Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study.

Stephanie K Y Choi,John Cairney,Evan J Collins,Sean B Rourke,Sandra Gardner,Eleanor Boyle,Jean Bacon,Viviane D Lima

doi:10.1371/journal.pone.0156652

Abstract

BackgroundMajor depression can profoundly impact clinical and quality-of-life outcomes of people living with HIV, and this disease is underdiagnosed and undertreated in many HIV-positive individuals. Here, we describe the prevalence of publicly funded primary and secondary mental health service use and antidepressant use, as well as mental health care for depression in accordance with existing Canadian guidelines for HIV-positive patients with depression in Ontario, Canada.MethodsWe conducted a prospective cohort study linking data from the Ontario HIV Treatment Network Cohort Study with administrative health databases in the province of Ontario, Canada. Current depression was assessed using the Center for Epidemiologic Depression Scale or the Kessler Psychological Distress Scale. Multivariable regressions were used to characterize prevalence outcomes.ResultsOf 990 HIV-positive patients with depression, 493 (50%) patients used mental health services; 182 (18%) used primary services (general practitioners); 176 (18%) used secondary services (psychiatrists); and 135 (14%) used both. Antidepressants were used by 407 (39%) patients. Patients who identified as gay, lesbian, or bisexual, as having low income or educational attainment, or as non-native English speakers or immigrants to Canada were less likely to obtain care. Of 493 patients using mental health services, 250 (51%) received mental health care for depression in accordance with existing Canadian guidelines.ConclusionsOur results showed gaps in delivering publicly funded mental health services to depressed HIV-positive patients and identified unequal access to these services, particularly among vulnerable groups. More effective mental health policies and better access to mental health services are required to address HIV-positive patient needs and reduce depression’s impact on their lives.

Highlights

Major depression is a substantial burden to HIV-positive patients, and the mental health needs of these patients are frequently unmet
Our results showed gaps in delivering publicly funded mental health services to depressed HIV-positive patients and identified unequal access to these services, among vulnerable groups
Studies have shown that untreated depression is associated with poor antiretroviral therapy (ART) compliance [7,8,9], poor clinical and quality-of-life outcomes [10,11], increased comorbidity and mortality [10,11], and elevated HIV transmission risk [12,13,14,15]

Summary

Introduction

Major depression is a substantial burden to HIV-positive patients, and the mental health needs of these patients are frequently unmet. Patients who perceived a need for care were two to three times more likely to seek help from mental health care providers [5,6], and 38–46% of HIV-positive women with depression received depression treatments that met evidence-based guidelines [3]. These studies were limited by self-report mental health services data [5,6], solely focusing on female HIV-positive patients [3], or solely focusing in patients with severe co-occurring mental and addiction disorders [6]. We describe the prevalence of publicly funded primary and secondary mental health service use and antidepressant use, as well as mental health care for depression in accordance with existing Canadian guidelines for HIV-positive patients with depression in Ontario, Canada

Methods

Results

Conclusion