Mental health disorders common among people with HIV in British Columbia

Over 50% of people with HIV, many from disenfranchised groups, in British Columbia, Canada, are living with a mental health disorder, investigators report in AIDS Care. Such disorders were associated with decreased functioning and life satisfaction and a higher burden of stigma and discrimination. However, HIV treatment outcomes were similarly good for people with and without mental health problems.

“Experiences of mental illness affected over half of a sample of individuals living with HIV suggesting that this issue should be priority for HIV related care among aging demographics of PHA [people with HIV and AIDS],” comment the authors. “This study found that mental illness was strongly associated with history of sexual assault, reduced functioning and health worries suggesting that PHA with mental disorders experience multiple vulnerabilities.”

Improvements in treatment and care mean that most people with HIV now have an excellent prognosis. However, many people living with HIV are also living with other health problems. It has been estimated that prevalence of mental health disorders is two to ten times more common among people with HIV than in the background population. Mental illness in those with HIV has been linked to poorer antiretroviral and clinical outcomes.

Investigators in British Columbia wished to identify the range of mental illnesses experienced by people living with HIV, and to determine the prevalence of these illnesses and their correlates.

The study population consisted of 917 people enrolled in the Longitudinal Investigations into Supportive and Ancillary health services (LISA) study. Adult patients were eligible for inclusion in the present analysis if they had enrolled in drug treatment services or started HIV therapy between 2007 and 2010. Information on mental health, demographics and use of health services was gathered using interviewer-led questionnaires.

Overall, 54% of participants reported being diagnosed with at least one mental health disorder during their lifetime, and 57% of these individuals reported being diagnosed with multiple mental health illnesses. Among those reporting a mental illness, the most common were mood disorders such as depression (85%), followed by anxiety disorders (65%), psychotic disorders (7%), personality disorders (4%), eating disorders (3%) and dementia (3%).

The median age of people reporting a mental health disorder was 45 years, almost two-thirds reported an annual income below $15,000 and 29% identified as Indigenous.

Compared to individuals never diagnosed with a mental illness, those with a mental health disorder were more likely to be female (33 vs 21%, p < 0.01), younger (45 vs 46, p = 0.05), reported food insecurity (72 vs 61%, p < 0.01), to have hepatitis C virus co-infection (71 vs 64%, p = 0.026) and to have used the emergency room in the three months before the study interview (32 vs 21%, p < 0.01).

There were no differences in clinical outcomes between people with and without mental illness, including adherence to HIV therapy, viral suppression and baseline CD4 count.

Predictors of ever having experienced a mental health disorder were a higher stigma score, lower life satisfaction and poorer overall function. People with a history of mental illness were significantly more likely to report a history of sexual assault (AOR = 2.45; 95% CI, 1.75-3.43) and to have used case management services (AOR = 1.63; 95% CI, 1.17-2.27).

Individuals with multiple mental health disorders were more likely to report stigma and discrimination (p = 0.027), financial worries (31 vs 45%, p = 0.012), medical worries (p = 0.023), experiences of violence (p = 0.012) and a history of sexual assault (p = 0.027).

“As HIV management continues to transition towards chronic care management, greater attention must be paid to concurrent conditions, such as mental illness, in order to improve the quality of life of people living with HIV,” conclude the authors.