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Israelski et al. (2007) utilized the Beck Depression Inventory, the Posttraumatic Stress Checklist-Civilian, and the Stanford Acute Stress Reaction Questionnaire to screen for diagnostic symptom criteria within an ethnically diverse and economically disadvantaged sample of 210 men and women living with HIV and receiving services at two public clinics in northern California. The investigators "found that three stress-related psychiatric disorders – depression, [PTSD], and acute stress disorder – appear to be highly prevalent among patients with HIV/AIDS who receive services for primary healthcare in a public setting. Well over one-third of the patients studied ... met screening criteria for one of these three diagnoses. Furthermore, many patients (38 per cent) concurrently met criteria for two or more mental health disorders; one in five patients met criteria for all three" (p. 222). "Notably, 43 per cent of the [118] patients who met screening criteria for at least one of the three disorders reported that they were not ... already receiving any psychiatric treatment (i.e.[,] either psychiatric medication or psychotherapy)" (p. 224). Israelski and colleagues conclude that "the primary healthcare of patients with HIV/AIDS could be improved by more regular use of tools to routinely screen and diagnose mental health disorders related to traumatic life events. It is likely that interventions to ameliorate concomitant psychiatric conditions will lead to improved healthcare outcomes for patients with HIV/AIDS and mental health disorders" (p. 223).
With regard to the diagnosis of psychiatric disorders, Beyer, Taylor, Gersing, and Krishnan (2007) drew on data from psychiatric outpatient clinics within a tertiary-care/academic medical center to estimate the prevalence of HIV infection in a general psychiatric population (as distinguished from the population of persons with severe mental illnesses, which has been studied extensively). Among the 11,284 patients evaluated through psychiatric outpatient clinics between 2001 and 2004, 130 reported that they were living with HIV. "HIV infection was present in 1.2% of the psychiatric outpatients, approximately four times the occurrence of HIV infection in the general adult population of the United States. The major psychiatric diagnostic categories with a high prevalence of HIV infection were substance abuse disorders (5%), personality disorders (3.1%), bipolar disorders (2.6%), and [PTSD] (2.1%)" (p. 31). Beyer and colleagues conclude that patients with substance-related disorders "remain at the highest risk for HIV infection, but patients with other psychiatric diagnoses are also vulnerable, especially those with personality disorders, bipolar disorder, and PTSD. The presence of a dual diagnosis (particularly in patients with these psychiatric diagnoses) substantially increases that risk of HIV infection. Clinicians should be aware that HIV infection is prevalent in ... psychiatric outpatients and should consider this in their evaluations and treatment plans" (p. 36).
Lam, Naar-King, and Wright (2007) sought "to describe mental health symptoms in a sample of [66] HIV-positive youth (ages 16-25 [years]) and to evaluate potential predictors of symptoms as a foundation for intervention" (p. 24, 26). Eighty-seven percent of the youths in this study were African American.
As measured by the Brief Symptom Inventory (BSI), 50% of the youth scored above the cutoff for clinically significant mental health symptoms ... . Lower social support, higher viral load, HIV-status disclosure to acquaintances, and being gay/lesbian/bisexual (GLB) were all significantly correlated with more mental health symptoms, but disclosure to family and close friends and contact with service providers were not. Furthermore, regression analysis showed that social support, viral load, and disclosure to acquaintances predicted 32% of the variance in mental health symptoms. Being GLB was no longer significant, most likely because of shared variance with low social support. (p. 20)
Although these findings represent "a first step in characterizing the mental health symptoms of a clinical sample of HIV-positive youth" (p. 27), Lam and colleagues suggest that
[m]ental health services and interventions to boost social support are critical in the care of HIV-positive youth and may even serve to improve health status. Alternatively improving the health status of youth, potentially via improved adherence to medication, may also serve to reduce mental health symptoms. There appear to be both cost and benefits to disclosing HIV-status, and youth may benefit from counseling around this issue. Finally, stigma around HIV and around sexual orientation may play a large role in mental health symptoms and social support of HIV-positive African American youth. Interventions to reduce stigma ... at the individual level (peer counseling) may be beneficial. (pp. 27-28)
Wiener, Battles, Ryder, and Pao (2006) documented the use of psychotropic medications among 64 children and adolescents receiving continuous HIV care at a single institution. On the basis of chart review, the investigators report that 45% of this sample had received at least one psychotropic medication and 13% had received two or more psychotropic medications concurrently at some point over a 4-year period. "The most common medication category prescribed was antidepressants (30%), followed by stimulant-type medications (25%)" (p. 747). Wiener and colleagues stress that
[t]his study highlights the need for careful psychiatric assessment at regular intervals in children and adolescents with HIV/AIDS who develop behavioral or psychiatric symptoms. It also underscores the importance of documenting clinical diagnoses and significant target symptoms of treatment in the medical chart to communicate critical information between practitioners of different disciplines. Many psychotropic medications are prescribed for a variety of conditions, and it is important for practitioners to document their rationale, e.g., whether a tricyclic antidepressant is used for pain, sleep, or depression or some combination. (p. 751)
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Spring 2007 Newsletter / Volume 8, Issue 3 
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