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Mental health disorders common among people with HIV in British Columbia
Michael Carter, 2016-10-18 10:30:00
of people with HIV, many from disenfranchised groups, in British Columbia,
Canada, are living with a mental health disorder, investigators report in AIDS Care. Such disorders were
associated with decreased functioning and life satisfaction and a higher burden
of stigma and discrimination. However, HIV treatment outcomes were similarly
good for people with and without mental health problems.
mental illness affected over half of a sample of individuals living with HIV
suggesting that this issue should be priority for HIV related care among aging
demographics of PHA [people with HIV and AIDS],” comment the authors. “This
study found that mental illness was strongly associated with history of sexual
assault, reduced functioning and health worries suggesting that PHA with mental
disorders experience multiple vulnerabilities.”
treatment and care mean that most people with HIV now have an excellent
prognosis. However, many people living with HIV are also living with other health problems. It has been estimated that prevalence of mental health disorders is
two to ten times more common among people with HIV than in the background
population. Mental illness in those with HIV has been linked to poorer
antiretroviral and clinical outcomes.
British Columbia wished to identify the range of mental illnesses experienced
by people living with HIV, and to determine the prevalence of these illnesses
and their correlates.
population consisted of 917 people enrolled in the Longitudinal
Investigations into Supportive and Ancillary health services (LISA) study.
Adult patients were eligible for inclusion in the present analysis if they had
enrolled in drug treatment services or started HIV therapy between 2007 and
2010. Information on mental health, demographics and use of health services was
gathered using interviewer-led questionnaires.
Overall, 54% of
participants reported being diagnosed with at least one mental health disorder
during their lifetime, and 57% of these individuals reported being diagnosed
with multiple mental health illnesses. Among those reporting a mental illness,
the most common were mood disorders such as depression (85%), followed by
anxiety disorders (65%), psychotic disorders (7%), personality disorders (4%),
eating disorders (3%) and dementia (3%).
The median age of
people reporting a mental health disorder was 45 years, almost two-thirds
reported an annual income below $15,000 and 29% identified as Indigenous.
individuals never diagnosed with a mental illness, those with a mental health
disorder were more likely to be female (33 vs 21%, p < 0.01), younger (45
vs 46, p = 0.05), reported food insecurity (72 vs 61%, p < 0.01), to have hepatitis C virus co-infection (71 vs 64%, p = 0.026) and to have used
the emergency room in the three months before the study interview (32 vs 21%,
p < 0.01).
There were no
differences in clinical outcomes between people with and without mental
illness, including adherence to HIV therapy, viral suppression and baseline CD4
Predictors of ever
having experienced a mental health disorder were a higher stigma score, lower
life satisfaction and poorer overall function. People with a history of
mental illness were significantly more likely to report a history of sexual
assault (AOR = 2.45; 95% CI, 1.75-3.43) and to have used case management
services (AOR = 1.63; 95% CI, 1.17-2.27).
multiple mental health disorders were more likely to report stigma and
discrimination (p = 0.027), financial worries (31 vs 45%, p = 0.012), medical
worries (p = 0.023), experiences of violence (p = 0.012) and a history of
sexual assault (p = 0.027).
“As HIV management
continues to transition towards chronic care management, greater attention must
be paid to concurrent conditions, such as mental illness, in order to improve
the quality of life of people living with HIV,” conclude the authors.