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Satre DD, Sarovar V, Levine T, Leibowitz AS, Lea AN, Ridout KK, Hare CB, Luu MN, Flamm J, Dilley JW, Davy-Mendez T, Sterling SA, Silverberg MJ. Factors associated with suicidal ideation among people with HIV engaged in care. J Affect Disord 2024; 358:369-376. [PMID: 38723683 DOI: 10.1016/j.jad.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND People with HIV (PWH) are at elevated risk for suicidal ideation (SI), yet few studies have examined how substance use, clinical and sociodemographic factors are associated with SI among PWH. METHOD We used substance use (Tobacco, Alcohol, Prescription Medication, and Other Substance Use [TAPS]) and depression (PHQ-9) data from computerized screening of adult PWH in primary care clinics in Northern California, combined with health record data on psychiatric diagnoses, HIV diagnosis, treatment, and control (HIV RNA, CD4), insurance, and neighborhood deprivation index (NDI) to examine factors associated with SI (PHQ-9 item 9 score > 0). Adjusted odds ratios (aOR) for SI were obtained from logistic regression models. RESULTS Among 2829 PWH screened (92 % male; 56 % white; mean (SD) age of 54 (13) years; 220 (8 %) reported SI. Compared with no problematic use, SI was higher among those reporting one (aOR = 1.65, 95 % CI = 1.17, 2.33), two (aOR = 2.23, 95 % CI = 1.42, 3.49), or ≥ 3 substances (aOR = 4.49, 95 % CI = 2.41, 8.39). SI risk was higher for those with stimulant use (aOR = 3.55, 95 % CI = 2.25, 5.59), depression (aOR = 4.18, 95 % CI = 3.04, 5.74), and anxiety diagnoses (aOR = 1.67, 95 % CI = 1.19, 2.34), or Medicaid (aOR = 2.11, 95%CI = 1.24, 3.60) compared with commercial/other insurance. SI was not associated with HIV-related measures or NDI. LIMITATIONS SI was assessed with a single PHQ-9 item. Simultaneous SI and exposure data collection restricts the ability to establish substance use as a risk factor. CONCLUSIONS HIV care providers should consider multiple substance use, stimulant use, depression or anxiety, and public insurance as risk factors for SI and provide interventions when needed.
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Affiliation(s)
- Derek D Satre
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America; Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America.
| | - Varada Sarovar
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Tory Levine
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Amy S Leibowitz
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Alexandra N Lea
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Kathryn K Ridout
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America; The Permanente Medical Group, Oakland, CA 94612, United States of America
| | - C Bradley Hare
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Mitchell N Luu
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Jason Flamm
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - James W Dilley
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America
| | - Thibaut Davy-Mendez
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Infectious Diseases, Chapel Hill, NC 27599, United States of America
| | - Stacy A Sterling
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America; Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Michael J Silverberg
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
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2
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Mandlate FM, Greene MC, Pereira LF, Gouveia ML, Mari JJ, Cournos F, Duarte CS, Oquendo MA, Mello MF, Wainberg ML. Association between mental disorders and adherence to antiretroviral treatment in health facilities in two Mozambican provinces in 2018: a cross-sectional study. BMC Psychiatry 2023; 23:274. [PMID: 37081470 PMCID: PMC10116733 DOI: 10.1186/s12888-023-04782-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/13/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Lower adherence to antiretroviral treatment (ART) has been found among people with HIV (PWH) who have comorbid mental disorders like depression and alcohol use in Sub-Saharan African. However, there has been less exploration with regards to other mental disorders. METHODS This study assessed the association of multiple mental disorders and adherence to ART based on the data from primary/tertiary health care facilities in Maputo and Nampula, Mozambique. We administered a sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI) Plus 4.0.0 adapted for use in Mozambique to assess mental conditions, and a 3-item self-report to measure ART adherence. RESULTS 395 HIV-positive (self-report) participants on ART, with an average age of 36.7 years (SD = 9.8), and 30.4% were male. The most common mental disorders were major depressive disorder (27.34%) followed by psychosis (22.03%), suicidal ideation/behavior (15.44%), and alcohol-use disorder (8.35%). Higher odds of missing at least one dose in the last 30 days (OR = 1.45, 95% CI: 1.01, 2.10) were found in participants with any mental disorder compared to those without a mental disorder. The highest levels of non-adherence were observed among those with drug use disorders and panic disorder. CONCLUSIONS In Mozambique, PWH with any co-occurring mental conditions had a lower probability of ART adherence. Integrating comprehensive mental health assessment and treatment and ART adherence interventions tailored to PWH with co-occurring mental disorders is necessary to attain optimal ART adherence and reach the UNAIDS ART target.
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Affiliation(s)
- Flavio M. Mandlate
- Department of Mental Health, Ministry of Health, Eduardo Mondlane Avenue, nr 1008, Postal Code 264 Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - M. Claire Greene
- Program on Forced Migration and Health, Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Luis F. Pereira
- New York State Psychiatric Institute, Columbia University, New York, USA
| | - Maria Lidia Gouveia
- Department of Mental Health, Ministry of Health, Eduardo Mondlane Avenue, nr 1008, Postal Code 264 Maputo, Mozambique
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Jair Jesus Mari
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Francine Cournos
- New York State Psychiatric Institute, Columbia University, New York, USA
| | | | - Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Marcelo Feijó Mello
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Columbia University, New York, USA
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3
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Tsai YT, K. M. SP, Ku HC, Wu YL, Ko NY. Global overview of suicidal behavior and associated risk factors among people living with human immunodeficiency virus: A scoping review. PLoS One 2023; 18:e0269489. [PMID: 36940193 PMCID: PMC10029973 DOI: 10.1371/journal.pone.0269489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/22/2022] [Indexed: 03/21/2023] Open
Abstract
Death by suicide is a major public health problem. People living with human immunodeficiency virus (PLHIV) have higher risk of suicidal behavior than the general population. The aim of this review is to summarize suicidal behavior, associated risk factors, and risk populations among PLHIV. Research studies in six databases from January 1, 1988, to July 8, 2021, were searched using keywords that included "HIV," "suicide," and "risk factors." The study design, suicide measurement techniques, risk factors, and study findings were extracted. A total of 193 studies were included. We found that the Americas, Europe, and Asia have the highest rates of suicidal behavior. Suicide risk factors include demographic factors, mental illness, and physiological, psychological, and social support. Depression is the most common risk factor for PLHIV, with suicidal ideation and attempt risk. Drug overdosage is the main cause of suicide death. In conclusion, the current study found that PLHIV had experienced a high level of suicidal status. This review provides an overview of suicidal behavior and its risk factors in PLHIV with the goal of better managing these factors and thus preventing death due to suicide.
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Affiliation(s)
- Yi-Tseng Tsai
- Department of Nursing, An Nan Hospital, China Medical University, Tainan,
Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Sriyani Padmalatha K. M.
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
- Operating Room Department, National Hospital of Sri Lanka, Colombo, Sri
Lanka
| | - Han-Chang Ku
- Department of Nursing, An Nan Hospital, China Medical University, Tainan,
Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Yi-Lin Wu
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung
University, Tainan, Taiwan
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Hu F, Zhao D, Fu X, Zhang W, Tang W, Hu S, Shen W, Chen H. Gender differences in suicidal ideation, suicide attempts, and suicide death among people living with
HIV
: A systematic review and meta‐analysis. HIV Med 2022; 24:521-532. [PMID: 36347514 DOI: 10.1111/hiv.13435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Although excess mortality, especially suicide, is a critical trait in people living with HIV, consensus about gender differences in these areas is lacking. We conducted meta-analyses to examine gender differences in suicidal ideation, suicide attempts, and suicide death among people living with HIV. METHODS We systematically searched PubMed and Web of Science for studies written in English. In this review, suicide among people living with HIV includes suicide death, suicidal ideation, and suicide attempts. Studies reporting the suicide prevalence among males and females living with HIV were eligible for inclusion in our review. Odds ratios (ORs) and 95% confidence intervals (CIs) served as the effect size index. Fixed-effects or random-effects meta-analyses were chosen based on the size of the heterogeneity. RESULTS A total of 27 studies comprising 801 017 participants from 11 countries were included in the meta-analysis. The overall prevalence of suicidal ideation was 18.0% (95% CI 13.3%-22.8%) in males and 20.8% (95% CI 16.4%-25.1%) in females, and there was a statistically significant higher risk of suicidal ideation in females living with HIV (OR 1.30; 95% CI 1.09-1.56; p < 0.05). The overall prevalence of suicide attempts was 16.8% (95% CI 9.0%-24.5%) in males and 24.7% (95% CI 12.4%-37.1%) in females, and there was a statistically significant higher risk of suicide attempts in females living with HIV (OR 1.34; 95% CI 1.02-1.75; p < 0.05). The pooled prevalence of suicide death was 1.2% (95% CI 0.5%-1.9%) among males and 0.2% (95% CI 0.1%-0.3%) among females, and the risk of suicide death between genders was not statistically significant (OR 0.78; 95% CI 0.50-1.24; p = 0.298). CONCLUSIONS There were gender differences in suicidal ideation and suicide attempts among people living with HIV. Females living with HIV were more likely to experience suicidal ideation and make suicide attempts, but there were no statistically significant gender differences in suicide death. Appropriate initiatives to optimize the recognition, treatment, and management suicide behaviours of males and females living with HIV may narrow this gender gap.
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Affiliation(s)
- Fei‐Hong Hu
- School of Medicine Nantong University Nantong China
| | - Dan‐Yan Zhao
- School of Medicine Nantong University Nantong China
| | - Xue‐Lei Fu
- School of Medicine Nantong University Nantong China
| | | | - Wen Tang
- School of Medicine Nantong University Nantong China
| | - Shi‐Qi Hu
- School of Medicine Nantong University Nantong China
| | | | - Hong‐Lin Chen
- School of Public Health Nantong University Nantong China
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Fernandes H, Lima DV, Hino P, Taminato M, Okuno MFP. Self-inflicted violence and suicide in people living with HIV/AIDS: a systematic review. Rev Bras Enferm 2022; 75Suppl 3:e20210768. [PMID: 35703675 DOI: 10.1590/0034-7167-2021-0768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/03/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze intellectual productions on self-inflicted violence and suicide in people living with HIV/AIDS. METHODS a systematic review, carried out between March and April 2021, in the PubMed®/MEDLINE®, Web of Science and LILACS databases, subsidized in the Strengthening the Reporting of Observational Studies in Epidemiology. The period outlined was from 2011 to 2020. RESULTS a total of 199 studies were identified, and 16 composed the final sample, grouped into the categories: Sociodemographic characteristics of victims of self-inflicted violence/suicide and their intervening factors (pointing to young adults, especially homosexuals, with low social support and a history of mental illness or substance abuse as usual victims); Successful measures for suicide prevention/control in people living with HIV/AIDS (suggesting more frequent psychosocial and clinical follow-up of those starting antiretroviral and immunocompromised treatment). CONCLUSIONS biopsychosocial follow-up, analysis of sociodemographic profile and intervening factors should be frequent in this population for disease prevention/control.
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Affiliation(s)
- Hugo Fernandes
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
| | | | - Paula Hino
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
| | - Mônica Taminato
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
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Wang X, Yan C, Tong Y, Gao J, Zhou W, Lan Z, Wu J, Li H, Yin Y, Wang Y, Liu NH, Deng F. Comparison of Psycho-Social Factors Associated With Suicidal Ideation and Suicide Attempts Among People Living With HIV in Central West China. Front Public Health 2022; 10:832624. [PMID: 35400050 PMCID: PMC8990087 DOI: 10.3389/fpubh.2022.832624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrevious studies have described the correlation of suicidal ideation (SI) or suicide attempts (SA) in people living with HIV (PLWH), whereas few studies compare the correlation between SI and SA in PLWH. Understanding specific risk factors for SI and SA among PLWH will help with developing tailored and effective suicide prevention strategies among this high-risk group.MethodsA cross-sectional study was conducted from December 2020 to April 2021 in Baoji municipality, Shaanxi Province. The PLWH registered with the Baoji Municipal Center for Disease Control and Prevention (CDC) were recruited and interviewed. Questionnaires and interviews for this study consisted of socio-demographic variables, mental health history, and psychosocial characteristics. The HIV-related clinical features were obtained from CDC medical records. The PLWH included were divided into three groups, i.e., those with a history of suicide attempts (SA group), those with suicidal ideation only (SI group), and those without any suicidal behavior (NSB group). Multinomial logistic regression was used for three-way comparisons among these three groups of PLWH.ResultsIn total, 995 PLWH were interviewed. The prevalence of probable depression, probable anxiety, SI, and SA in PLWH after being diagnosed as HIV+ was 18.6%, 13.5%, 26.7%, and 3.2%, respectively. Compared with the NSB group, the SI or SA groups were more likely to report probable depression [adjusted odds ratio (AOR) = 2.43, 4.44, respectively], probable anxiety (AOR = 2.80, 5.62, respectively), and high HIV-related stigma (AOR = 2.05, 2.65, respectively). The SI group was more likely to experience high HIV-related stress (AOR = 1.91) and lower quality of life (AOR = 0.56) than the NSB group. Social support and HIV-related clinical features were not associated with SI or SA in this sample. The SA group did not differ from the SI group on any of the psychosocial or HIV-related clinical features.ConclusionsMental health problems are serious in community residents identified with having an HIV infection in a Central West China municipality. It is important to deliver low-cost and effective psychological services tailored for PLWH that are focused on reducing mental health problems. Future studies should utilize sensitive screening measures and further clarify factors potentially associated with the transition from SI to SA in PLWH.
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Affiliation(s)
- Xuelian Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing, China
- Beijing Suicide Research and Prevention Center, Beijing HuiLongGuan Hospital, Beijing, China
- World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Chuanyuan Yan
- Baoji Center for Disease Control and Prevention, Baoji, China
- *Correspondence: Chuanyuan Yan
| | - Yongsheng Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing, China
- Beijing Suicide Research and Prevention Center, Beijing HuiLongGuan Hospital, Beijing, China
- World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
- Yongsheng Tong
| | - Juan Gao
- Baoji Center for Disease Control and Prevention, Baoji, China
| | - Wei Zhou
- Beijing Suicide Research and Prevention Center, Beijing HuiLongGuan Hospital, Beijing, China
- World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Zhichao Lan
- Center of Disease Control and Prevention of Meixian County, Baoji, China
| | - Jianlan Wu
- Peking University HuiLongGuan Clinical Medical School, Beijing, China
- Beijing Suicide Research and Prevention Center, Beijing HuiLongGuan Hospital, Beijing, China
- World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Hongbing Li
- Baoji Center for Disease Control and Prevention, Baoji, China
| | - Yi Yin
- Peking University HuiLongGuan Clinical Medical School, Beijing, China
- Beijing Suicide Research and Prevention Center, Beijing HuiLongGuan Hospital, Beijing, China
- World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Yuehua Wang
- Beijing Suicide Research and Prevention Center, Beijing HuiLongGuan Hospital, Beijing, China
- World Health Organization Collaborating Center for Research and Training in Suicide Prevention, Beijing, China
| | - Nancy H. Liu
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Feng Deng
- Baoji Center for Disease Control and Prevention, Baoji, China
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7
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Fernandes H, Lima DV, Hino P, Taminato M, Okuno MFP. Violência autoprovocada e suicídio em pessoas que vivem com HIV/AIDS: revisão sistemática. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0768pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivos: analisar as produções intelectuais sobre a violência autoprovocada e suicídio em pessoas que vivem com HIV/AIDS. Métodos: revisão sistemática, realizada entre março e abril de 2021, nas bases PubMed®/MEDLINE®, Web of Science e LILACS, subsidiada no instrumento Strengthening the Reporting of Observational Studies in Epidemiology. O período delineado foi de 2011 a 2020. Resultados: identificaram-se 199 estudos, e 16 compuseram a amostra final, sendo agrupados nas categorias: Características sociodemográficas das vítimas de violência autoprovocada/suicídio e seus fatores intervenientes (apontando adultos jovens, especialmente homossexuais, com baixo suporte social e histórico de doenças mentais ou abuso de substâncias como as vítimas usuais); Medidas exitosas para prevenção/controle de suicídio em pessoas vivendo com HIV/AIDS (sugerindo acompanhamento psicossocial e clínico mais frequente daqueles em início de tratamento antirretroviral e imunodeprimidos). Conclusões: acompanhamento biopsicossocial, análise do perfil sociodemográfico e dos fatores intervenientes devem ser frequentes nesta população, para prevenção/controle do agravo.
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Affiliation(s)
| | | | - Paula Hino
- Universidade Federal de São Paulo, Brazil
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8
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Hoare J, Sevenoaks T, Mtukushe B, Williams T, Heany S, Phillips N. Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV. Curr HIV/AIDS Rep 2021; 18:569-580. [PMID: 34792706 PMCID: PMC8600343 DOI: 10.1007/s11904-021-00583-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE OF THE REVIEW By reviewing the most recent common mental health disorders (CMHD) studies in people living with HIV (PLWH) (2018-2020), this review discusses the prevalence of CMHD, factors associated with CMHD in PLWH, mental health in PLWH from vulnerable groups, the impact of CMHD on HIV disease progression and adherence to antiretroviral therapy and the efficacy of different treatment approaches. RECENT FINDINGS After screening for eligibility 142 studies were included in the final systematic review. Only 27% of studies were conducted in Sub-Saharan Africa, which carries the highest burn of HIV disease globally. Despite the well-established increased risk of CMHD in PLWH, the current prevalence remains high, with studies reporting 28%-62% of PLWH having mental health symptoms. CONCLUSION Despite the significant challenges that CMHDs present to successful HIV treatment, there are many mental health treatments and interventions which can improve outcomes in PLWH and opportunities to task-shift and integrate mental health care with HIV care.
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Affiliation(s)
- Jacqueline Hoare
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa.
- Faculty of Health Sciences, Penisula Medical School, University of Plymouth, Plymouth, UK.
| | - Tatum Sevenoaks
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Bulelwa Mtukushe
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Taryn Williams
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Sarah Heany
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Nicole Phillips
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
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9
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Serving the Co-Morbid Mental Health and Substance Use Needs of People with HIV. Community Ment Health J 2021; 57:1328-1339. [PMID: 33387180 DOI: 10.1007/s10597-020-00756-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/11/2020] [Indexed: 02/05/2023]
Abstract
People with HIV (PWH) who have mental health disorders (MHD) and substance use disorders (SUD) have lower HIV medication adherence, higher unsuppressed viral loads, and higher mortality rates than those who do not. Individuals who have triple diagnoses (HIV, MHD and SUD) are at an exponential risk for these adverse outcomes. This study explored the barriers and facilitators to accessing and linking PWH with MHD and SUD services. Qualitative interviews with 90 participants were conducted to explore their experiences seeking treatment for MHD and SUD. Results of a thematic analysis found two important barriers to treatment access and utilization: unstable motivation to change and negative experiences with providers. Conversely, an internal drive to heal and rapport with providers facilitated positive treatment experiences. Findings of the study also indicate a need for an integrated treatment model where MHD, SUD, and HIV treatment are available at the same location.
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10
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Brown MJ, Qian Y, Harrison S, Haider MR, Conserve DF, Deming M, Zhang J, Li X. Age and Sex Disparities in Sexual Trauma, Depressive Symptoms, and Antiretroviral Adherence Among People Living with HIV in the Deep South: A Mediation Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1805-1816. [PMID: 33051779 PMCID: PMC8041915 DOI: 10.1007/s10508-020-01811-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 04/21/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
People living with HIV (PLWH) have a higher risk of experiencing sexual assault compared to populations without HIV. Prior studies have shown independent associations between sexual assault, depression, and antiretroviral therapy (ART) adherence. However, research analyzing the potential mediating effects of depressive symptoms between sexual assault and ART adherence, and the associated age and sex disparities, especially among PLWH in the Southern United States, is lacking. Therefore, the current study sought to determine whether depressive symptoms mediate the association between sexual assault and ART adherence and to evaluate the associated age and sex disparities among PLWH in South Carolina. Data were collected from 337 individuals who received HIV care from an immunology center in South Carolina. Crude and adjusted path analysis models stratified by age and sex were used to determine the association between sexual assault, depressive symptoms, and ART adherence. Depressive symptoms were associated with ART adherence among adults aged 18-34 (β = - 0.281, p = .018) and 35-49 (β = - 0.185, p = .005), and men (β = - 0.205, p = .011). Sexual assault was associated with depressive symptoms (β = 0.211, p = .001) and with ART adherence (β = - 0.172, p = .010) among adults 35-49. Among men (β = - 0.238; p = .029) and women (β = - 0.344, p = .001), sexual assault was associated with ART adherence; among women, sexual assault was associated with depressive symptoms (β = 0.280, p = .006). Depressive symptoms mediated the association between sexual assault and ART adherence among adults 35-49 (β = - 0.039, p = .035). Interventions addressing depressive symptoms may improve ART adherence among adults aged 18-34 and 35-49 and men. Programs also addressing depressive symptoms and using trauma-informed approaches may improve ART adherence, especially among middle-age populations, men, and women.
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Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, 435C, Columbia, SC, 29208, USA.
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- Office of the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Yuhang Qian
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sayward Harrison
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Mohammad Rifat Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Donaldson F Conserve
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michelle Deming
- Department of History, Culture and Society, Baker University, Baldwin City, KS, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Discovery I, 435C, Columbia, SC, 29208, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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11
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Pelton M, Ciarletta M, Wisnousky H, Lazzara N, Manglani M, Ba DM, Chinchillli VM, Du P, Ssentongo AE, Ssentongo P. Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis. Gen Psychiatr 2021; 34:e100247. [PMID: 33912798 PMCID: PMC8042999 DOI: 10.1136/gpsych-2020-100247] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/18/2020] [Accepted: 02/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND People living with HIV/AIDS (PLWHA) must contend with a significant burden of disease. However, current studies of this demographic have yielded wide variations in the incidence of suicidality (defined as suicidal ideation, suicide attempt and suicide deaths). AIMS This systematic review and meta-analysis aimed to assess the lifetime incidence and prevalence of suicidality in PLWHA. METHODS Publications were identified from PubMed (MEDLINE), SCOPUS, OVID (MEDLINE), Joanna Briggs Institute EBP and Cochrane Library databases (from inception to before 1 February 2020). The search strategy included a combination of Medical Subject Headings associated with suicide and HIV. Researchers independently screened records, extracted outcome measures and assessed study quality. Data were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted to explore the associated risk factors and to identify the sources of heterogeneity. Main outcomes were lifetime incidence of suicide completion and lifetime incidence and prevalence of suicidal ideation and suicide attempt. RESULTS A total of 185 199 PLWHA were identified from 40 studies (12 cohorts, 27 cross-sectional and 1 nested case-control). The overall incidence of suicide completion in PLWHA was 10.2/1000 persons (95%CI: 4.5 to 23.1), translating to 100-fold higher suicide deaths than the global general population rate of 0.11/1000 persons. The lifetime prevalence of suicide attempts was 158.3/1000 persons (95%CI: 106.9 to 228.2) and of suicidal ideation was 228.3/1000 persons (95%CI: 150.8 to 330.1). Meta-regression revealed that for every 10-percentage point increase in the proportion of people living with HIV with advanced disease (AIDS), the risk of suicide completion increased by 34 per 1000 persons. The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations for the suicide deaths was graded as 'moderate' quality. CONCLUSIONS The risk of suicide death is 100-fold higher in people living with HIV than in the general population. Lifetime incidence of suicidal ideation and attempts are substantially high. Suicide risk assessments should be a priority in PLWHA, especially for those with more advanced disease.
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Affiliation(s)
- Matt Pelton
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Matt Ciarletta
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Holly Wisnousky
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Nicholas Lazzara
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Monica Manglani
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Djibril M Ba
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Vernon M Chinchillli
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Ping Du
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Anna E Ssentongo
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
- Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, Pennsylvania, USA
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12
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Wisnousky H, Lazzara N, Ciarletta M, Pelton M, Chinchilli VM, Ssentongo AE, Ssentongo P. Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e037154. [PMID: 33550223 PMCID: PMC7925913 DOI: 10.1136/bmjopen-2020-037154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION The prevalence of HIV/AIDS is high and is associated with psychiatric morbidity and suicide risk. The objective of this study will be to assess the rates of suicidal ideation, suicide attempts and suicide deaths in people living with HIV/AIDS (PLWHA). METHODS AND ANALYSIS We present a study protocol for a systematic review and meta-analysis of studies reporting the suicidality outcomes (suicidal ideation, suicide attempts and suicide deaths) in PLWHA. PubMed (MEDLINE), Scopus, EMBASE, Cochrane Library, OVID (HEALTH STAR), OVID (MEDLINE), Joanna Briggs Institute EBP Database, Web of Science and PsychINFO databases will be searched from their inception until 1 January 2020. The primary outcome of interest will be the incidence of suicidality in PLWHA. In addition, we will delineate risk factors associated with suicidality in PLWHA. Citations, full-text articles and abstracts will be screened by four reviewers independently. Disagreements will be resolved through discussion. The study methodological quality (or bias) will be appraised using an appropriate tool. Random-effects meta-analysis will be conducted if we find that the studies are very heterogenous. For the suicidality outcome, probability of suicide risk will be reported. Relative risk ratios (with 95% CIs) will be reported for the effects of the risk factors. Potential publication bias will be assessed by conducting Egger's test and creating funnel plots. We will conduct additional analyses to explore the potential sources of heterogeneity (eg, age, sex and geographical location). ETHICS AND DISSEMINATION No ethics clearance is required as no primary data will be collected. The results of this systematic review and meta-analysis will be presented at scientific conferences and published in a peer-reviewed journal. The results may inform clinical management of PLWHA and may guide future population-specific interventions.We will search PubMed (MEDLINE), Scopus, EMBASE, Cochrane Library, OVID (HEALTH STAR), OVID (MEDLINE), Joanna Briggs Institute EBP Database, Web of Science and PsychINFO from their inception until 1 January 2020. PROSPERO REGISTRATION NUMBER CRD42020161501.
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Affiliation(s)
| | - Nick Lazzara
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Matt Ciarletta
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Matt Pelton
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Vernon M Chinchilli
- Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Anna E Ssentongo
- Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Paddy Ssentongo
- Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
- Center for Neural Engineering, Penn State University, University Park, Pennsylvania, USA
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13
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Durham MD, Armon C, Mahnken JD, Novak RM, Palella FJ, Tedaldi E, Buchacz K. Rates of suicidal ideation among HIV-infected patients in care in the HIV Outpatient Study 2000-2017, USA. Prev Med 2020; 134:106011. [PMID: 32027915 PMCID: PMC10132173 DOI: 10.1016/j.ypmed.2020.106011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/21/2020] [Accepted: 02/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suicidal ideation (SI) refers to an individual thinking about, considering or planning suicide. Identifying and characterizing persons with HIV (PWH) at greater risk for SI may lead to better suicide prevention strategies and quality of life improvement. METHODS Using clinical data gathered from medical chart abstraction for HIV Outpatient Study (HOPS) participants from 2000 to 2017, we assessed SI frequency among PWH in care and explored factors associated with the presence of SI diagnoses using linear mixed models analyses. RESULTS Among 6706 participants, 224 (3.3%) had a charted diagnosis of SI. Among those with SI, median age (interquartile range [IQR]) was 43.4 years [IQR: 38.7-50.3], median (IQR) CD4+ cell count was 439 cells/mm3 (IQR: 237-686), 71.4% were male, 54% were men who have sex with men (MSM), 25.4% heterosexual, and 13.4% persons who inject drugs. In multivariable analysis, persons at increased risk for SI were more likely to be: <50 years old (adjusted rate ratio [aRR] 1.86, 95% confidence interval [95%CI] 1.36-2.53), non-Hispanic/Latino black (aRR 1.75; 95%CI 1.29-2.38), have CD4+ cell count <350 cells/mm3 (aRR 1.32; 95%CI 1.05-1.65), have a viral load ≥50 copies/mL (aRR 1.49; 95%CI 1.12-1.98), have stopped antiretroviral therapy (aRR 1.46; 95%CI 1.10-1.95), have a history of: alcohol dependence (aRR 2.75; 95%CI 1.67-4.52), and drug overdose (aRR 4.09; 95%CI 2.16-7.71). CONCLUSION Routine mental health assessment and monitoring are needed in HIV clinical practice to better understand factors associated with SI and to inform the development of preventive interventions.
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Affiliation(s)
- Marcus D Durham
- Division of HIV/AIDS Prevention Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Carl Armon
- Cerner Corporation, Kansas City, MO, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Ellen Tedaldi
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Stroumpouki T, Perrett S, Kasdovasilis P, Papatheodorou P, Paparizos V, Stavropoulou A. "A journey towards acceptance": The process of adapting to life with HIV in Greece. A Qualitative study. Appl Nurs Res 2020; 53:151249. [PMID: 32451004 DOI: 10.1016/j.apnr.2020.151249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
Aim To identify the experiences related to adaptation for people living with HIV in Greece and to explore different adaptation stages as well as their individual reactions. BACKGROUND Receiving an HIV positive diagnosis leads to major changes in an individual's life and it can trigger an array of emotions including fear, despair and loss of control. As the profile of the disease has changed due to its transition into a chronic disease and extended life expectancy, adaptation to life and coping with uncertain events is of paramount importance. METHOD Interpretative phenomenological research design was used to guide data collection and analysis. A purposive sampling technique was used. Ethical procedures were taken into account and nine individuals who were diagnosed with HIV took part in the study using semi-structured interviews. RESULTS Data analysis revealed the different stages of adaptation that the participants experienced after an HIV positive diagnosis. A superordinate theme identified as 'a journey towards acceptance' while five subthemes were formed, namely, 'Communicating the bad news, Conscious loneliness, Getting information, Receiving Support, and Moving on with hope'. CONCLUSION An HIV positive diagnosis can affect the very core of the individual as the essence of -self- is targeted and in need of reform. Education, empathy, family and social support can help the individual make small steps towards a greater journey, that of acceptance.
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Affiliation(s)
- Theodora Stroumpouki
- Acute Adult Nursing, Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, Kingston Hill Campus, Kingston upon Thames KT2 7LB, United Kingdom.
| | - Stephanie Perrett
- Health and Justice, Health Protection Team, Public Health Wales, 4th Floor, Number 2 Capital Quarter, Tyndall Way, Cardiff CF10 4BZ, United Kingdom.
| | - Pavlos Kasdovasilis
- Health Psychology, Business Improvement and Research Manager, Rehability UK, 25 Hatton Place, 118 Midland Rd, Luton, LU2 0FB, United Kingdom
| | | | - Vasilios Paparizos
- HIV/AIDS Unit, 'A. Syggros' Hospital, 5 I. Dragoumi Str., Kessariani 161 21, Athens, Greece
| | - Areti Stavropoulou
- Department of Nursing, University of West Attica, Ag. Spiridonos 28, 12243 Aegaleo, Greece.
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15
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Tyree GA, Vaida F, Zisook S, Mathews WC, Grelotti DJ. Clinical correlates of depression chronicity among people living with HIV: What is the role of suicidal ideation? J Affect Disord 2019; 258:163-171. [PMID: 31426014 PMCID: PMC6909554 DOI: 10.1016/j.jad.2019.07.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/16/2019] [Accepted: 07/29/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Chronicity of depression among people living with HIV (PLWH) is associated with poorer viral suppression and mortality risk. The extent to which suicidal ideation (SI) and other baseline characteristics predict a prolonged duration of depressive illness among PLWH is not known but could help identify PLWH most at risk. METHODS Data were drawn from a sample of 1002 depressed PLWH engaged in primary care at a metropolitan HIV clinic from 2007-2018, representing 2,569 person-years. Depression characteristics were derived from the Patient Health Questionnaire 9 (PHQ-9), administered during routine screening. Other characteristics were derived from clinic data. Unadjusted and covariate-adjusted survival analyses compared the time to depression remission between depressed participants with and without SI at their initial screening. RESULTS At baseline, 38.4% of depressed PLWH endorsed SI. Depressed PLWH with SI took significantly longer to achieve remission from depression than those without SI. The association appeared to be mediated by depression symptom severity. When adjusted for age, depression diagnosis, any recent drug use, and depression symptom severity, baseline SI no longer predicted remission hazard. LIMITATIONS Participants were assessed for depression with variable frequency. The analysis assumed all patients received comparable treatment for their depression. Some variables were based on clinic measurements that may be subject to misclassification bias. CONCLUSIONS These data suggest that depressed PLWH with SI are at risk for greater chronicity of depression because their depression is more severe. Accordingly, PLWH should be urgently engaged in psychiatric care in the event of SI or severe depressive symptoms.
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Affiliation(s)
- Griffin A Tyree
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Florin Vaida
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA; HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - William C Mathews
- Center for AIDS Research, University of California San Diego, La Jolla, CA, USA
| | - David J Grelotti
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Center for AIDS Research, University of California San Diego, La Jolla, CA, USA.
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16
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Scott-Sheldon LAJ, Balletto BL, Donahue ML, Feulner MM, Cruess DG, Salmoirago-Blotcher E, Wing RR, Carey MP. Mindfulness-Based Interventions for Adults Living with HIV/AIDS: A Systematic Review and Meta-analysis. AIDS Behav 2019; 23:60-75. [PMID: 30054765 PMCID: PMC6344266 DOI: 10.1007/s10461-018-2236-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This meta-analysis examined the effects of mindfulness-based interventions (MBIs) on stress, psychological symptoms, and biomarkers of disease among people living with HIV/AIDS (PLWHA). Comprehensive searches identified 16 studies that met the inclusion criteria (N = 1059; M age = 42 years; 20% women). Participants had been living with HIV for an average of 8 years (range = < 1-20 years); 65% were currently on antiretroviral therapy. Between-group analyses indicated that depressive symptoms were reduced among participants receiving the MBIs compared to controls (d+ = 0.37, 95% CI 0.03, 0.71). Within-group analyses showed reductions in psychological symptoms (i.e., less anxiety, fewer depressive symptoms) and improved quality of life over time among MBI participants (d+s = 0.40-0.85). No significant changes were observed for immunological outcomes (i.e., CD4 counts) between- or within-groups. MBIs may be a promising approach for reducing psychological symptoms and improving quality of life among PLWHA. Studies using stronger designs (i.e., randomized controlled trials) with larger sample sizes and longer follow-ups are needed to clarify the potential benefits of MBIs for PLWHA.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Brittany L Balletto
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Marissa L Donahue
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Melissa M Feulner
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Rena R Wing
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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17
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Leblanc NM, Albuja L, DeSantis J. The Uses of Self and Space: Health Providers' Approaches to Engaging Patients into the HIV Care Continuum. AIDS Patient Care STDS 2018; 32:321-329. [PMID: 30067407 DOI: 10.1089/apc.2017.0284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In the context of HIV prevention, the provider-patient relationship has been found to profoundly impact HIV screening, patient initiation into HIV care, and adherence to medication following an HIV diagnosis. Given the importance of the provider-patient relationship, insight into provider approaches to cultivate such relationships is essential. Such insight could highlight considerations for provider engagement with patients that can address the current challenges in HIV prevention and treatment. This qualitative descriptive study sought to describe current health providers' approaches to engage patients into the HIV care continuum (HCC). Findings from the content and thematic analysis indicated that health providers (N = 22) used various approaches to engage patients/clients into HIV screening, and subsequent HIV care. Approaches were represented by an interpersonal process and a thematic analysis revealed the nuances in the approaches that manifested in the following themes: uses of self, normalizing disease, and engaging couples. This study demonstrated the importance for health providers to be aware of the specific context of patient's vulnerability to HIV infection and barriers to care. Self-awareness and the capability to self-reflect on one's personal practice also helped to ensure engagement of those vulnerable to infection or infected with HIV into the HCC.
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Affiliation(s)
| | - Laura Albuja
- Department of Pediatrics, School of Medicine, Pediatric Mobile Clinic, University of Miami, Miami, New York
| | - Joseph DeSantis
- School of Nursing and Health Sciences, University of Miami, Miami, New York
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18
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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: 5] [Impact Index Per Article: 0.8] [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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