Front Psychiatry 2020; 11:772. [PMID: 32848940 PMCID: PMC7411995 DOI: 10.3389/fpsyt.2020.00772] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
HIV-related stigma has been documented as one of the greatest obstacles to reducing HIV spread, engagement in HIV treatment, and poor mental health functioning among people living with HIV (PLWH). Although disclosure is important for people to receive social support, the fear of stigma and discrimination prevents PLWH from disclosing their status. For children and adolescents growing up with HIV -with no opportunity for normal transition through adolescence due to stigma, it is important to identify additional family and community support systems, to improve their acceptance and health outcomes, including mental health functioning. This study examined family communication and social support factors associated with HIV disclosure and HIV-related stigma among children and adolescents living with HIV in Uganda. Baseline data from an NICHD-funded Suubi+Adherence study (N=702) were analyzed. Adolescents (10-16 years) were eligible to participate if they were: 1) HIV positive and knew their HIV status, 2) prescribed antiretroviral therapy, 3) lived within a family, not an institution, and 4) enrolled in one of the 39 health centers in the study area. Multiple regression analyses were conducted to determine family communication (frequency and level of comfort communicating with caregiver), social support (perceived child-caregiver support and social support from classmates, close friends, teachers, and caregivers), associated with HIV disclosure, disclosure comfort, and HIV internalized and anticipated stigma. Results show that level of comfort communicating with a caregiver was significantly associated with how often children discussed their HIV status with other people (B = 0.02, 95% CI = 0.00, 0.03, p = 0.04), and level of HIV disclosure comfort (B = 0.08, 95% CI = 0.04, 0.13, p < 0.01). In addition, support from within the school environment, i.e., from teachers and classmates, was uniquely associated with both HIV disclosure and HIV-related stigma. Findings point to schools as potential for implementing HIV stigma-reduction programs. In addition, programming aimed at improving HIV care and treatment outcomes for adolescents living with HIV should consider incorporating both family communication strengthening and HIV-stigma reduction strategies in their efforts, in order to improve HIV health-related outcomes, including overall mental health functioning of HIV positive adolescents.
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Affiliation(s)
- Proscovia Nabunya
- Brown School, Washington University in St. Louis, St Louis, MO, United States.,International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - William Byansi
- Brown School, Washington University in St. Louis, St Louis, MO, United States.,International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St Louis, MO, United States.,International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Mary McKay
- Brown School, Washington University in St. Louis, St Louis, MO, United States
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, St Louis, MO, United States.,International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Christopher Damulira
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States
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23
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Zuñiga JA, Harrison ML, Henneghan A, García AA, Kesler S. Biomarkers panels can predict fatigue, depression and pain in persons living with HIV: A pilot study. Appl Nurs Res 2019; 52:151224. [PMID: 31987713 DOI: 10.1016/j.apnr.2019.151224] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/13/2019] [Accepted: 12/21/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Persons living with HIV experience high symptom burden that can negatively impact medication adherence, work productivity, and quality of life. Symptoms are highly subjective, which can lead to under- or improper treatment. The purpose of this exploratory study was to examine relationships between circulating biomarkers representative of inflammatory, coagulation, and vascular function pathways and prevalent HIV symptoms. SETTING AND SAMPLE Adults >18 years who were diagnosed with HIV and spoke English for this cross-sectional study were recruited from community clinics and organizations. METHODS Symptom burden was measured with the HIV Symptom Index; depression with the Patient Health Questionnaire. Human multiplex kits were used to determine serum concentrations of select biomarkers representing inflammatory, coagulation, and vascular function pathways. The biomarkers were included as features in machine learning models to determine which biomarkers predicted the most prevalent HIV symptoms (fatigue and muscle/joint pain) and the symptom of depression. RESULTS Participants (N = 32) were representative of the local population of people with HIV, being mostly Black (54.4%) and male (60.6%). Depression was predicted by age, gender, glucose, hemoglobin A1c, and inflammation. Muscle/joint pain was predicted by adiponectin, C-reactive protein, and serum amyloid A (SAA). Fatigue was predicted by adiponectin, SAA, and soluble interleukin-1 receptor type II (sIL-1RII). CONCLUSION Biomarker clusters can be a tool to monitor symptoms. Adding an objective measure to subjective patient experiences could improve management and monitoring of symptoms. Defining a biomarker cluster for the objective assessment of HIV symptoms warrants further investigation; however, the presence of comorbid conditions needs to be controlled.
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Affiliation(s)
- Julie A Zuñiga
- The University of Texas at Austin, School of Nursing, United States of America.
| | - Michelle L Harrison
- The University of Texas at Austin, College of Education, Department of Kinesiology and Health Education, United States of America
| | - Ashley Henneghan
- The University of Texas at Austin, School of Nursing, United States of America
| | - Alexandra A García
- The University of Texas at Austin, School of Nursing, United States of America
| | - Shelli Kesler
- MD Anderson, Department of Neuro-Oncology, Division of Cancer Medicine, United States of America
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24
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Masters MC, Krueger KM, Williams JL, Morrison L, Cohn SE. Beyond one pill, once daily: current challenges of antiretroviral therapy management in the United States. Expert Rev Clin Pharmacol 2019; 12:1129-1143. [PMID: 31774001 DOI: 10.1080/17512433.2019.1698946] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Modern antiretroviral therapy (ART) has revolutionized HIV treatment. ART regimens are now highly efficacious, well-tolerated, safe, often with one multi-drug pill, once-daily regimens available. However, clinical challenges persist in managing ART in persons with HIV (PWH), such as drug-drug interactions, side effects, pregnancy, co-morbidities, and adherence.Areas Covered: In this review, we discuss the ongoing challenges of ART for adults in the United States. We review the difficulties of initiating ART and maintaining therapy throughout adulthood and discuss new agents and strategies under investigation to address these issues. A PubMed search was utilized to identify relevant publications and guidelines through July 2019.Expert Opinion: Challenges persist in initiation and maintenance of ART. An individual's coexisting medical, social and personal factors must be considered in selecting and continuing ART to ensure safety, tolerability, and efficacy throughout adulthood. Continued development of new therapeutics and novel approaches to ART, such as long acting drugs or dual therapy, are needed to respond to many of these challenges. In addition, future research must address therapeutic disparities for populations historically underrepresented in clinical trials, including women, people aging with HIV, and those with complex comorbidities.
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Affiliation(s)
- Mary Clare Masters
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen M Krueger
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Janna L Williams
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lindsay Morrison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susan E Cohn
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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25
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Goutte J, Killian M, Antoine JC, Massoubre C, Fakra E, Cathébras P. [First-episode psychosis as primary manifestation of medical disease: An update]. Rev Med Interne 2019; 40:742-749. [PMID: 31421899 DOI: 10.1016/j.revmed.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/09/2019] [Accepted: 07/17/2019] [Indexed: 11/15/2022]
Abstract
A huge variety of medical diseases may potentially present with isolated psychotic symptoms, and disease-specific treatment or management is available for a significant part of them. The initial medical work-up of a first-episode psychosis (FEP) is of crucial importance. This literature review aimed to identify medical conditions potentially revealed by FEP, to list the warning signs of secondary psychosis, and to discuss a screening strategy. Underlying organic conditions may be drugs and medications, neurologic diseases, infections, inflammatory and/or autoimmune pathologies, and metabolic disorders whether of hereditary origin. Each patient presenting with a first-episode psychosis should be evaluated with a precise anamnesis, a careful clinical examination, and routine laboratory tests. Brain imaging and tests (depending on the context) should be performed in the presence of atypical clinical features or "red flags", leading to suspect an organic disease.
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Affiliation(s)
- J Goutte
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
| | - M Killian
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
| | - J C Antoine
- Service de neurologie, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
| | - C Massoubre
- Service de psychiatrie, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
| | - E Fakra
- Service de psychiatrie, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
| | - P Cathébras
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
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26
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Steinbrink J, Imlay H, Rao K, Riddell J. Identifying causes of persistent HIV viremia in adult patients at an academic medical center. SAGE Open Med 2019; 7:2050312119851006. [PMID: 31205698 PMCID: PMC6537052 DOI: 10.1177/2050312119851006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/24/2019] [Indexed: 12/05/2022] Open
Abstract
Objectives: Despite many advances in medicine, not all individuals with HIV are able to achieve complete virologic suppression. This retrospective study identifies variables associated with persistent HIV viremia in an academic clinic. Methods: We studied 66 HIV-infected patients with a viral load of >200 copies/mL over 1 year, with controls matched 1:1 via a propensity score utilizing age at diagnosis, era of diagnosis, gender, and initial CD4 count. We collected data on multiple variables including medications, adherence, comorbidities, hospitalizations, and insurance status. Conditional logistic regression was used for unadjusted and adjusted analyses. Results: A total of 66 viremic cases/matched controls were included. Fewer viremic patients were on antiretroviral therapy for all 12 months (45% vs 77%; odds ratio: 0.33, p = .018) and fewer were of white race (52% vs 70%; odds ratio: 0.49, p = .053). Hospitalization (11% vs 3%; odds ratio: 10, p = .028), underinsurance (20% vs 1%; odds ratio: 5.87, p = .022), and conflicting personal beliefs about their disease (17% vs 3%; odds ratio: 5.5, p = .027) were more common in viremic patients. Psychiatric illness increased the odds of viremia in patients who had four or more visits (odds ratio: 1.63/6.64 with four/five clinic visits, respectively). Conclusion: Psychiatric illness is an important contributor to the presence of persistent viremia in HIV-infected patients and deserves further study.
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Affiliation(s)
- Julie Steinbrink
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Division of Infectious Diseases, Duke University Hospital, Durham, NC, USA
| | - Hannah Imlay
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Krishna Rao
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
| | - James Riddell
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA
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27
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Bigna JJ, Tounouga DN, Kenne AM, Djikeussi TK, Foka AJ, Um LN, Asangbeh SL, Sibetcheu AT, Kaze AD, Ndangang MS, Nansseu JR. Epidemiology of depressive disorders in people living with HIV in Africa: a systematic review and meta-analysis: Burden of depression in HIV in Africa. Gen Hosp Psychiatry 2019; 57:13-22. [PMID: 30654293 DOI: 10.1016/j.genhosppsych.2018.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The burden of HIV infection is higher in Africa where 70% of people living with HIV (PLHIV) resides. Since depression can negatively impact the course of HIV infection, it is therefore important to accurately estimate its burden among PLHIV in the continent. METHODS We searched multiple databases to identify articles published between January 2000 and February 2018, reporting the prevalence of (major) depressive disorders in PLHIV residing in Africa. We used a random-effects meta-analysis model to pool studies. RESULTS Overall, 118 studies (60,476 participants, 19 countries) were included. There was no publication bias. The overall prevalence estimates of depressive disorders and probable major depressive disorders were 36.5% (95% CI 32.3-41.0; 101 studies) and 14.9% (12.1-17.9; 55 studies) respectively. The heterogeneity of the overall prevalence of depressive disorders was significantly explained by screening tool used, period (higher prevalence in recent studies) and distribution in sub-regions. The study setting, site, CD4 cell counts, age, sex, proportion of people with undetectable viral load were not sources of heterogeneity. CONCLUSIONS This study shows that more than one third of PLHIV face depressive disorders and half of them having major form, with heterogeneous distribution in the continent. As such, depressive disorders deserve more attention from HIV healthcare providers for improved detection and overall proper management.
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Affiliation(s)
- Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaounde, Cameroon.
| | | | | | - Tatiana K Djikeussi
- Department for the Control of Disease, Epidemics and Pandemics Diseases, Ministry of Public Health, Yaounde, Cameroon
| | - Audrey Joyce Foka
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Lewis N Um
- Mfou District Hospital, Ministry of Public Health, Mfou, Cameroon
| | - Serra Lem Asangbeh
- Department of Clinical Research, National Agency on Research for HIV and Viral Hepatitis, Yaounde, Cameroon
| | - Aurelie T Sibetcheu
- Department of Pediatrics and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
| | - Arnaud D Kaze
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Marie S Ndangang
- Department of Medical Information and Informatics, Rouen University Hospital, Rouen, France
| | - Jobert Richie Nansseu
- Department for the Control of Disease, Epidemics and Pandemics Diseases, Ministry of Public Health, Yaounde, Cameroon; Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon
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28
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Vitale A, Ryde J. Exploring Risk Factors Affecting the Mental Health of Refugee Women Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102326. [PMID: 30360458 PMCID: PMC6209869 DOI: 10.3390/ijerph15102326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/21/2022]
Abstract
Little is known about how the intersection of being a forced migrant and living with HIV can contribute to the development or exacerbation of pre-existing mental conditions. This study is set in this context and it aims to explore specific risk factors affecting the mental health of refugee women living with HIV. A total of eight refugee women living with HIV took part in the study; they were individually interviewed, and their transcripts were thematically analyzed. The overall findings indicated that participants’ mental health was impaired by multiple stressors associated with their conditions, such as racial discrimination, HIV-related stigma, including from health professionals, loneliness, and resettlement adversities. These all represent threats to public health, as they discourage individuals from engaging with adequate health/mental health services. Despite their situation, participants had not received psychological interventions and their healthcare was reduced to managing the physical symptoms of HIV. Participants indicated their need to take part in group interventions that could promote their mental health and social recovery. These findings are relevant to raising awareness about the specific risk factors affecting refugee women living with HIV and to provide evidence for public health interventions based on this specific population’s need.
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Affiliation(s)
- Agata Vitale
- College of Liberal Arts (CoLA), Bath Spa University, Newton Park, Bath BA29BN, UK.
| | - Judy Ryde
- Trauma Foundation South West, Barrow Castle, Rush Hill, Bath BA22QR, UK.
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29
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Guo Y, Hong YA, Qiao J, Xu Z, Zhang H, Zeng C, Cai W, Li L, Liu C, Li Y, Zhu M, Harris NA, Yang C. Run4Love, a mHealth (WeChat-based) intervention to improve mental health of people living with HIV: a randomized controlled trial protocol. BMC Public Health 2018; 18:793. [PMID: 29940921 PMCID: PMC6019517 DOI: 10.1186/s12889-018-5693-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/11/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND People living with HIV (PLWH) suffer from high rates of mental illness; but targeted effective interventions are limited, especially in developing countries. High penetration of smartphone usage and widespread acceptance of social media applications provide an unprecedented opportunity for mobile-based health interventions (mHealth interventions) in resource-limited settings like China. The current report describes the design and sample characteristics of the Run4Love randomized controlled trial (RCT) aimed at improving mental health in PLWH in China. METHODS A total of 300 PLWH with elevated depressive symptoms were recruited and randomized into either the intervention or control group. Participants in the intervention group received an adapted cognitive-behavioral stress management (CBSM) course delivered by the enhanced WeChat platform (for 3 months) and were motivated to engage in physical activities. Progress of the participants was automatically tracked and monitored with timely feedback and rewards. The control group received a brochure on nutrition for PLWH in addition to standard care. The outcome assessments are conducted at baseline, 3, 6, and 9 months using tablets. The primary outcome is depressive symptoms measured by the scale of the Center for Epidemiology Studies Depression (CES-D). Secondary outcomes include quality of life, chronic stress measured with biomarker of hair cortisol, and other measures of stress and depression, self-efficacy, coping, HIV-related stigma, physical activity, and patient satisfaction. Mixed effects model with repeated measures (MMRM) will be used to analyze the intervention effects. DISCUSSION The Run4Love study is among the first efforts to develop and evaluate a multicomponent and integrated mHealth intervention to improve the mental health and quality of life of PLWH. Once proven effective, Run4Love could be scaled up and potentially integrated into the routine case management of PLWH and adapted to other populations with chronic diseases. TRIAL REGISTRATION Chinese Clinical Trial Registry - ChiCTR-IPR-17012606 , registered on 07 September 2017.
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Affiliation(s)
- Yan Guo
- School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
- Center for Migrant Health Policy, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
| | - Y. Alicia Hong
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843 USA
| | - Jiaying Qiao
- Department of Infectious Disease, Guangzhou Number Eight People’s Hospital, #627 Dongfeng Road, Guangzhou, 510080 China
| | - Zhimeng Xu
- Johns Hopkins Bloomberg School of Public Health Baltimore, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Hanxi Zhang
- School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
- Center for Migrant Health Policy, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
| | - Chengbo Zeng
- School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
- Center for Migrant Health Policy, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
| | - Weiping Cai
- School of Public Health, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
- Center for Migrant Health Policy, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
| | - Linghua Li
- Department of Infectious Disease, Guangzhou Number Eight People’s Hospital, #627 Dongfeng Road, Guangzhou, 510080 China
| | - Cong Liu
- Johns Hopkins Bloomberg School of Public Health Baltimore, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Yiran Li
- Johns Hopkins Bloomberg School of Public Health Baltimore, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Mengting Zhu
- Johns Hopkins Bloomberg School of Public Health Baltimore, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Nathan Asher Harris
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, #74 Zhongshan 2nd Road, Guangzhou, 510080 China
| | - Cui Yang
- Johns Hopkins Bloomberg School of Public Health Baltimore, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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30
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Theall KP, Felker-Kantor E, Wallace M, Zhang X, Morrison CN, Wiebe DJ. Considering high alcohol and violence neighborhood context using daily diaries and GPS: A pilot study among people living with HIV. Drug Alcohol Depend 2018; 187:236-241. [PMID: 29684891 PMCID: PMC5959796 DOI: 10.1016/j.drugalcdep.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 02/07/2023]
Abstract
Our understanding of how community-level context impacts care of persons living with HIV (PLWH), including antiretroviral therapy (ART) adherence and retention in care, is limited. The objective of this study was to characterize the activity spaces of PLWH from an urban area in Southeastern U.S., where the epidemic is among the nation's highest, and to examine how such activity spaces are associated with daily mood and health behaviors. In this small, pilot study, 11 participants were tracked with a global positioning system (GPS)-enabled application on their smartphones for 2 weeks. Activity spaces were created by connecting GPS points sequentially and adding buffers. Contextual exposure data (e.g., alcohol outlets) were connected to activity spaces. Participants also completed daily diary entry through texts 3 times per day regarding outcomes of substance use behaviors, mood, and medication adherence. This yielded a total of 18,007 GPS polyline records that we aggregated into 258 person-days that captured discrete occasions of exposure to contextual factors and subjects' behaviors and moods. On average, the participants spent 19% of their time awake during the 2-week periods in their residential census tract. Exposure to social and built environment factors such as alcohol outlets was greater when participants were outside versus inside their residential census tract. Exposures on daily routes were also significantly associated with ART adherence, alcohol consumption, and mood. Findings suggest substantial differences between activity spaces and residential contexts. Activity spaces are relevant for PLWH and may impact HIV care and behavioral outcomes such as ART adherence and substance use.
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Affiliation(s)
- Katherine P Theall
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA; Louisiana State University Health Sciences Center Comprehensive Alcohol Research Center (CARC), 1901 Perdido Street, New Orleans, LA, 70112, USA.
| | - Erica Felker-Kantor
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA
| | - Maeve Wallace
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA; Louisiana State University Health Sciences Center Comprehensive Alcohol Research Center (CARC), 1901 Perdido Street, New Orleans, LA, 70112, USA
| | - Xiao Zhang
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA
| | - Christopher N Morrison
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Douglas J Wiebe
- University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
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Ng’ang’a PW, Mathai M, Obondo A, Mutavi T, Kumar M. Undetected psychiatric morbidity among HIV/AIDS patients attending Comprehensive Care Clinic (CCC) in Nairobi Kenya: towards an integrated mental health care. Ann Gen Psychiatry 2018; 17:11. [PMID: 29507598 PMCID: PMC5833144 DOI: 10.1186/s12991-018-0179-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric morbidity is commonly associated with HIV disease and may have adverse effects. This aspect may be overlooked at comprehensive HIV care centers in Low and Middle-Income Countries. OBJECTIVES The aim of this study was to determine the prevalence of undetected psychiatric morbidity among HIV/AIDS adult patients attending Comprehensive Care Centre in a semi-urban clinic, in Nairobi, Kenya. DESIGN Descriptive cross-sectional study of adult HIV patients not receiving any psychiatric treatment was conducted. PARTICIPANTS/METHODS The participants consisted of consecutive sample of adults (n = 245) attending HIV Comprehensive Care Clinic at Kangemi Health Centre, Nairobi. The Mini International Neuropsychiatric Interview (MINI) was administered to screen for undetected psychiatric morbidity. Socio-demographic characteristics were recorded in a questionnaire. Sample descriptive analysis was performed and prevalence of undetected psychiatric morbidity calculated. Chi-square test for independence was used to examine the associations between patient characteristics and undetected morbidity. Multivariable logistic regression analysis was performed to determine independent predictors of undetected psychiatric morbidity. RESULTS The mean age of our participants was 37.3 years (SD 9.2) Three-quarters (75.9%) of participants were females and median duration of HIV illness was 5 years. The prevalence of (previously undetected) psychiatric morbidity was 71.4% (95% CI 65.3-77). The leading psychiatric disorders were MDD (32.2%), PTSD (18.4%), Dysthymia (17.6%), and OCD (17.6%). Overall psychiatric morbidity was associated with low income ( CONCLUSION The burden of psychiatric morbidity in Kenyan HIV patients remains high and is most significantly associated with lower socioeconomic status. There is need to provide holistic care including screening for mental well-being all through the treatment of HIV patients in low-income settings.
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Affiliation(s)
- Pauline W. Ng’ang’a
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P O Box 19676, Nairobi, 00202 Kenya
| | - Muthoni Mathai
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P O Box 19676, Nairobi, 00202 Kenya
| | - Anne Obondo
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P O Box 19676, Nairobi, 00202 Kenya
| | - Teresia Mutavi
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P O Box 19676, Nairobi, 00202 Kenya
| | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P O Box 19676, Nairobi, 00202 Kenya
- Research Department of Clinical Health and Educational Psychology, University College London, London, WC1E 7HB UK
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Drury A, Gleadow-Ware S, Gilfillan S, Ahrens J. HIV and mental illness in Malawi and the neuropsychiatric sequelae of efavirenz. Malawi Med J 2018; 30:40-45. [PMID: 29868159 PMCID: PMC5974386 DOI: 10.4314/mmj.v30i1.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/18/2017] [Accepted: 11/05/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction Little is published about mental disorders in Malawi, specifically in relation to Human Immunodeficiency Virus (HIV) and it's treatment. Efavirenz is a medication commonly used as part of triple therapy for HIV treatment. Indeed, in 2013, Malawi introduced 5A with Efavirenz as part of it's 1st line treatment for HIV. There exists some literature documenting known psychiatric side effects of Efavirenz, which include anxiety, mood changes, nightmares, psychosis and suicidal ideation. Little is known about what features are most common in the presentation and what factors in the patient and drug which may make this reaction more likely. Aim The aim of this commentary is to review the association between HIV and psychiatric disorder, and consider the neuropsychiatric side-effects of Efavirenz. Method An evaluative literature review was completed by means of multiple electronic database search as well as an additional manual search to obtain published works identified through the electronic search. Search terms used were: Efavirenz, Acquired Immunodeficiency Syndrome, Africa, Antiretroviral Therapy, Developing Countries, Malawi, Mental Disorders, Public Health, and Psychiatry. Conclusion This is an important area of study, as potentially large numbers of individuals with HIV are being placed on Efavirenz as first line treatment, yet 60% may experience some form of neuropsychiatric side effects.
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Affiliation(s)
- Andrew Drury
- South London and Maudsley NHS Foundation Trust
- Scotland Malawi Mental Health Education Project
| | - Selena Gleadow-Ware
- Scotland Malawi Mental Health Education Project
- Honorary lecturer in psychiatry, University of Aberdeen
| | - Sheila Gilfillan
- Scotland Malawi Mental Health Education Project
- Herdmanflat Hospital, NHS Lothian
| | - Jen Ahrens
- Scotland Malawi Mental Health Education Project
- College of Medicine, Blantyre, Malawi
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Michlig GJ, Westergaard RP, Lam Y, Ahmadi A, Kirk GD, Genz A, Keruly J, Hutton H, Surkan PJ. Avoidance, meaning and grief: psychosocial factors influencing engagement in HIV care. AIDS Care 2018; 30:511-517. [PMID: 29338328 DOI: 10.1080/09540121.2018.1425366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Although the introduction of antiretroviral therapy has rendered HIV a chronic illness, inconsistent engagement in HIV care by key populations limits its public health impact. Poor engagement in care is especially prevalent among vulnerable populations with mental health and substance use disorders. Beyond structural and health system considerations, psychosocial factors may present challenges to sustained engagement. We conducted a qualitative study using in-depth interviews with 31 primarily African American, urban-based individuals, many with past or current drug use and mental disorders, living with HIV. Participants identified several psychosocial barriers that detract from their motivation to attend appointments and take medication. These included mental distress or detachment over a lack of purpose in life; denial about the need to be engaged in care; insufficient trust in the efficacy of care or the health system; deaths of loved ones leading to bereavement or loss of social support; and engagement in specific avoidance behaviors like drugs and alcohol. The study findings suggest that more comprehensive HIV care, which integrates mental health and substance abuse services in order to enhance meaning and address coping and grief, may be important. Considering these services in addition to improving the logistical components of care such as cues/reminders, accessibility, and patient-provider communication may improve intervention packages.
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Affiliation(s)
- Georgia J Michlig
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Ryan P Westergaard
- b University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Yukyan Lam
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Azal Ahmadi
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Gregory D Kirk
- a International Health , Johns Hopkins University , Baltimore , MD , USA.,c Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Andrew Genz
- a International Health , Johns Hopkins University , Baltimore , MD , USA
| | - Jeanne Keruly
- c Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Heidi Hutton
- c Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Pamela J Surkan
- a International Health , Johns Hopkins University , Baltimore , MD , USA
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Bigna JJ, Um LN, Asangbeh SL, Sibetcheu AT, Kazé AD, Nansseu JR. Prevalence and incidence of major depressive disorders among people living with HIV residing in Africa: a systematic review and meta-analysis protocol. Syst Rev 2018; 7:6. [PMID: 29329579 PMCID: PMC5767019 DOI: 10.1186/s13643-018-0672-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/03/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Depression represents one of the most frequent neuro-psychiatric diseases; it seems to be more prevalent in people living with HIV compared to the general population. However, summarized data in the African setting on the topic are scarce. This systematic review and meta-analysis aims at assessing the prevalence and incidence of major depressive disorders (MDD) in HIV-infected African populations residing in Africa. METHODS AND DESIGN This review will include observational studies conducted among HIV-infected people residing in Africa, which have reported either the prevalence or incidence of MDD or enough data for its appraisal. Relevant records will be searched using PubMed/Medline, EMBASE, African Journals Online, and Africa Index Medicus. In addition, reference lists of eligible papers and relevant review articles will be screened. Published studies from inception Jan 1, 2000 to Dec 31, 2017 will be considered regardless of language of publication. Two review authors will independently screen, select studies, and extract data, with discrepancies resolved by consensus or arbitration by a third review author. Methodological quality of included studies will be assessed using the scale developed by Hoy and colleagues. Funnel-plots and Egger's test will be used to determine publication bias. The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate. The heterogeneity will be evaluated by the χ2 test on Cochrane's Q statistic. Results will be presented by geographical region and antiretroviral therapy status. DISCUSSION This study is based on published data; therefore, ethical approval is not a requirement. The final report of this study in the form of a scientific paper will be published in a peer-reviewed journal and presented at scientific conferences. This review will help to have an overview of the burden of MDD among HIV-infected people residing in Africa. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42017058118 .
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Affiliation(s)
- Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, PO Box: 1274, Yaoundé, Cameroon
- School of Public Health, Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France
| | - Lewis N. Um
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Serra Lem Asangbeh
- Agence Nationale de Recherche sur le Sida et les hépatites virales, Yaoundé, Cameroon
| | - Aurelie T. Sibetcheu
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Arnaud D. Kazé
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Jobert Richie Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Department of Disease, Epidemics and Pandemics Control, Ministry of Public Health, Yaoundé, Cameroon
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Chang L, Lim A, Lau E, Alicata D. Chronic Tobacco-Smoking on Psychopathological Symptoms, Impulsivity and Cognitive Deficits in HIV-Infected Individuals. J Neuroimmune Pharmacol 2017; 12:389-401. [PMID: 28303534 PMCID: PMC5529218 DOI: 10.1007/s11481-017-9728-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/09/2017] [Indexed: 12/21/2022]
Abstract
HIV-infected individuals (HIV+) has 2-3 times the rate of tobacco smoking than the general population, and whether smoking may lead to greater psychiatric symptoms or cognitive deficits remains unclear. We evaluated the independent and combined effects of being HIV+ and chronic tobacco-smoking on impulsivity, psychopathological symptoms and cognition. 104 participants [27 seronegative (SN)-non-Smokers, 26 SN-Smokers, 29 HIV+ non-Smokers, 22 HIV+ Smokers] were assessed for psychopathology symptoms (Symptom Checklist-90, SCL-90), depressive symptoms (Center for Epidemiologic Studies-Depression Scale, CES-D), impulsivity (Barratt Impulsiveness Scale, BIS), decision-making (The Iowa Gambling Task, IGT, and Wisconsin Card Sorting Test, WCST), and cognition (seven neurocognitive domains). Both HIV+ and Smoker groups had higher SCL-90 and CES-D scores, with highest scores in HIV+ Smokers. On BIS, both HIV+ and Smokers had higher Total Impulsiveness scores, with higher behavioral impulsivity in Smokers, highest in HIV+ Smokers. Furthermore, across the four groups, HIV+ Smokers lost most money and made fewest advantageous choices on the IGT, and had highest percent errors on WCST. Lastly, HIV+ had lower z-scores on all cognitive domains, with the lowest scores in HIV+ Smokers. These findings suggest that HIV-infection and chronic tobacco smoking may lead to additive deleterious effects on impulsivity, psychopathological (especially depressive) symptoms and cognitive dysfunction. Although greater impulsivity may be premorbid in HIV+ and Smokers, the lack of benefits of nicotine in chronic Smokers on attention and psychopathology, especially those with HIV-infection, may be due to the negative effects of chronic smoking on dopaminergic and cardio-neurovascular systems. Tobacco smoking may contribute to psychopathology and neurocognitive disorders in HIV+ individuals.
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Affiliation(s)
- Linda Chang
- Neuroscience & MR Research Program, Department of Medicine, John A. Burns School of Medicine, University of Hawaii and Queen's Medical Center, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA.
| | - Ahnate Lim
- Neuroscience & MR Research Program, Department of Medicine, John A. Burns School of Medicine, University of Hawaii and Queen's Medical Center, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
| | - Eric Lau
- Neuroscience & MR Research Program, Department of Medicine, John A. Burns School of Medicine, University of Hawaii and Queen's Medical Center, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
| | - Daniel Alicata
- Neuroscience & MR Research Program, Department of Medicine, John A. Burns School of Medicine, University of Hawaii and Queen's Medical Center, 1356 Lusitana Street, 7th Floor, Honolulu, HI, 96813, USA
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Bahall M. Prevalence, patterns, and perceived value of complementary and alternative medicine among HIV patients: a descriptive study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:422. [PMID: 28830419 PMCID: PMC5567497 DOI: 10.1186/s12906-017-1928-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 08/15/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Use of complementary and alternative medicine (CAM) is widespread among different patient populations despite the availability of evidence-based conventional medicine and lack of supporting evidence for the claims of most CAM types. This study explored the prevalence, patterns, and perceived value of CAM among human immunodeficiency virus (HIV) patients. METHODS This quantitative descriptive study was conducted between November 1, 2014 and March 31, 2015 among a cross-sectional, convenience sample of attendees of the HIV clinic of a public tertiary health care institution. Face-to-face interviews using a 34-item questionnaire were conducted. Data analysis included descriptive statistics, chi-square tests, and binary logistic regression analysis. RESULTS CAM was used by 113 (32.8%) of a total of 343 HIV patients, but <1% informed their health care providers of CAM usage. Medicinal herbs were the most common type of CAM used (n = 110, 97.3%) followed by spiritual therapy (n = 56, 49.6%), including faith healing/prayer and meditation. The most used medicinal herbs were Aloe vera (n = 54, 49.1%), ginger (n = 33, 30.0%), and garlic (n = 23, 20.9%). The most used vitamins were complex B vitamins (n = 70, 61.9%), followed by vitamin A (n = 58, 51.3%), vitamin E (n = 51, 45.1%), and vitamin D (n = 42, 37.1%). Most CAM users continued using conventional medicine in addition to CAM and were willing to use CAM without supervision and without informing their health care provider. Patients were generally satisfied with CAM therapy (n = 91, 80.5%). The main reasons for CAM use were the desire to take control of their treatment (8.8%) or just trying anything that could help (18.8%). Main influences were the mass media (32.7%) and non-hospital health personnel (19.5%). Predictors of CAM use were being 30-50 years, married and having a secondary school education. CONCLUSION About one-third of HIV patients used CAM, but virtually none informed their healthcare provider. Medicinal herbs were the most common type of CAM, followed by spiritual therapy and vitamins. A patient's decision to use CAM was influenced for the most part by the mass media and non- hospital health care personnel.
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Affiliation(s)
- Mandreker Bahall
- School of Medicine and Arthur Lok Jack Graduate School of Business, University of the West Indies, St. Augustine, Trinidad and Tobago.
- Department of Medicine, San Fernando General Hospital, Chancery Lane, San Fernando, Trinidad and Tobago.
- , House #57 LP 62, Calcutta Road Number 3, McBean, Couva, Trinidad, Trinidad and Tobago.
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Nedelcovych MT, Manning AA, Semenova S, Gamaldo C, Haughey NJ, Slusher BS. The Psychiatric Impact of HIV. ACS Chem Neurosci 2017; 8:1432-1434. [PMID: 28537385 DOI: 10.1021/acschemneuro.7b00169] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This Viewpoint is based on a recent panel featured at the 2017 Winter Conference on Brain Research in which the psychiatric comorbidities of HIV infection were discussed. Psychiatric comorbid conditions occur at high rates in HIV infected patients, complicating treatment and contributing to poor outcomes. A complex relationship between HIV infection and psychiatric comorbidity is an active area of investigation, but increased awareness of the impact of psychiatric complications of NeuroAIDS is needed in both the laboratory and the clinic to better understand and treat these interrelated conditions.
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Affiliation(s)
| | | | - Svetlana Semenova
- Department
of Psychiatry, University of California San Diego, La Jolla, California 92093, United States
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Knights MJ, Chatziagorakis A, Kumar Buggineni S. HIV infection and its psychiatric manifestations: A clinical overview. BJPSYCH ADVANCES 2017. [DOI: 10.1192/apt.bp.116.016311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryHighly active antiretroviral therapy (HAART) has led to a reduction in HIV-related morbidity and mortality, and the life expectancy of HIV-positive individuals has improved significantly. It is therefore becoming more likely that clinicians will encounter patients with psychiatric manifestations of the disease. This review summarises the evidence on prevalence, manifestations and treatment of psychiatric conditions in HIV-positive adults. The most prevalent psychiatric illness in this population is depression (35.6%), followed by substance misuse, anxiety, psychosis, adjustment disorder and bipolar affective disorder. Neurocognitive impairment is also common, ranging in severity from asymptomatic (the most frequent) to dementia (the least frequent). Effective treatment of both HIV and psychiatric manifestations is essential to maximising life expectancy and quality of life.Learning Objectives• Comprehend the prevalence, manifestations and treatment of psychiatric conditions in HIV-positive individuals• Learn about the HIV-associated neurocognitive disorders• Develop an understanding of the relationship between HIV infection and psychiatric symptoms
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Oji VU, Hung LC, Abbasgholizadeh R, Terrell Hamilton F, Essien EJ, Nwulia E. Spiritual care may impact mental health and medication adherence in HIV+ populations. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2017; 9:101-109. [PMID: 28694708 PMCID: PMC5490435 DOI: 10.2147/hiv.s126309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore a potential role for spirituality in medication-related needs assessment for integrated care in chronically ill populations. METHOD A systematic literature review was conducted to explore the impact of faith beliefs on health and/or medication adherence in individuals with depression and/or HIV+/AIDS. Retrospective electronic medical record review of adult HIV+ patients of an urban primary care clinic with integrated mental health services was conducted, with Substance Abuse and Mental Illness Symptoms Screener (SAMISS), major depressive disorder (MDD) incidence over the preceding year, and history of contact with a spiritual advisor. A convenience sample was interviewed to qualitatively assess potential medication therapy management needs and medication-related problems. Another sample was examined utilizing the Daily Spiritual Experience Scale. RESULTS The literature reports positive influence on health behaviors, coping and outcomes; and poor medication adherence and treatment decisions due to patient passivity or resistance. Spiritual advisor contact (not limited to a specific religion) was significantly associated with MDD absence (1.7% vs. 15.3%, P<0.005) and inversely related to SAMISS, depression, and poor health behaviors. Patient interviews reflected significance of faith in terms of insight and acceptance of illness, the role or need for medications, coping, and medication adherence. An illustrative model was designed based on the literature and data collection. CONCLUSION Spiritual assessment may help identify positive or negative influence on health. Spiritual interventions could be beneficial in promoting adherence and positive health outcomes. Further research is recommended.
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Affiliation(s)
- Valerie U Oji
- Lifefountain Center Ministries Inc, Houston, TX, USA.,Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX, USA.,University of Texas, College of Pharmacy, Austin, TX, USA
| | - Leslie C Hung
- University of Texas, College of Pharmacy, Austin, TX, USA
| | - Reza Abbasgholizadeh
- Lifefountain Center Ministries Inc, Houston, TX, USA.,University of Houston, Houston, TX, USA
| | | | - E James Essien
- University of Houston Institute for Community Health, Houston, TX, USA
| | - Evaristus Nwulia
- Psychiatry, Howard University Translational Neuroscience Laboratory, Washington, DC, USA
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Dos Santos M, Wolvaardt G. Integrated intervention for mental health co-morbidity in HIV-positive individuals: A public health assessment. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:325-331. [PMID: 27974022 DOI: 10.2989/16085906.2016.1229683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In South Africa, where it is estimated that more people have HIV than anywhere else in the world, HIV/AIDS and psychological disorder co-morbidity have been shown both to exacerbate the late diagnosis and treatment of psychological disorders and to affect adherence to ARVs. Targeted, affordable and evidence-based strategies to reach these populations are essential. Against this backdrop, a pilot project and situational assessment aimed at determining the context of psychological care and HIV treatment services in South Africa was undertaken. The situational analysis consisted of individual interviews, a patient survey, and a retrospective medical record data review. Training and mentorship were conducted from 2011 to 2013 by the Foundation for Professional Development (FPD) in five anti-retroviral therapy (ART) clinics in the Tshwane-Metsweding area. Data were both descriptively and inferentially analysed. Outcomes indicate that the general structure of HIV services is well organised and well run in the sampled clinics. However, mental healthcare and HIV services need to be integrated further. There is also a need to develop and pilot-test appropriate materials and models for the delivery of mental healthcare within the parameters of affordability, acceptability and availability further, and to advocate the advancement of mental health and HIV treatment and policy integration.
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Affiliation(s)
- Monika Dos Santos
- a Department of Psychology , University of South Africa , Pretoria , South Africa
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Tesfaw G, Ayano G, Awoke T, Assefa D, Birhanu Z, Miheretie G, Abebe G. Prevalence and correlates of depression and anxiety among patients with HIV on-follow up at Alert Hospital, Addis Ababa, Ethiopia. BMC Psychiatry 2016; 16:368. [PMID: 27806711 PMCID: PMC5094082 DOI: 10.1186/s12888-016-1037-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 09/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression and anxiety disorders are common among people living with Human Immunodeficiency Virus than the non-infected individuals. The co-existence of these disorders are associated with barriers to treatment and worsening medical outcomes, including treatment resistance, increased risk for suicide, greater chance for recurrence and utilization of medical resources and/or increase morbidity and mortality. Therefore, assessing depression and anxiety among HIV patients has a pivotal role for further interventions. METHODS Institution based cross-sectional study was conducted at ALERT hospital May, 2015. Data were collected using a pretested, structured and standardized questionnaire. Systematic sampling technique was used to select the study participants. Binary logistic regression analysis was used to identify associated factors. Odds ratio with 95 % CI was computed to assess the strength of associations. RESULTS The prevalence of co-morbid depression and anxiety among HIV patients was 24.5 % and prevalence of depression and anxiety among HIV patients was 41.2 % (172) and 32.4 % (135) respectively. Multivariate analysis showed that individual who had perceived HIV stigma (AOR = 3.60, 95 % CI (2.23, 5.80), poor social support (AOR = 2.02, 95 % CI (1.25, 3.27), HIV stage III (AOR = 2.80, 95 % CI (1.50, 5.21) and poor medication adherence (AOR = 1.61, 95 % CI (1.02, 2.55) were significantly associated with depression. Being female (AOR = 3.13, 95 % CI (1.80, 5.44), being divorced (AOR = 2.51, 95 % CI (1.26, 5.00), having co morbid TB (AOR = 2.74, 95 % CI (1.37, 5.47) and perceived HIV stigma (AOR = 4.00, 95 % CI (2.40, 6.69) were also significantly associated with anxiety. CONCLUSION Prevalence of depression and anxiety was high. Having perceived HIV stigma, HIV Stage III, poor social support and poor medication adherence were associated with depression. Whereas being female, being divorced and having co morbid TB and perceived HIV stigma were associated with anxiety. Ministry of health should give training on how to screen anxiety and depression among HIV patients and should develop guidelines to screen and treat depression and anxiety among HIV patients.
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Affiliation(s)
- Getachew Tesfaw
- Department of psychiatry, Felege Hiwot Referral hospital, Bahirdar University, Bahirdar, Ethiopia
| | - Getinet Ayano
- Research and training department, Amanuel mental specialized hospital, Addis Ababa, Ethiopia
| | - Tadesse Awoke
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dawit Assefa
- Research and training department, Amanuel mental specialized hospital, Addis Ababa, Ethiopia
| | - Zelalem Birhanu
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getenet Miheretie
- Department of psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Genet Abebe
- Department of non communicable diseases, Addis Ababa Health office, Addis Ababa, Ethiopia
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Choi SKY, Boyle E, Cairney J, Collins EJ, Gardner S, Bacon J, Rourke SB. 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; 11:e0165816. [PMID: 27802346 PMCID: PMC5089724 DOI: 10.1371/journal.pone.0165816] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/18/2016] [Indexed: 12/16/2022] Open
Abstract
Introduction Current studies of depression among people living with HIV focus on describing its point prevalence. Given the fluctuating nature of depression and its profound impacts on clinical and quality-of-life outcomes, this study aimed to examine the prevalence, recurrence and incidence of current depressive symptoms and its underlying catalysts longitudinally and systematically among these individuals. Methods We conducted a prospective cohort study between October 1, 2007 and December 31, 2012 using longitudinal linked data sources. Current depressive symptoms was identified using the Centre for Epidemiologic Studies Depression Scale or the Kessler Psychological Distress Scale, first at baseline and again during follow-up interviews. Multivariable regressions were used to characterize the three outcomes. Results Of the 3,816 HIV-positive participants, the point prevalence of depressive symptoms was estimated at 28%. Of the 957 participants who were identified with depressive symptoms at baseline and who had at least two years of follow-up, 43% had a recurrent episode. The cumulative incidence among 1,745 previously depressive symptoms free participants (at or prior to baseline) was 14%. During the five-year follow-up, our multivariable models showed that participants with greater risk of recurrent cases were more likely to feel worried about their housing situation. Participants at risk of developing incident cases were also likely to be younger, gay or bisexual, and unable to afford housing-related expenses. Conclusions Depressive symptoms are prevalent and likely to recur among people living with HIV. Our results support the direction of Ontario’s HIV/AIDS Strategy to 2026, which addresses medical concerns associated with HIV (such as depression) and the social drivers of health in order to enhance the overall well-being of people living with or at risk of HIV. Our findings reinforce the importance of providing effective mental health care and demonstrate the need for long-term support and routine management of depression, particularly for individuals at high risk.
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Affiliation(s)
- Stephanie K Y Choi
- The Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Eleanor Boyle
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - John Cairney
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.,Infant and Child Health Lab, McMaster University, Hamilton, Ontario, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.,Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Collins
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,University Health Network, Toronto, Ontario, Canada
| | - Sandra Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jean Bacon
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Sean B Rourke
- Ontario HIV Treatment Network, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,St. Michael's Hospital, Toronto, Ontario, Canada
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Diagnostic validity of the Patient Health Questionnaire-2 (PHQ-2) among Ethiopian adults. Compr Psychiatry 2016; 70:216-21. [PMID: 27567282 PMCID: PMC5108453 DOI: 10.1016/j.comppsych.2016.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/10/2016] [Accepted: 07/26/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The Patient Health Questionnaire-2 (PHQ-2) is an ultra-brief questionnaire widely used by researchers and clinicians to detect major depressive disorder (MDD). Despite its individual and societal impact, MDD is often undetected and untreated particularly among sub-Saharan Africans. We conducted this study to evaluate the reliability and validity of using the PHQ-2 as a screen for MDD among Ethiopian adults. METHODS A total of 926 adults attending outpatient departments in a major referral hospital in Addis Ababa, Ethiopia participated in this study. Construct validity was assessed by examining associations of PHQ-2 scores with World Health Organization Quality of Life (WHO-QOL) domains. We assessed criterion validity and performance characteristics against an independent, blinded, and psychiatrist administered semi-structured Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. RESULTS The PHQ-2 items showed good reliability (intraclass correlation coefficient=0.92). Quality of life, as reflected by subscale scores for four WHO-QOL domains, was significantly lower among patients with increasing PHQ-2 scores demonstrating good construct validity. ROC analysis and Youden Index showed that a PHQ-2 threshold score of 3 offered optimal discriminatory power with respect to the diagnosis of MDD via the clinical interview (sensitivity=74% and specificity=60%). CONCLUSION The Amharic language version of the PHQ-2 had good sensitivity and fair specificity for detecting MDD compared against a psychiatrist administered SCAN diagnosis. This study provides evidence for the PHQ-2 as a reliable and valid ultra-brief screening tool for initial identification of MDD.
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Douet V, Tanizaki N, Franke A, Li X, Chang L. Polymorphism of Kynurenine Pathway-Related Genes, Kynurenic Acid, and Psychopathological Symptoms in HIV. J Neuroimmune Pharmacol 2016; 11:549-61. [PMID: 27072370 PMCID: PMC6502481 DOI: 10.1007/s11481-016-9668-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 03/23/2016] [Indexed: 01/02/2023]
Abstract
HIV-infection is associated with neuroinflammation and greater psychopathological symptoms, which may be mediated by imbalances in the kynurenic pathway (KP). Two key KP enzymes that catabolize kynurenine include kynurenine-aminotransferase II (KATII), which yields antioxidative kynurenine acid [KYNA] in astrocytes, and kynurenine-3-monooxygenase (KMO), which produces neurotoxic metabolites in microglia. The relationships between polymorphisms in KMO and KATII, psychopathological symptoms, and cerebrospinal fluid (CSF) [KYNA] were evaluated in subjects with and without HIV-infection. Seventy-two HIV-positive and 72-seronegative (SN) participants were genotyped for KATII-rs1480544 and KMO-rs1053230. Although our participants were not currently diagnosed with depression or anxiety, they were assessed for psychopathological distress with Center for Epidemiologic Studies-Depression scale and Symptom Checklist-90-Revised. CSF-[KYNA] was also measured in 100 subjects (49 HIV/51 SN). HIV-participants had more psychopathological distress than SN, especially for anxiety. KATII-by-HIV interactions were found on anxiety, interpersonal sensitivity and obsessive compulsivity; KATII-C-carriers had lower scores than TT-carriers in SN but not in HIV. In contrast, the KMO-polymorphism had no influence on psychopathological symptoms in both groups. Overall, CSF-[KYNA] increased with age independently of HIV-serostatus, except KATII-TT-carriers tended to show no age-dependent variations. Therefore, the C-allele in KATII-rs1480544 appears to be protective against psychopathological distress in SN but not in HIV individuals, who had more psychopathological symptoms and likely greater neuroinflammation. The age-dependent increase in CSF-[KYNA] may reflect a compensatory response to age-related inflammation, which may be deficient in KATII-TT-carriers. Targeted treatments that decrease neuroinflammation and increase KYNA in at risk KATII-TT-carriers may reduce psychopathological symptoms in HIV.
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Affiliation(s)
- Vanessa Douet
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i and Queen's Medical Center, 1356 Lusitana Street, 7th Floor, Room 716, Honolulu, HI, 96813, USA.
| | - Naomi Tanizaki
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i and Queen's Medical Center, 1356 Lusitana Street, 7th Floor, Room 716, Honolulu, HI, 96813, USA
| | - Adrian Franke
- The University of Hawai'i Cancer Center, University of Hawai'i at Manoa, Honolulu, HI, USA
| | - Xingnan Li
- The University of Hawai'i Cancer Center, University of Hawai'i at Manoa, Honolulu, HI, USA
| | - Linda Chang
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i and Queen's Medical Center, 1356 Lusitana Street, 7th Floor, Room 716, Honolulu, HI, 96813, USA.
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Bachis A, Forcelli P, Masliah E, Campbell L, Mocchetti I. Expression of gp120 in mice evokes anxiety behavior: Co-occurrence with increased dendritic spines and brain-derived neurotrophic factor in the amygdala. Brain Behav Immun 2016; 54:170-177. [PMID: 26845379 PMCID: PMC4828280 DOI: 10.1016/j.bbi.2016.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/20/2016] [Accepted: 01/31/2016] [Indexed: 01/28/2023] Open
Abstract
Human immunodeficiency virus type 1 (HIV) infection of the brain produces cognitive and motor disorders. In addition, HIV positive individuals exhibit behavioral alterations, such as apathy, and a decrease in spontaneity or emotional responses, typically seen in anxiety disorders. Anxiety can lead to psychological stress, which has been shown to influence HIV disease progression. These considerations underscore the importance of determining if anxiety in HIV is purely psychosocial, or if by contrast, there are the molecular cascades associated directly with HIV infection that may mediate anxiety. The present study had two goals: (1) to determine if chronic exposure to viral proteins would induce anxiety-like behavior in an animal model and (2) to determine if this exposure results in anatomical abnormalities that could explain increased anxiety. We have used gp120 transgenic mice, which display behavior and molecular deficiencies similar to HIV positive subjects with cognitive and motor impairments. In comparison to wild type mice, 6 months old gp120 transgenic mice demonstrated an anxiety like behavior measured by open field, light/dark transition task, and prepulse inhibition tests. Moreover, gp120 transgenic mice have an increased number of spines in the amygdala, as well as higher levels of brain-derived neurotrophic factor and tissue plasminogen activator when compared to age-matched wild type. Our data support the hypothesis that HIV, through gp120, may cause structural changes in the amygdala that lead to maladaptive responses to anxiety.
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Affiliation(s)
- Alessia Bachis
- Laboratory of Preclinical Neurobiology, Department of Neuroscience, Georgetown University Medical Center Washington DC 20057
| | - Patrick Forcelli
- Department of Pharmacology and Physiology, Georgetown University Medical Center Washington DC 20057
| | - Eliezer Masliah
- Departments of Pathology and Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Lee Campbell
- Laboratory of Preclinical Neurobiology, Department of Neuroscience, Georgetown University Medical Center Washington DC 20057,Department of Pharmacology and Physiology, Georgetown University Medical Center Washington DC 20057
| | - Italo Mocchetti
- Laboratory of Preclinical Neurobiology, Department of Neuroscience, Georgetown University Medical Center, Washington, DC 20057, USA.
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Yator O, Mathai M, Vander Stoep A, Rao D, Kumar M. Risk factors for postpartum depression in women living with HIV attending prevention of mother-to-child transmission clinic at Kenyatta National Hospital, Nairobi. AIDS Care 2016; 28:884-9. [PMID: 27045273 DOI: 10.1080/09540121.2016.1160026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mothers with HIV are at high risk of a range of psychosocial issues that may impact HIV disease progression for themselves and their children. Stigma has also become a substantial barrier to accessing HIV/AIDS care and prevention services. The study objective was to determine the prevalence and severity of postpartum depression (PPD) among women living with HIV and to further understand the impact of stigma and other psychosocial factors in 123 women living with HIV attending prevention of mother-to-child transmission (PMTCT) clinic at Kenyatta National Hospital located in Nairobi, Kenya. We used the Edinburgh Postnatal Depression Scale and HIV/AIDS Stigma Instrument - PLWHA (HASI - P). Forty-eight percent (N = 59) of women screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported high levels of stigma. Multivariate analyses showed that lower education (OR = 0.14, 95% CI [0.04-0.46], p = .001) and lack of family support (OR = 2.49, 95% CI [1.14-5.42], p = .02) were associated with the presence of elevated depressive symptoms. The presence of stigma implied more than ninefold risk of development of PPD (OR = 9.44, 95% CI [1.132-78.79], p = .04). Stigma was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to women to address mental health problems especially depression screening and offering psychosocial treatments bolstering quality of life of the mother-baby dyad.
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Affiliation(s)
- Obadia Yator
- a Department of Psychiatry , University of Nairobi , Nairobi , Kenya
| | - Muthoni Mathai
- a Department of Psychiatry , University of Nairobi , Nairobi , Kenya
| | - Ann Vander Stoep
- b Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , WA , USA.,c Department of Epidemiology , University of Washington , Seattle , WA , USA
| | - Deepa Rao
- b Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , WA , USA.,d Department of Global Health , University of Washington , Seattle , WA , USA
| | - Manasi Kumar
- a Department of Psychiatry , University of Nairobi , Nairobi , Kenya
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Le HN, Hipolito MMS, Lambert S, Terrell-Hamilton F, Rai N, McLean C, Kapetanovic S, Nwulia E. Culturally Sensitive Approaches to Identification and Treatment of Depression among HIV Infected African American Adults: A Qualitative Study of Primary Care Providers' Perspectives. JOURNAL OF DEPRESSION & ANXIETY 2016; 5:223. [PMID: 27347445 PMCID: PMC4916768 DOI: 10.4172/2167-1044.1000223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent among HIV-infected (HIV+) individuals, and is associated with non-adherence to antiretroviral therapy (ART), and accelerated disease progression. MDD is underdiagnosed and undertreated among low-income African Americans, who are disproportionately impacted by the HIV epidemic. To improve detection and treatment of depression among African Americans living with HIV/AIDS, it is important to understand culturally and contextually relevant aspects of MDD and attitudes about mental health treatment. METHODS A focus group session was conducted with seven providers and staff at a primary care center that serves a largely African-American community heavily impacted by the HIV epidemic in Washington, DC. Data were analyzed using an inductive approach to distill prominent themes, perspectives, and experiences among participating providers. RESULTS Five themes emerged to characterize the lived experiences of HIV+ African-American patients: (a) Changes in perceptions of HIV over time; (b) HIV is comorbid with mental illness, particularly depression and substance abuse; (c) Stigma is associated with both HIV and depression; (d) Existing mental health services vary and are insufficient and (e) Suggestions for optimal treatment for comorbid HIV and depression. LIMITATION This study reflects the views of providers from one clinic in this community. CONCLUSION Substantial economic disadvantage, pervasive childhood adversity, limited education and limited resources jointly put members of this community at risk for acquisition of HIV and for development of depression and addictions. These contextual factors provide an important reminder that any patient-level depression identification or intervention in this community will have to be mindful of such circumstances.
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Affiliation(s)
- Huynh-Nhu Le
- Department of Psychology, George Washington University, Washington, D.C., USA
| | - Maria Mananita S Hipolito
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
| | - Sharon Lambert
- Department of Psychology, George Washington University, Washington, D.C., USA
| | | | - Narayan Rai
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
| | - Charlee McLean
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
| | | | - Evaristus Nwulia
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
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Amanor-Boadu S, Hipolito MS, Rai N, McLean CK, Flanagan K, Hamilton FT, Oji V, Lambert SF, Le HN, Kapetanovic S, Nwulia EA. Poor CD4 count is a predictor of untreated depression in human immunodeficiency virus-positive African-Americans. World J Psychiatry 2016; 6:128-35. [PMID: 27014603 PMCID: PMC4804261 DOI: 10.5498/wjp.v6.i1.128] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/05/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023] Open
Abstract
AIM To determine if efforts to improve antiretroviral therapy (ART) adherence minimizes the negative impact of depression on human immunodeficiency virus (HIV) outcomes. METHODS A cross-sectional study of a clinic-based cohort of 158 HIV seropositive (HIV+) African Americans screened for major depressive disorder (MDD) in 2012. CD4 T lymphocyte (CD4+) counts were obtained from these individuals. Self-report on adherence to ART was determined from questionnaire administered during clinic visits. The primary outcome measure was conditional odds of having a poorer CD4+ count (< 350 cells/mm(3)). Association between CD4+ count and antidepressant-treated or untreated MDD subjects was examined controlling for self-reported adherence and other potential confounders. RESULTS Out of 147 individuals with available CD4+ T lymphocyte data, 31% hadCD4+ count < 350 cells/mm(3) and 28% reported poor ART adherence. As expected the group with > 350 cells/mm(3) CD4+ T lymphocyte endorsed significantly greater ART adherence compared to the group with < 350 cells/mm(3) CD4+ T lymphocyte count (P < 0.004). Prevalence of MDD was 39.5% and 66% of individuals with MDD took antidepressants. Poor CD4+ T lymphocyte count was associated with poor ART adherence and MDD. Adjusting for ART adherence, age, sex and education, which were potential confounders, the association between MDD and poor CD4+ T lymphocyte remained significant only in the untreated MDD group. CONCLUSION Therefore, CD4+ count could be a clinical marker of untreated depression in HIV+. Also, mental health care may be relevant to primary care of HIV+ patients.
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Rossato L, Loreto ÉS, Zanette RA, Chassot F, Santurio JM, Alves SH. In vitro synergistic effects of chlorpromazine and sertraline in combination with amphotericin B against Cryptococcus neoformans var. grubii. Folia Microbiol (Praha) 2016; 61:399-403. [DOI: 10.1007/s12223-016-0449-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
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Gender Differences in Psychosocial Factors Associated with HIV Viral Suppression Among African-American Injection Drug Users. AIDS Behav 2016; 20:385-94. [PMID: 26143248 DOI: 10.1007/s10461-015-1131-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Research suggests gender differences exist in achieving undetectable viral load (UVL) among persons living with HIV (PLHIV), and that psychosocial health factors may play a role. The present study examined these factors among African-American PLHIV enrolled in the BEACON study. Participants completed self-report surveys and gave biomarker data. Poisson regression with robust standard errors was implemented. Men with moderate religious activity had 1.3 times the likelihood of UVL as men with low religious activity (p < 0.10; N = 199). Men with 1-2 mental illness diagnoses had 1.3 times the likelihood of UVL as men with none (p < 0.05). Women using 1-2 substances had 28 % lower likelihood of UVL than non-using women (N = 122; p < 0.10). Finally, women with frequent doctor-patient communication had 35 % higher likelihood of UVL as women with less doctor-patient communication (p < 0.05). Results suggest that social support, substance use, and mental illness function differently among men and women. Healthcare professionals should employ gender-specific interventions to address and improve HIV health outcomes.
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