HIV testing among individuals with a severe mental illness: review, suggestions for research, and clinical implications

BACKGROUND: The prevalence of human immunodeficiency virus (HIV) is elevated among individuals with a severe mental illness (SMI). Because of the benefits of HIV testing, it is important for individuals with SMI to have routine access to testing. The goals of this review are: to summarize knowledge about HIV testing prevalence, correlates, and interventions among individuals with an SMI; to identify research needs; and to discuss clinical implications of the studies reviewed.MethodLiterature searches were conducted using PsycINFO, PubMed, and Medline. Additional articles were obtained from reference lists of relevant articles. RESULTS: Fewer than one-half of individuals with an SMI have been tested for HIV in the past year. Engaging in sex or drug risk behavior was the only consistent correlate of HIV testing. Interventions for promoting HIV testing among individuals with an SMI have not been well developed or evaluated. CONCLUSIONS: Research on HIV testing among individuals with an SMI is needed. Mental health settings may be opportune venues for HIV testing, even though providers face ethical challenges when implementing testing programs in these settings.     

Influence of psychiatric diagnoses and symptoms on HIV risk behavior in adults with serious mental illness

HIV seroprevalence among people with serious mental illness has increased substantially in recent years. Although the prevalence of HIV behavioral risk factors has been well documented, few researchers have chosen to investigate the impact that psychopathology may have on HIV risk behavior. A review of the literature on psychiatric diagnoses related to HIV sexual risk reveals that bipolar disorder and perhaps schizophrenia are related to increased HIV risk. Further, persons in whom both Axis I and Axis II disorders are diagnosed appear to be at greater HIV behavioral risk. Research on psychiatric symptoms shows that illness severity may vary in its relation to HIV risk according to the specific symptoms present and that excited and possibly positive symptoms may be predictors of HIV sexual risk behavior. However, there is a need for research to elucidate these relationships. Future efforts that will add most to the literature will include examinations of psychiatric symptoms and illness severity, adequate sample sizes, statistical tests showing prediction of HIV risk behavior rather than the correlation with it, controls for substance abuse or dependence, and comparisons of psychopathology across HIV-positive and HIV-negative persons.     

The relation of alcohol use to HIV-risk sexual behavior among adults with a severe and persistent mental illness

The authors examined the relationship between alcohol use and HIV-risk sexual behavior and tested whether alcohol use immediately prior to sex is related to decreased condom use. The participants were 159 adults living with a severe and persistent mental illness. Each participated in a structured interview to assess all sexual and drug-use behavior over a 3-month period. Analysis of 3,026 sexual behaviors reported by 123 sexually active participants indicated that at the global level, participants who drank more heavily were more likely to have engaged in sexual risk behavior. At the event level, however, alcohol use was not related to condom use during vaginal or anal intercourse; that is, participants who used condoms when sober tended to use them to the same extent when drinking.     

Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review

There is a great deal of research on the prevalence, correlates, and treatment of PTSD in the general population. However, we know very little about the manifestation and consequences of PTSD in more complicated patient populations. The purpose of the current paper is to provide a comprehensive review of PTSD within the context of severe mental illness (SMI; i.e., schizophrenia spectrum disorders, mood disorders). Extant data suggest that trauma and PTSD are highly prevalent among individuals with SMI relative to the general population, and both are associated with adverse clinical functioning and increased healthcare burden. However, trauma and PTSD remain overlooked in this population, with low recognition rates in public-sector settings. Additionally, there are few data on the clinical course and treatment of PTSD among individuals with SMI. Particularly lacking are longitudinal studies, randomized controlled treatment trials, and studies using ethno-racially diverse samples. Furthermore, there is a need to better understand the interplay between trauma, PTSD, and severe forms of mental illness and to further develop and disseminate evidence-based PTSD treatments in this population. The current state of the literature and future directions for practice are discussed.     

A systematic review of the nutritional status of women of a childbearing age with severe mental illness

Little is known about the nutritional status of pregnant women with severe mental illness. We therefore carried out a systematic review to investigate whether pregnant women and childbearing aged women with severe mental illness have significantly greater nutritional deficiencies compared with pregnant women and childbearing aged women with no mental illness. We carried out a search using MEDLINE, EMBASE and PsycINFO from January 1980 to January 2011 for studies on nutritional status of childbearing aged women with psychotic disorders. Identification of papers and quality rating of papers (using a modified version of the Newcastle–Ottawa scale) was carried out by two reviewers independently. We identified and screened 4,130 potentially relevant studies from the electronic databases. Fifteen studies met the inclusion criteria (n?=?587 women). There were no studies of pregnant women. There was some evidence of low serum folate and vitamin B₁₂ levels and elevated homocysteine levels in childbearing aged women with psychotic disorders. Further research into the nutritional status of childbearing aged women with severe mental illness is needed. Maternal nutrition has a profound impact on foetal outcome, is a modifiable risk factor and therefore needs prioritising in the care of all childbearing aged women with severe mental illness.     

Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness

The majority of women with a severe mental illness (SMI) become pregnant and have children. The aim of this systematic review and meta-synthesis was to examine the qualitative research on the experiences of motherhood in women with SMI from preconception decision making to being a mother. The experiences of the health professionals treating women with SMI were also reviewed. Eleven databases were searched for papers published up to April 25, 2012, using keywords and mesh headings. A total of 23 studies were identified that met the inclusion criteria on the views of women with SMI, eight reported the views of health professionals including one which reported both. The meta-synthesis of the 23 studies on women's views produced two overarching themes Experiences of Motherhood and Experiences of Services. Sub-themes included the following: Guilt, Coping with Dual Identities, Stigma, and Centrality of Motherhood. Four themes emerged from the synthesis of the eight papers reporting the views of health professionals: Discomfort, Stigma, Need for education, and Integration of services. An understanding of the experiences of pregnancy and motherhood for women with SMI can inform service development and provision to ensure the needs of women and their families are met.     

Prevalence of HIV risk behaviors,risk perceptions,and testing among US adults with mental disorders

Persons with mental disorders may lack the knowledge, skills, and social networks that help limit the spread of HIV by reducing risk behaviors. Nationally representative data from the 1999 U.S. National Health Interview Survey were used to estimate the prevalence of HIV risk behaviors among civilian noninstitutionalized adults with and without at least one of three psychiatric conditions (depression, generalized anxiety disorder, and panic attacks) in the previous 12 months. Relative to adults without these mental disorders, adults with a mental disorder (8.8% of adults nationally) were more likely to have engaged in HIV risk behaviors since 1980 (5.5% vs. 1.6%). Adults with a mental disorder were also more likely to report a high or medium chance of becoming infected, were more likely to have been tested for HIV infection, and were more likely to expect to be tested within the next 12 months.     

A review of the role of illness models in severe mental illness

The ways in which people think about illness experiences have been associated with a variety of important behaviours and emotional responses in patients, carers, and professionals. Some of these responses have been shown to be related to outcome. Explicit models such as the self-regulation model (SRM) [Leventhal, H., Nerenz, D. R., & Steele, D. F. (1984). Illness representations and coping with health threats. In A. Baum & J. Singer (Eds.), A handbook of psychology and health. Hillsdale, NJ: Erlbaum, 219-252.] have been shown to be useful in highlighting key beliefs across a wide range of different physical illnesses. The specific beliefs about mental illness that have been assessed have been varied and largely without a common theoretical framework. This has resulted in a literature from which it is difficult to draw firm conclusions. The central aim of this paper is to assess the applicability of the SRM to mental illness. To this end, we review studies to date that have examined the beliefs that people with a mental illness have about their experiences. In addition, we review studies that have examined the beliefs of relatives of people with a mental illness and professionals who work with this population. We assess to what extent these studies are consistent with the SRM before suggesting ways in which the model could be further developed and tested. The SRM is presented as a useful framework for more advanced investigations into the function of beliefs about mental illness and how these can be modified in order to effect outcome. Developing psychological theories common to both physical and mental health may eventually result in an integrated approach in which mental illness becomes less stigmatised within the treatment setting.     

The HIV epidemic among individuals with mental illness in the United States

People with depression and other mental illness comprise a growing proportion of individuals living with HIV in the United States; at the same time, the prevalence of HIV among mentally ill individuals is at least seven times higher than in the general population. Individuals with mental illness are particularly vulnerable to infection with HIV because of several factors, including the higher prevalence of poverty, homelessness, high-risk sexual activities, drug abuse, sexual abuse, and social marginalization found in this population. Nevertheless, mentally ill individuals are often not screened for HIV and may not be appropriately targeted in current HIV prevention efforts. Moreover, despite widespread access to antiretroviral treatment in the United States, HIV outcomes among mentally ill individuals continue to be poor. This disparity can be explained by several interrelated factors, including lower rates of highly active antiretroviral therapy (HAART) utilization, lower rates of adherence to HAART, and immunologic changes associated with mental illness itself. We need to improve our design of prevention, screening, and treatment programs to better reach individuals with comorbid HIV and mental illness.     

Exploring the effectiveness of couples interventions for adults living with a chronic physical illness: A systematic review

ObjectivePartners have a significant role in a person’s ability to adjust to a chronic physical illness, which warrants their inclusion in couples interventions. However to deliver more specific, tailored support it is necessary to explore which types of couples interventions are most effective across certain chronic illness populations and outcomes.MethodsFive databases were searched using selected terms. Thirty-five articles met the eligibility criteria for inclusion.ResultsThe majority of studies were from the US, and most interventions targeted cancer populations. Couples interventions fell into two categories according to therapeutic approach; Cognitive Behavioural Skills Training (CBST) and Relationship Counselling (RC). When compared with a patient-only intervention or controls, CBST interventions effectively targeted behavioural, physical/somatic and cognitive outcomes, while RC more effectively targeted interpersonal outcomes.ConclusionCouples interventions can be more effective than patient-only interventions or controls across various patient and partner outcomes. Couples interventions tend to favour a skills-based or a relationship-based approach, which strongly influences the types outcomes effectively targeted.Practice implicationsOur findings suggest it could be therapeutically useful to integrate these two approaches to more holistically support couples living with chronic illness. We also identify the need to target understudied illness groups and ethnicities.     

Community pharmacy services to optimise the use of medications for mental illness: a systematic review

The objective of this systematic review was to evaluate the impact of pharmacist delivered community-based services to optimise the use of medications for mental illness. Twenty-two controlled (randomised and non-randomised) studies of pharmacists' interventions in community and residential aged care settings identified in international scientific literature were included for review. Papers were assessed for study design, service recipient, country of origin, intervention type, number of participating pharmacists, methodological quality and outcome measurement. Three studies showed that pharmacists' medication counselling and treatment monitoring can improve adherence to antidepressant medications among those commencing treatment when calculated using an intention-to-treat analysis. Four trials demonstrated that pharmacist conducted medication reviews may reduce the number of potentially inappropriate medications prescribed to those at high risk of medication misadventure. The results of this review provide some evidence that pharmacists can contribute to optimising the use of medications for mental illness in the community setting. However, more well designed studies are needed to assess the impact of pharmacists as members of community mental health teams and as providers of comprehensive medicines information to people with schizophrenia and bipolar disorder     

HIV risk reduction in a nurse case-managed TB and HIV intervention among homeless adults

This study evaluated a six-month nurse case-managed intervention against a standard care control program among 295 sheltered homeless adults from Los Angeles, USA. The primary aim of the intervention was encouraging latent tuberculosis infection treatment completion. The secondary aim was reducing HIV risk, the focus of this report. A longitudinal path model revealed that the intervention impacted cognitive factors of AIDS Knowledge, Perceived AIDS Risk and Self-efficacy for Condom Use, but did not impact substance use and risky sexual behaviors. The dual intervention program for HIV and TB provided promising synergistic effects by targeting risk factors common to both infections.     

Nonabusive physical punishment and child behavior among African-American children: a systematic review

BACKGROUND: The use of nonabusive physical punishment as a form of discipline has been greatly debated in the scientific and popular literature. Impact on child behavioral outcomes has frequently been found; however, the effects of its use are not clear, particularly for African-American children. This systematic review of the literature examined the impact of exposure to nonabusive physical punishment on the behavior of African-American children. METHODS: A search was conducted of PubMed and Psyclnfo from 1970 to 2000 using the key terms: corporal punishment, physical punishment, disciplinary practices, and discipline and parenting. Studies that described ethnicity of the population and included a majority of a well-described African-American population were included. Each study was required to include measurable data on child behavioral outcomes and at least one measure of discipline that assessed use of nonabusive physical punishment in children 0-14 years of age. RESULTS: All seven included studies used lower socioeconomic status (SES) and/or urban African-American populations. Study design and rural versus urban populations differentiated beneficial and detrimental outcomes. In all longitudinal studies, African-American children had beneficial or neutral outcomes. DISCUSSION: This review suggests that it is possible that there are benefits to nonabusive physical punishment for African-American children. However, needed are further longitudinal studies that better assess the multiple confounders that impact the use of discipline, such as SES, parental education level, and exposure to community or domestic violence.     

Hepatitis C treatment for people with severe mental illness

Over 4 million people in the United States are chronically infected with hepatitis C virus (HCV), and, if untreated, over 20% of these will progress to more serious disease. Persons with severe mental illness (SMI) have markedly elevated rates of HCV infection, but treatment of persons with SMI and HCV has been controversial. Effective antiviral treatment is available, but side effects include depression and other neuropsychiatric symptoms. This article reviews the available data on neuropsychiatric side effects of interferon (IFN) treatment, discusses the limitations of the current research, and makes recommendations regarding HCV treatment in persons with SMI.