Symptoms of posttraumatic stress and death anxiety in persons with HIV and medication adherence difficulties

The present study examined the frequency and correlates of self-reported symptoms of posttraumatic stress among patients with HIV and medication adherence problems. Self-report data revealed that more than half of participants met diagnostic criteria for posttraumatic stress disorder (PTSD) according to the Posttraumatic Diagnostic Scale PDS. Death anxiety was associated with overall PTSD symptom severity scores as well as severity scores for reexperiencing, avoidance, and arousal symptoms. The association between death anxiety and total PTSD severity, reexperiencing and avoidance symptom scores remained after controlling for depression and satisfaction with social support. Anxiety, as manifested by PTSD symptoms should be routinely assessed among patients with HIV, and variables such as death anxiety, social support, and depression are appropriate targets for mental health interventions.     

Post-traumatic stress disorder among recently diagnosed patients with HIV/AIDS in South Africa

This study examined the prevalence of and factors associated with post-traumatic stress disorder in recently diagnosed HIV/AIDS patients in South Africa. One hundred and forty-nine (44 male, 105 female) recently diagnosed HIV/AIDS patients (mean duration since diagnosis = 5.8 months, SD = 4.1) were evaluated. Subjects were assessed using the MINI International Neuropsychiatric Interview (MINI), the Carver Brief COPE coping scale and the Sheehan Disability Scale. In addition, previous exposures to trauma and past risk behaviours were assessed. Twenty-two patients (14.8%) met criteria for PTSD. Current psychiatric conditions more likely to be associated with PTSD included major depressive disorder (29% in PTSD patients versus 7% in non-PTSD patients, p = 0.004), suicidality (54% versus 11%, p = 0.001) and social anxiety disorder (40% versus 13%, p = 0.04). Further patients with PTSD reported significantly more work impairment and demonstrated a trend towards higher usage of alcohol as a means of coping. Discriminant function analysis indicated that female gender and a history of sexual violation in the past year were significantly associated with a diagnosis of PTSD. Patients whose PTSD was a direct result of an HIV/AIDS diagnosis (8/22) did not differ from other patients with PTSD on demographic or clinical features. In the South African context, PTSD is not an uncommon disorder in patients with HIV/AIDS. In some cases, PTSD is secondary to the diagnosis of HIV/AIDS but in most cases it is seen after other traumas, with sexual violation and intimate partner violence in women being particularly important.     

The relationship of post-traumatic stress disorder and depression to antiretroviral medication adherence in persons with HIV

In HIV/AIDS, symptoms of depression or post-traumatic stress may interfere with important self-care behaviors such as the ability to adhere to one's medical treatment regimen. However, these problems may frequently go undetected in HIV care settings. The present study used brief self-report screening measures of depression and post-traumatic stress disorder (PTSD) in the HIV/AIDS care settings to examine (1) frequency of positive screens for these diagnoses; (2) the degree to which those with a positive screen were prescribed antidepressant treatment; and (3) the association of continuous PTSD and depression symptom scores, and categorical (screening positive or negative) PTSD and depression screening status, to each other and to ART adherence as assessed by the Medication Event Monitoring System, regardless of antidepressant treatment. Participants were 164 HIV-infected individuals who took part in a multisite adherence intervention study in HIV treatment settings in Massachusetts. Available data from 5 time points was used, yielding 444 data points. Participants screened positive for PTSD at 20% of visits, and depression at 22% of visits. At visits when participants screened positive for both depression and PTSD, 53.6% of the time they were on an antidepressant. Those who screened positive for PTSD were more likely to also screen positive for depression. In multiple regression analyses that included both continuous and dichotomous PTSD and depression and controlled for shared variance due to clustering of multiple observations, only depression contributed significant unique variance, suggesting the primary role of depression and the secondary role of PTSD in poor adherence in individuals with HIV.     

Posttraumatic stress disorder in women attending human immunodeficiency virus outpatient clinics

This study examined posttraumatic stress disorder (PTSD) in human immunodeficiency virus (HIV)-positive women seeking medical care. Specifically, we examined traumatic life events, psychiatric treatment, social support, and demographic characteristics in relation to level of PTSD symptoms. We recruited and obtained informed consent from 47 ethnically diverse HIV-positive women from two HIV outpatient clinics in a county medical system. Forty-one of these women provided complete data on measures assessing demographics, traumatic life events, PTSD symptoms, social support, and psychotherapy/medical history. Analysis of the data demonstrated that a high percentage (42%) of the HIV-positive women were likely to meet criteria for full current PTSD, and an additional 22% for partial PTSD. Of the women likely with full PTSD, 59% were not receiving any psychiatric treatment, and of those likely with partial PTSD, 78% were not receiving any psychiatric treatment. Also, women reported having experienced a mean of 12 traumatic life events. As hypothesized, the level of PTSD was significantly related to the number of life events experienced (rs = 0.52, p < 0.001), and to perceived social support from friends (rs = - 0.34, p < 0.02) and family (rs = - 0.29, p < 0.05). Given the high percentages of women who were found to have experienced traumatic life events and high levels of PTSD symptoms, it seems important to assess and treat PTSD in women with HIV/acquired immune deficiency syndrome (AIDS).     

Incidence and impact of posttraumatic stress disorder and comorbid depression on adherence to HAART and CD4+ counts in people living with HIV

Recent research suggests that the presence of posttraumatic stress disorder (PTSD) and depressive symptoms is independently related to abnormal hormone levels, inadequate medication adherence, and faster HIV disease progression. Although PTSD and depression occur comorbidly at high rates, the impact of both disorders on adherence and disease progression has not been examined. The present study examined the impact of PTSD and comorbid depression on CD4 cell counts and medication adherence in 58 male and 11 female (36% African American) HIV-positive individuals recruited from an AIDS service organization. Results revealed that participants high in depressive symptoms had lower CD4 cell counts and were less likely to adhere to their medication regimens than participants high in PTSD symptoms and those high in comorbid symptomatology. The present results suggest that the presence of depressive symptoms may be responsible for the observed impact of PTSD on people living with HIV (PLWH), and that failure to examine comorbid disorders may not adequately address the impact of clinical symptoms on people living with HIV.     

Psychiatric morbidity among HIV-infected children and adolescents in a resource-poor Kenyan urban community

The course of HIV/AIDS in children has been transformed from an acute to a chronic one with the advent of Anti-Retroviral Therapy. The aim of this study was to determine the prevalence and pattern of psychiatric morbidity in HIV-infected children and adolescents between 6 and 18 years of age and the relationship between their socio-demographic factors, immune suppression and psychiatric morbidity. The study was conducted at a paediatric HIV clinic in Nairobi, between February and April 2010. One hundred and sixty-two HIV-infected children and adolescents aged between 6 and 18 years and their guardians were interviewed. Seventy-nine (48.8%) of the study participants were found to have psychiatric morbidity. The most prevalent Diagnostic Statistical Manual, 4th Edition TR psychiatric disorders were: Major depression (17.8%), Social phobia (12.8%), Oppositional Defiant Disorder (12.1%) and Attention Deficit Hyperactivity Disorder (12.1%). Twenty-five per cent of the study participants had more than one psychiatric disorder. The prevalence of psychiatric morbidity in HIV-infected children is higher than that found in children in the general population. There is therefore a need to integrate psychiatric services into the routine care of HIV-infected children.     

Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales

Despite the high prevalence of both mental disorders and HIV infection in much of sub-Saharan Africa, little is known about the occurrence of mental health disorders among HIV-infected individuals. We conducted a cross-sectional study among individuals enrolled into HIV care and treatment services near Cape Town, South Africa. Psychiatric diagnoses were measured using the Mini-International Neuropsychiatric Interview (MINI) administered by trained research nurses. In addition, all participants were administered brief rating scales for depression (the Center for Epidemiological Studies Depression Scale [CES-D]), posttraumatic stress disorder (PTSD), the Harvard Trauma Questionnaire (HTQ), and alcohol dependence/abuse (the Alcohol Use Disorders Identification Test [AUDIT]). The median age among the 465 participants was 33 years and 75% were female; 48% were receiving antiretroviral therapy. Overall, the prevalence of depression, PTSD and alcohol dependence/abuse was 14% (n = 62), 5% (n = 24), and 7% (n = 35), respectively. In multivariate analysis, the prevalence of all disorders was significantly higher among individuals who spoke Afrikaans compared to Xhosa. While the AUDIT showed excellent sensitivity and specificity in detecting MINI-defined dependence/abuse (area under the receiver-operating characteristic curve, 0.96), the HTQ and CES-D had lower performance characteristics in detecting PTSD (0.74) and depression (0.76), respectively. These data demonstrate high levels of depression, PTSD and alcohol dependence/abuse among HIV-infected individuals in this setting. Additional research is required to refine these rating scales for maximum applicability in cross-cultural populations. More generally, HIV care and treatment services represent an important venue to identify and manage individuals with common mental disorders in resource-limited settings.     

The prevalence of post-traumatic stress disorder and its relation to childhood adversity in subjects with eating disorders

The prevalence of post-traumatic stress disorder (PTSD) and its relation to childhood adversity and Axis I psychiatric disorders was assessed in a clinical population of 164 eating disorders patients. Eleven per cent (18/164) had a lifetime history of PTSD. There was no difference in the prevalence of PTSD between the subgroups of eating disorders. Higher prevalences of PTSD symptoms were found in those who had a history of childhood sexual abuse (23 per cent versus 9 per cent; p<0.05), discord in the home (16 per cent versus 6 per cent; p<0.05) and high parental control (44 per cent versus 6 per cent; p<0.001). Higher rates of life-time comorbidity of other Axis I disorders in PTSD sufferers was only found for anxiety disorders (67 per cent versus 39 per cent, p<0.03). Possible mechanisms linking childhood experiences to PTSD are discussed. © 1997 John Wiley & Sons, Ltd and Eating Disorders Association.     

The association between HIV clinical disease severity and psychiatric disorders as seen in Western Romania

HIV disease continues to be a serious health issue all over the world. By the end of 2016, 36.7 million people were living with HIV, 1.8 million people became newly infected and 1 million died of HIV-related causes/diseases. In order to develop effective treatment strategies, is important to assess the risk factors that affect negatively the HIV-positive patients. HIV-infected patients are at high risk of developing psychiatric disorders in every stage of the illness. Psychiatric disorders can negatively influence the treatment adherence, induce risk behavior and influence the quality of life. The purpose of this study is to determine if the severity of HIV disease is associated with increased frequency of psychiatric disorders. We evaluated 101 HIV-positive patients receiving antiretroviral therapy in Western Romania via Psychiatric Diagnostic Screening Questionnaire (PDSQ). We conducted a risk analysis in order to see if the patients have a higher risk of developing psychiatric disorders depending on HIV serostatus factor (HIV asymptomatic, symptomatic, AIDS converted). Our study shows that, the patients having AIDS and symptomatic HIV have a higher prevalence for the most common psychiatric disorders: major depressive disorder (OR?=?5.81;p?p?=?0.016), agoraphobia (OR?=?4.31; p?=?0.024), social phobia (OR?=?2.81; p?=?0.038), generalized anxiety disorder (OR?=?4.79; p?=?0.006), somatization (OR?=?8.72; p?p?=?0.0013). Symptomatic HIV and AIDS converted serostatus is also a risk factor for post-traumatic stress disorder, obsessive-compulsive disorder and psychosis. The main conclusion of this study is that the more severe HIV clinical disease was associated with increased frequency of psychiatric disorders. As a consequence, we conclude that psychiatric disorders and HIV/AIDS treatment should be addressed simultaneously, depending on the risk specific factors such as the HIV infection stage and, due to psychiatric repercussions of HIV is expected to become more relevant in the coming years.     

Psychiatric Disorders,Drug Use,and Medical Status in Injection Drug Users With HIV Disease

The authors reviewed records of 84 HIV-infected methadone- maintenance treatment (MMT) patients for psychiatric disorders, HIV disease status, and urine drug-test results. Sixty-six patients (79%) required psychiatric consultation (P+). Their diagnoses are presented. P+ patients and patients not requiring consultation (P?) were compared for drug abuse, HIV status, and zidovudine (AZT) treatment while in MMT. P+ patients had a higher rate of drug-positive urine tests than P? patients, were more likely to have progressed to AIDS, and were less likely to have AZT prescribed. Among injection drug users in MMT, current psychiatric comorbidity is common and may be associated with worsened drug-abuse treatment and HIV disease outcome. (American Journal on Addictions 1996; 5:249–258)     

Psychological distress in the first year after diagnosis of HIV infection among women in South Africa

Cross-sectional studies on psychological responses associated with an HIV diagnosis are replete, but a paucity of research exists to evaluate the changes and stability of these responses, particularly among black African women. One hundred and five HIV-positive black and coloured women were studied as they reported for follow-up health management at the outpatient clinic for infectious diseases at Tygerberg Hospital in Cape Town, South Africa. They were assessed at baseline and 51 returned for a follow-up interview six months later. Assessments involved use of the Mini-International Neuropsychiatric Interview (MINI), the Carver Brief COPE, and the Sheehan Disability Scale. Negative life events and risk behaviours were also evaluated. Fifty-nine women (56.2%) were diagnosed with at least one psychiatric disorder on the MINI at baseline. The most frequent diagnosis was major depression (38.1%), followed by dysthymic disorder (22.9%). A diagnosis of HIV or AIDS exacerbated the premorbid state of 19% of the women who reported a past history of depression. Twelve women (11.4%) were at risk for suicide, while 19% met criteria for a clinical diagnosis of post-traumatic stress disorder (PTSD) and 6.7% met the diagnosis of generalised anxiety disorders. At follow-up, 26 (51%) were diagnosed with at least a psychiatric disorder. Eleven (21.6%) met the criteria for major depression, while eight (15.7%) had a past history of depression. The number of women with PTSD increased from 19% of the total sample at baseline to 29.4% of those interviewed at follow-up. Conversely, the number with dysthymia dramatically decreased from 24 women (22.9%) at baseline to just one woman at follow-up. The number displaying suicidality also decreased from 12 at baseline to four at follow-up. At both baseline and follow-up, the number and impact of negative life events significantly increased the likelihood of major depression persisting or recurring, but this association was not found for PTSD. These findings indicate that, over time, there is variability in psychiatric morbidity among coloured and black African women living with HIV and that a high number of negative life events may increase the likelihood of persistent major depression in these women.     

Routine Depression Screening in an HIV Clinic Cohort Identifies Patients with Complex Psychiatric Co-morbidities Who Show Significant Response to Treatment

This study described characteristics, psychiatric diagnoses and response to treatment among patients in an outpatient HIV clinic who screened positive for depression. Depressed (25 %) were less likely to have private insurance, less likely to have suppressed HIV viral loads, had more anxiety symptoms, and were more likely to report current substance abuse than not depressed. Among depressed, 81.2 % met diagnostic criteria for a depressive disorder; 78 % for an anxiety disorder; 61 % for a substance use disorder; and 30 % for co-morbid anxiety, depression, and substance use disorders. Depressed received significantly more treatment for depression and less HIV primary care than not depressed patients. PHQ-9 total depression scores decreased by 0.63 from baseline to 6-month follow-up for every additional attended depression treatment visit. HIV clinics can routinely screen and treat depressive symptoms, but should consider accurate psychiatric diagnosis as well as co-occurring mental disorders.     

Posttraumatic stress disorder symptom severity and HIV-risk behaviors among substance-dependent inpatients

Despite findings that the co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is associated with heightened risk for a variety of risky behaviors, few studies have examined behaviors linked to heightened risk for HIV infection and transmission in particular, or explored the unique associations between specific PTSD symptom clusters and these HIV-risk behaviors. Therefore, the goal of this study was to examine the associations between PTSD symptom severity and HIV-risk behaviors (i.e., risky sexual behavior [RSB] and injection drug use [INJ]) within an ethnically diverse sample of 85 SUD patients in residential SUD treatment. Participants completed a battery of questionnaires assessing PTSD symptom severity and HIV-risk behaviors, including RSB and INJ. Results demonstrated significant positive associations between PTSD symptom severity and RSB; however, no significant relationship between PTSD symptom severity and INJ was found. Furthermore, the severity of hyperarousal symptoms in particular was found to significantly predict RSB above and beyond age and all other PTSD symptom clusters. Results of this study suggest that PTSD symptoms (and, more specifically, the hyperarousal symptoms of PTSD) may heighten the risk for some forms of HIV-risk behaviors (RSB) but not others (INJ). Results highlight the importance of identifying and targeting hyperarousal symptoms in the treatment of SUD patients experiencing symptoms of PTSD in order to reduce HIV infection or transmission risk.     

High prevalence of psychiatric and substance use disorders among persons seeking treatment for HIV and other STIs in Jamaica: a short report

This cross-sectional study explored the range of psychiatric and substance use disorders and unmet need for mental health care among 84 HIV-positive and 44 HIV-negative public clinic attendees in Jamaica. We used a brief interviewer-administered diagnostic tool, the Client Diagnostic Questionnaire. Two-thirds (65.6%) screened positive for at least one psychiatric disorder; 30.5% screened positive for multiple disorders. The most common disorders were post-traumatic stress disorder (PTSD) (41.4%), alcohol abuse (22.7%), and depressive disorders (21.9%). One in fourteen (7.1%) participants with at least one diagnosis received care in the last 6 months. Adjusting for age and sex, PTSD was associated with non-adherence to antiretroviral treatment (AOR?=?5.32), anxiety disorders (AOR?=?5.82), depression (AOR?=?4.29), and suicidal ideation (AOR?=?8.17). Psychiatric and substance use disorders, particularly PTSD, were common among STI/HIV clinic attendees in Jamaica. Such clinics may be efficient places to screen, identify, and treat patients with psychiatric disorders in low- and middle- income countries.     

DSM psychiatric disorders in the context of pediatric HIV/AIDS

In HIV-infected adults, psychiatric disorders result in poor quality of life, HIV disease progression, poor compliance and increased mortality. The same may be true for children and adolescents challenged with HIV/AIDS. The literature regarding the prevalence of Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) psychiatric disorders in pediatric patients with HIV/AIDS was reviewed. Of over 500 papers reviewed only eight attempted to quantify prevalence in some way. Average prevalences of 28.6% for attention deficit hyperactivity disorder, 24.3% for anxiety disorders and 25% for depression were found with respective risk ratios of 6.0, 3.8 and 7.1. However, sample sizes were small and only two of the eight studies were controlled. Surprisingly little has been done to describe and quantify what mental-health problems these HIV-positive children and adolescents face.     

Comparative profiles of women with PTSD and comorbid cocaine or alcohol dependence

This study examined differences in substance abuse severity, trauma history, posttraumatic stress disorder (PTSD) symptomatology and psychiatric comorbidity among treatment-seeking women (N= 74) with PTSD and either comorbid cocaine or alcohol dependence. Women in the cocaine/PTSD group, compared with the alcohol/PTSD group, demonstrated greater occupational impairment (e.g., greater severity on the employment subscale of the Addiction Severity Index, less monthly income, fewer days worked in past month), more legal problems (e.g., greater number of months incarcerated and arrests for prostitution), and greater social impairment (e.g., fewer number of close friends, less likely to be married). Women in the alcohol/PTSD group evidenced higher rates of exposure to serious accidents, other situations involving serious injury, and other extraordinarily stressful life events. Rates of major depression and social phobia were higher among the alcohol/PTSD group than the cocaine/PTSD group. Women in the alcohol/PTSD group scored higher on the CAPS avoidance, hyperarousal, and total subscale scores. The current findings enhance our understanding of the substance-specific profiles of women with PTSD and comorbid substance use disorders and may have important implications for the design of dual-diagnosis interventions.     

The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals

Information regarding the prevalence of mental illness and substance use among HIV-infected patients and the effect of these problems on HIV treatment is needed. We conducted an observational study of patients in the University of Washington (UW) HIV Cohort to determine prevalence rates for mental illness and substance use. Cox regression analyses were used to examine the relationship between mental illness and substance use, pharmacologic treatment for depression/anxiety, and initiation of highly active antiretroviral therapy (HAART) within 9 months of becoming eligible for HAART. Among 1774 patients in the UW HIV cohort during 2004, 63% had a mental illness (including mood, anxiety, psychotic, or personality disorders), 45% had a substance use disorder, and 38% had both. There were 278 patients who met criteria for HAART eligibility. After controlling for other factors, patients with depression and/or anxiety were significantly less likely to initiate HAART compared with patients without a mental illness (hazard ratio [HR] 0.4, p = 0.02). However, patients with depression/anxiety who received antidepressant/antianxiety medications were equally likely to initiate HAART as patients without a mental illness (HR 0.9, p = 0.5). We found that patients with mental illness or substance use disorders receive HAART at lower CD4+ cell counts and higher HIV-1 RNA levels than patients without these disorders. However, HAART initiation among patients who receive treatment for depression/anxiety is associated with no delay. Screening for these disorders in primary care settings and access to appropriate treatment are increasingly important components of providing care to HIV-infected patients.     

Psychiatric disorders among veterans with hepatitis C infection

BACKGROUND & AIMS: The presence of psychiatric, drug-, and alcohol-use disorders in hepatitis C virus (HCV)-infected patients may influence their management and prognosis. The frequency and the risk for these disorders among HCV-infected patients are unknown. METHODS: We identified all HCV-infected veteran patients who were hospitalized during 1992-1999 and searched the inpatient and outpatient computerized files for predefined psychiatric, drug-, and/or alcohol-use disorders. We then performed a case-control study among Vietnam veterans; controls without HCV were randomly chosen from hospitalized patients. RESULTS: We identified 33,824 HCV-infected patients, in whom 86.4% had at least one past or present psychiatric, drug-, or alcohol-use disorder recorded. However, only 31% had active disorders as defined by hospitalization to psychiatric or drug-detoxification bed sections. There were 22,341 HCV-infected patients from the Vietnam period of service (cases) who were compared with 43,267 patients without HCV (controls). Cases were more likely to have depressive disorders (49.5% vs. 39.1%), posttraumatic stress disorder (PTSD) (33.5% vs. 24.5%), psychosis (23.7% vs. 20.9%), bipolar disorder (16.0% vs. 12.6%), anxiety disorders (40.8% vs. 32.9%), alcohol (77.6% vs. 45.0%), and drug-use disorders (69.4% vs. 31.1%). In multivariable regression analyses that adjust for age, sex, and ethnicity, drug use, alcohol-use, depression, PTSD, and anxiety remained strongly associated with HCV. CONCLUSIONS: Several psychiatric, drug-, and alcohol-use disorders are commonly found among HCV-infected veterans compared with those who are not infected. At least one third of these patients have active disorders. A multidisciplinary approach to the management of HCV-infected patients is needed.     

The Differential Impact of PTSD and Depression on HIV Disease Markers and Adherence to HAART in People Living with HIV

Despite high rates of comorbidity, research has typically focused on the independent impact of posttraumatic stress disorder (PTSD) and depression symptoms in people living with HIV (PLWH). The present study examined the independent and comorbid influence of PTSD and depression symptoms on medication adherence, CD4 cell counts, and viral load, over the course of 3 months in 57 PLWH (82% men, 54% Caucasian, 44% African American) recruited from a clinic or social service agency. Both PTSD and depressive symptoms predicted lower subsequent adherence. However, only depressive symptoms predicted lower CD4 counts and presence of a detectable viral load. Participants reporting symptoms consistent with diagnostic levels of comorbid PTSD and depression were less likely to adhere to HAART and were more likely to have a detectable viral load. These results highlight the influences of PTSD and depression on adherence and HIV disease markers, and underscore the importance of examining comorbid symptomatology in PLWH.