Adequacy of mental health services for HIV-positive patients with depression: Ontario HIV Treatment Network Cohort Study

PLoS ONE
Volume 11, Issue 6, 2016

Adequacy of mental health services for HIV-positive patients with depression: Ontario HIV Treatment Network Cohort Study (Article) (Open Access)

Choi S.K.Y. , Boyle E. , Cairney J. , Gardner S. , Collins E.J. , Bacon J. , Rourke S.B. , Burchell A.N. , Rueda S. , Bayoumi A. , Gough K. , Cohen J. , Cooper C. , Kilby D. , Loutfy M. , Crouzat F. , Rachlis A. , Mittmann N. , Raboud J. , Salit I. , Ralph E. , Sandre R. , Evans G. , Wobeser W. , OHTN Cohort Study Group

^a Ontario HIV Treatment Network, Toronto, ON, Canada, Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
^b Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
^c Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada, Centre for Addiction and Mental Health, Toronto, ON, Canada, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
^d Ontario HIV Treatment Network, Toronto, ON, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Baycrest Health Sciences, Toronto, ON, Canada, University of Toronto, Canada
^e University Health Network, Toronto, ON, Canada, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
^f Ontario HIV Treatment Network, Toronto, ON, Canada
^g Ontario HIV Treatment Network, Toronto, ON, Canada, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada, St. Michael's Hospital, Toronto, ON, Canada, University of Toronto, Canada
^h Ontario HIV Treatment Network, Toronto, ON, Canada
ⁱ Ontario HIV Treatment Network, Toronto, ON, Canada
^j St. Michael's Hospital, Toronto, ON, Canada
^k St. Michael's Hospital, Toronto, ON, Canada
^l Windsor Regional Hospital, Canada
^m Ottawa General Hospital, Canada
ⁿ University of Ottawa Health Services, Canada
^o Maple Leaf Medical Clinic, Canada
^p Maple Leaf Medical Clinic, Canada
^q Sunnybrook Health Sciences Centre, Canada
^r Sunnybrook Health Sciences Centre, Canada
^s Toronto General Hospital, Canada
^t Toronto General Hospital, Canada
^u St. Joseph's Health Care, Canada
^v Sudbury Regional Hospital, Canada
^w Hotel Dieu Hospital, Canada
^x Hotel Dieu Hospital, Canada
^y [Affiliation not available]

Abstract

Background: Major 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. Methods: We 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. Results: Of 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. Conclusions: Our 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. © 2016 Choi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Author Keywords

[No Keywords available]

Index Keywords

rating scale prospective study depression educational status immigrant HIV Infections mental health service multicenter study Human immunodeficiency virus infection lowest income group Center for Epidemiological Studies Depression Scale clinical trial complication Prospective Studies human psychiatrist middle aged health service homosexual male Human immunodeficiency virus infected patient general practitioner funding Mental Health Services mental health care Health Services Needs and Demand Young Adult Humans bisexuality psychology virology homosexual female Adolescent Canada male female Socioeconomic Factors risk factor psychological rating scale Risk Factors socioeconomics Psychiatric Status Rating Scales Antidepressive Agents prevalence isolation and purification Incidence Article standards health care utilization Ontario Kessler Psychological Distress Scale major clinical study adult HIV-1 drug use cohort analysis Human immunodeficiency virus 1 secondary health care antidepressant agent practice guideline primary health care

Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84976259073&doi=10.1371%2fjournal.pone.0156652&partnerID=40&md5=1e3ad378a8c66761ec410d225d7ed9a2

DOI: 10.1371/journal.pone.0156652

ISSN: 19326203

Cited by: 9

Original Language: English