Abstract
SummaryBackgroundAlthough people with serious mental illnesses have a high risk of contracting blood-borne viral infections, sexual health has largely been neglected by researchers and policy makers involved in mental health. Failure to address this shortcoming could increase morbidity and mortality as a result of undetected and untreated infection. We did a systematic review and meta-analysis to estimate the prevalence of blood-borne viral infection in people with serious mental illness.MethodWe searched the Cochrane Library, Medline, Embase, PsycInfo, CINAHL, and DARE for studies of the prevalence of HIV, hepatitis B virus, and hepatitis C virus in people with serious mental illness, published between Jan 1, 1980, and Jan 1, 2015. We group prevalence data by region and by virus and estimated pooled prevalence. We did a sensitivity analysis of the effect of study quality on prevalence.FindingsAfter removal of duplicates, we found 373 abstracts, 91 of which met our eligibility criteria. The prevalences of blood-borne viral infections in people with serious mental illness were higher than in the general population in places with low prevalence of blood-borne viruses, such as the USA and Europe, and on par with the general population in regions with high prevalence of blood-borne viruses (Africa for HIV and southeast Asia for hepatitis B virus and hepatitis C virus). Pooled prevalence of HIV in people with serious mental illness in the USA was 6·0% (95% CI 4·3–8·3). Sensitivity analysis showed that quality scores did not significantly affect prevalence.InterpretationPeople with serious mental illness are at risk of blood-borne viral infections. However, because of methodological limitations of the studies the prevalence might be overestimated. Serious mental illness is unlikely to be a sole risk factor and risk of blood-borne viral infection is probably multifactorial and associated with low socioeconomic status, drug and alcohol misuse, ethnic origin, and sex. Health providers should routinely discuss sexual health and risks for blood-borne viruses (including risks related to drug misuse) with people who have serious mental illness, as well as offering testing and treatment for those at risk.FundingWellcome Trust.
Highlights
With the increasing evidence that people with serious mental illness have significant health inequalities,[2] increasing prominence has been given to physical health screening, health education, and improving access to treatment in primary and secondary care
Data collection We systematically searched the scientific literature for observational cross-sectional studies that reported the seroprevalence of HIV, hepatitis B virus, or hepatitis C virus according to opt-in, opt-out, or anonymous unlinked blood or other bodily fluids research methods, in people aged older than 15 years, diagnosed with serious mental illness, and treated in a psychiatric setting
Studies reported prevalence of hepatitis B virus,[53,57,59–62] including a total of 8163 patients with serious mental illness tested for hepatitis B virus
Summary
With the increasing evidence that people with serious mental illness have significant health inequalities,[2] increasing prominence has been given to physical health screening, health education, and improving access to treatment in primary and secondary care. Sexual health needs, including screening for and prevention of sexually transmitted infections and bloodborne viruses, are neglected in this population. Of particular concern is the higher risk of blood-borne virus infections (HIV, hepatitis B virus, and hepatitis C virus), shown by prevalence studies done over the past 30 years.[3,4] These viruses are transmitted by parenteral contact with contaminated body fluids (blood and blood products; contaminated instruments and needles; semen and vaginal fluids). Transmission can occur through unprotected sex (anal, vaginal, or oral), vertical transmission from mother to baby, and by sharing drug injecting equipment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
