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HIV and Elevated Mental Health Problems: Diagnostic, Treatment, and Risk Patterns for Symptoms of Depression, Anxiety, and Stress in a National Community-Based Cohort of Gay Men Living with HIV

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Abstract

People living with HIV (PLHIV) have almost double the risk of depression than the rest of the population, and depression and anxiety among PLHIV have been linked with greater disease progression and other physical health problems. Studies to date, however, have focused almost exclusively on depression or general mental health. Much less research has investigated predictors of anxiety and generalized stress among HIV-positive gay men. This paper reports findings from a national community-based sample of 357 HIV-positive Australians gay men aged 18 years and older. Participants reported elevated rates of depression, anxiety, and generalized stress symptoms. A significant proportion of men with elevated depression and anxiety symptoms were not receiving treatment or had not been diagnosed. Risk factors for elevated mental health concerns included experiences of internalized stigma and discrimination. Anxiety was also associated with lower T-cell CD4 counts. A key protective factor was access to social support. The type of support, in particular emotional support, was found to be more important than the source of support. Our findings suggest that greater emphasis is needed on mental health screening and the provision of emotional support for PLHIV.

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References

  1. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–30.

    Article  CAS  PubMed  Google Scholar 

  2. Lyons A, Pitts M, Grierson J. Exploring the psychological impact of HIV: health comparisons of older Australian HIV-positive and HIV-negative gay men. AIDS Behav. 2012;16(8):2340–9.

    Article  PubMed  Google Scholar 

  3. Miners A, Phillips A, Kreif N, et al. Health-related quality-of-life of people with HIV in the era of combination antiretroviral treatment: a cross-sectional comparison with the general population. Lancet HIV. 2014;1(1):e32–40.

    Article  PubMed  Google Scholar 

  4. Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58(2):181–7.

    PubMed  Google Scholar 

  5. Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA. 2007;298(14):1685–7.

    Article  CAS  PubMed  Google Scholar 

  6. Cruess DG, Petitto JM, Leserman J, et al. Depression and HIV infection: impact on immune function and disease progression. CNS Spectr. 2003;8(1):52–8.

    PubMed  Google Scholar 

  7. Hartzell JD, Janke IE, Weintrob AC. Impact of depression on HIV outcomes in the HAART era. J Antimicrob Chemother. 2008;62(2):246–55.

    Article  CAS  PubMed  Google Scholar 

  8. Leserman J. HIV disease progression: depression, stress, and possible mechanisms. Biol Psychiatry. 2003;54(3):295–306.

    Article  PubMed  Google Scholar 

  9. Bouhnik A-D, Préau M, Schiltz M-A, et al. Unsafe sex with casual partners and quality of life among HIV-infected gay men: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA). J Acquir Immune Defic Syndr. 2006;42(5):597–603.

    Article  PubMed  Google Scholar 

  10. Asch SM, Kilbourne AM, Gifford AL, et al. Underdiagnosis of depression in HIV: who are we missing? J Gen Intern Med. 2003;18(6):450–60.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rodkjaer L, Laursen T, Balle N, Sodemann M. Depression in patients with HIV is under-diagnosed: a cross-sectional study in Denmark. HIV Med. 2010;11(1):46–53.

    Article  CAS  PubMed  Google Scholar 

  12. Pence BW, O’Donnell JK, Gaynes BN. Falling through the cracks: the gaps between depression prevalence, diagnosis, treatment, and response in HIV care. AIDS. 2012;26(5):656–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mao L, Kidd MR, Rogers G, et al. Social factors associated with major depressive disorder in homosexually active, gay men attending general practices in urban Australia. Aust N Z J Public Health. 2009;33(1):83–6.

    Article  PubMed  Google Scholar 

  14. Rogers G, Curry M, Oddy J, Pratt N, Beilby J, Wilkinson D. Depressive disorders and unprotected casual anal sex among Australian homosexually active men in primary care. HIV Med. 2003;4(3):271–5.

    Article  CAS  PubMed  Google Scholar 

  15. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Logie C, Gadalla T. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009;21(6):742–53.

    Article  CAS  PubMed  Google Scholar 

  18. Hall VP. The relationship between social support and health in gay men with HIV/AIDS: an integrative review. J Assoc Nurses AIDS Care. 1999;10(3):74–86.

    Article  CAS  PubMed  Google Scholar 

  19. Lam PK, Naar-King S, Wright K. Social support and disclosure as predictors of mental health in HIV-positive youth. AIDS Patient Care STDS. 2007;21(1):20–9.

    Article  PubMed  Google Scholar 

  20. McDowell TL, Serovich JM. The effect of perceived and actual social support on the mental health of HIV-positive persons. AIDS Care. 2007;19(10):1223–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Friedland J, Renwick R, McColl M. Coping and social support as determinants of quality of life in HIV/AIDS. AIDS Care. 1996;8(1):15–32.

    Article  CAS  PubMed  Google Scholar 

  22. Emlet CA, Fredriksen-Goldsen KI, Kim H-J. Risk and protective factors associated with health-related quality of life among older gay and bisexual men living with HIV disease. Gerontologist. 2013;53(6):963–72.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. 2nd ed. Sydney: Psychological Foundation; 1995.

    Google Scholar 

  24. Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44(2):227–39.

    Article  PubMed  Google Scholar 

  25. Clark LA, Watson D. Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Psychol. 1991;100(3):316–36.

    Article  CAS  PubMed  Google Scholar 

  26. Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: the Internalized AIDS-Related Stigma Scale. AIDS Care. 2009;21(1):87–93.

    Article  PubMed  Google Scholar 

  27. Cohen S, Mermelstein R, Kamarck T, Hoberman HM. Measuring the functional components of social support. In: Sasason IG, Sarason B, editors. Social support: theory, research and applications. The Hague: Martinus Nijhoff; 1985. p. 73–94.

    Chapter  Google Scholar 

  28. O’Brien RM. A caution regarding rules of thumb for variance inflation factors. Qual Quant. 2007;41(5):673–90.

    Article  Google Scholar 

  29. Cohen J, Cohen P, West SG, Aiken LS. Applied multiple regression/correlation analysis for the behavioral sciences. 3rd ed. Mahwah, NJ: Lawrence Erlbaum Associates; 2003.

    Google Scholar 

  30. Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Boston: Pearson Education Inc.; 2007.

    Google Scholar 

  31. Slade T, Johnson A, Teesson M, et al. The mental health of Australians 2: report on the 2007 National Survey of Mental Health and Wellbeing. Canberra: Department of Health and Ageing; 2009.

    Google Scholar 

  32. Lyons A, Pitts M, Grierson JW, Thorpe R, Power J. Ageing with HIV: health and psychosocial well-being of older gay men. AIDS Care. 2010;22(10):1236–44.

    Article  PubMed  Google Scholar 

  33. Grierson JW, Pitts M, Koelmeyer R. HIV futures seven: The health and wellbeing of HIV positive people in Australia, monograph series 88. Melbourne: The Australian Research Centre in Sex, Health and Society, La Trobe University; 2013.

  34. Joint United Nations Programme on HIV/AIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2014.

    Google Scholar 

  35. Degroote S, Vogelaers D, Vandijck DM. What determines health-related quality of life among people living with HIV: an updated review of the literature. Arch Public Health. 2014;72(1):40.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hoffman MA. HIV disease and work: effect on the individual, workplace, and interpersonal contexts. J Vocat Behav. 1997;51(2):163–201.

    Article  Google Scholar 

  37. Schrimshaw EW, Siegel K. Perceived barriers to social support from family and friends among older adults with HIV/AIDS. J Health Psychol. 2003;8(6):738–52.

    Article  PubMed  Google Scholar 

  38. Fryers T, Melzer D, Jenkins R. Social inequalities and the common mental disorders. Soc Psychiatry Psychiatr Epidemiol. 2003;38(5):229–37.

    Article  PubMed  Google Scholar 

  39. Weich S, Lewis G. Poverty, unemployment, and common mental disorders: population based cohort study. BMJ. 1998;317(7151):115–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Crawford J, Cayley C, Lovibond PF, Wilson PH, Hartley C. Percentile norms and accompanying interval estimates from an Australian general adult population sample for self-report mood scales (BAI, BDI, CRSD, CES-D, DASS, DASS-21, STAI-X, STAI-Y, SRDS, and SRAS). Aust Psychol. 2011;46(1):3–14.

    Article  Google Scholar 

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Acknowledgments

This study was funded by the Australian Government Department of Health.

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Authors and Affiliations

  1. Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia

    Wendy Heywood & Anthony Lyons

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  1. Wendy Heywood
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  2. Anthony Lyons
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Correspondence to Wendy Heywood.

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Heywood, W., Lyons, A. HIV and Elevated Mental Health Problems: Diagnostic, Treatment, and Risk Patterns for Symptoms of Depression, Anxiety, and Stress in a National Community-Based Cohort of Gay Men Living with HIV. AIDS Behav 20, 1632–1645 (2016). https://doi.org/10.1007/s10461-016-1324-y

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