Common mental disorders and psychological adjustment among individuals seeking HIV testing: a study protocol to explore implications for mental health care systems (original) (raw)
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The Prevalence of Common Mental Disorders Among South Africans Seeking HIV Testing
We administered the Structured Clinical Interview for the DSM to 485 persons seeking HIV testing at five community testing centres in South Africa to determine the prevalence of common mental disorders among this population. The prevalence estimates for the various disorders were as follows: major depressive disorder: 14.2 % (95 % CI [11.1, 17.3]); generalised anxiety disorder 5.0 % (95 % CI [3.07, 6.93]); posttraumatic stress disorder 4.9 % (95 % CI [2.98, 6.82]); and alcohol use disorder 19.8 % (95 % CI [16.26, 23.34]). Our findings imply the need to research the integration of screening and referral trajectories in the context of voluntary HIV counselling and testing.
Distress, depression and anxiety among persons seeking HIV testing
We investigated psychological distress and symptoms of depression and anxiety among 485 South Africans seeking HIV testing. The mean scores of the sample were 45.78 (SD = 16.81) on the Hopkins Symptom Checklist; 15.8 (SD = 12.4) on the Beck Depression Inventory and 12.44 (SD = 13.00) on the Beck Anxiety Inventory, which fell in the elevated, mild and low ranges on these instruments, respectively. For more than a third of participants, symptoms of depression and clinically significant distress were at least moderate and in some cases severe, indicating that they may have benefitted from psychological help. We make the case that symptoms of depression and distress are common among persons seeking HIV testing and are therefore not a consequence of an HIV-positive test result.
Journal of psychosomatic research, 2006
Background: Psychiatric disorders in HIV/AIDS are common, emerging soon after diagnosis or during the subsequent course of illness. However, there are few prospective studies on the rates of psychiatric disorders in HIV/AIDS, particularly in the context of the developing world. Methods: Sixty-five patients with recently diagnosed HIV were interviewed on presentation to a hospital-based HIV clinic and then 6 months later. On both interviews, the patients were assessed using the MINI International Neuropsychiatric Interview, the Carver Brief COPE, and the Sheehan Disability Scale. Exposure to negative life events and risk behaviors was also evaluated. Results: The overall prevalence of psychiatric disorders in the follow-up period remained high (56% of patients had at least one psychiatric disorder at baseline, and 48% of patients had at least one psychiatric disorder at 6 months). Depression and posttraumatic stress disorder (PTSD) were the most prevalent disorders at both baseline (34.9% and 14.8%) and follow-up (26% and 20%), respectively. More than half of all patients with depression at baseline improved (16 of 29; 55.1%). However, there was a new onset of both depression (4 of 49; 8.1%) and PTSD (12 of 17; 70.5%) on follow-up. In univariate analysis, depression on follow-up was significantly associated with: (a) disability in work/social/family functioning, (b) greater number of negative life events, and (c) a decline in CD4 lymphocyte count. Univariate analysis also revealed that a diagnosis of PTSD on follow-up was significantly associated with (a) a longer duration of infection and (b) baseline disability in work/social/family functioning. However, in multivariate analysis, only disability scores predicted the diagnoses of major depression and PTSD on follow-up assessment. Persistence of risky sexual behaviour was also noted, with a significantly higher number of participants reporting nonuse of condom on follow-up. There appeared to be a shift from maladaptive coping behaviors to more adaptive coping behaviors over the 6-month period. Conclusion: The rate of psychiatric disorders in HIV/AIDS patients was consistent over time. These findings emphasize the importance of regular evaluation for psychiatric disorders in HIV/AIDS patients, not only at the commencement of treatment but also during subsequent follow-up visits. D
African Journal of AIDS Research, 2016
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.
PsycEXTRA Dataset
Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV (PLWH) and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare, and are among the most challenging barriers to achieving the end of the HIV epidemic. Rates of mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. Mental health impairments increase risk for HIV acquisition and for negative health outcomes among PLWH at each step in the HIV care continuum. We have the necessary screening tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment with appropriate resources to address the current mental health screening and treatment gaps. Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.
Delivering Mental Health Care to HIV-Positive Individuals
Psychosomatics, 1999
Data on initial psychiatric evaluations performed in 1995 were compared to assess whether psychiatric consultation for human immunodeficiency virus (HIV)-positive/acquired immunodeficiency syndrome (AIDS) patients provided on-site in an infectious disease (ID) clinic improved compliance and were preferred by staff to evaluations performed in a specialized AIDS psychiatric program. Compliance with initial appointments remained below 50% in both settings, but more patients seen in the ID clinic had received prior psychiatric treatment and medication and they were more likely to receive a psychotropic prescription at this initial visit. The ID clinic staff preferred on-site consultations. Stationing psychiatric consultants in the ID clinic may reach a more impaired population but did not improve compliance with the initial visit.
Psychology, Health & Medicine, 2004
This study examines the validity, feasibility, and utility of the Client Diagnostic Questionnaire (CDQ), a brief diagnostic screening tool designed for use by non-mental health professionals and designed specifically to assess the range of psychiatric disorders known to be prevalent among persons infected with HIV or at high risk of infection: depression, anxiety, PTSD, substance abuse. Non-clinically trained personnel administered the CDQ to a diverse sample of 260 HIV infected individuals at six primary care or social service agencies; a second interview was conducted by an experienced mental health clinician. There was good agreement between positive screen on the CDQ and diagnosis made by an independent mental health professional. For the diagnosis of any disorder, sensitivity = 91%, specificity = 78%, and overall accuracy = 85%. Clients who screened positive for disorder based on the CDQ interview had significantly impaired mental health functioning compared to individuals without CDQ screening diagnosis. CDQ was well received by both clients and agency staff. Findings support the feasibility and utility of the CDQ. The CDQ can be used by providers in a range of service settings to identify persons in need of formal mental health assessment and treatment, to more effectively target scarce mental health resources, and to reduce the negative impact of unrecognized disorder on the health and well-being of individuals in their care.
Psychiatric Problems in HIV Care
Infectious diseases, 2023
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.
Psychiatric Symptoms and Barriers to Care in HIV-Infected Individuals Who Are Lost to Care
Journal of the International Association of Providers of AIDS Care, 2017
Past studies of barriers to HIV care have not comprehensively assessed psychiatric symptoms, and few have assessed barriers to care among people living with HIV (PLWH) who are lost to care (LTC). We examined psychiatric symptoms, barriers to HIV care, and immune functioning in PLWH who were retained in care (RIC; n = 21) or LTC (n = 21). Participants completed diagnostic interviews for posttraumatic stress disorder (PTSD) and other psychiatric disorders, self-report measures of HIV risk behaviors and psychiatric symptoms, and a blood draw to assess viral load. Compared to RIC participants, LTC participants met criteria for a greater number of psychiatric disorders and reported greater depressive symptoms and more barriers to HIV care. There were no group differences in PTSD severity, risk behaviors, or viral load, suggesting that LTC individuals experience greater psychiatric problems and perceive more barriers to care than RIC participants, but are not less likely to have achieved ...