mental health AIDS

Fall 2006 Newsletter / Volume 8, Issue 1

HIV Assessment News

Psychiatric Assessment

Pence, Miller, Whetten, Eron, and Gaynes (2006) "estimate[d] the 12-month prevalence of DSM-IV-defined mood, anxiety, and substance use diagnoses in a sample of ... [1,125] HIV-positive patients at an academic medical center in the southeastern United States" (p. 303). The investigators "estimated that in the clinic patient population as a whole, 2 out of every 5 patients would meet DSM-IV criteria for a mood or anxiety diagnosis during the preceding 12 months, 1 out of 5 would meet criteria for ... [a substance abuse] or dependence diagnosis, and 1 out of 12 would have both types of diagnoses. Three out of every 10 patients would have clinically relevant depression" (p. 303).

Of note is the investigators' comparison of these data with those derived from a nationally representative sample of adults receiving HIV medical care in 1996. "Although cross-study comparisons cannot be conclusive, ... [these] results suggest that mood, anxiety, and substance use disorders may be more common in HIV-positive patients in the Southeast than nationally" (p. 304). Pence and colleagues point out, however, that in their sample, "none of the diagnoses was associated with clinical measures of immunologic and virologic status[, which] support[s] the hypothesis that mood, anxiety, and substance use disorders generally are not secondary to HIV disease progression in this population" (p. 304), but may instead predate infection with HIV. These investigators, among others, are conducting research to further explore this supposition and to identify factors that may be contributing to the development of these disorders in that region of the United States. In the meantime, Pence and colleagues conclude that the present findings "underscore ... the importance of integrating mental health assessment, treatment, and referral into clinical HIV care. ... The links between these disorders, medication adherence, clinical outcomes, and risk behavior indicate a clear need for mental health treatment in HIV-positive patients. Well-tested psychotherapeutic and pharmacological interventions can successfully address these disorders. ..." (p. 304).

Taking a new tack, Wu, El-Bassel, Gilbert, and Morse (2006) examined "psychological distress as a function of dyadic HIV status – that is, the combination of a participant and her partner's HIV statuses – among women attending methadone maintenance treatment programs (MMTPs)" (p. 113). The investigators conducted interviews with a random sample of 349 women attending MMTPs who had an intimate partner. Interestingly, "[l]evels of psychological distress did not differ significantly between HIV-negative and HIV-positive women. HIV-negative women with HIV-positive partners reported significantly greater global levels, number of symptoms, and symptom severity of psychological distress compared to those with HIV-negative partners. HIV-positive participants with HIV-positive partners reported significantly lower global levels and symptom severity of psychological distress compared to those with HIV-negative partners" (p. 113). These findings suggest that psychological distress "differ[s] as a function of the combination of a woman and her partner's HIV status rather than the woman's HIV status alone" (p. 113) and that "dyadic HIV status represents an important factor with respect to the mental health needs of women in drug treatment" (p. 113). To promote psychological well-being with such clients more effectively, Wu and colleagues recommend that clinicians "not stop with only a client's HIV status, but ask about and explore distress associated with [the] HIV status of significant others in a client's living situation. ... [An additional implication of these findings] is that supportive services need to be provided for HIV-negative clients, particularly those who have HIV-positive intimate partners" (p. 119).

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