183688 HIV-Infected patients have high rates of mental health services utilization in a multisite, multistate HIV cohort

Wednesday, October 29, 2008

Joshua Saul Josephs, BA , Johns Hopkins School of Medicine, Baltimore, MD
Seth Himelhoch, MD, MPH , Department of Pyschiatry, University of Maryland, Baltimore, MD
Geetanjali Chander, MD , Johns Hopkins School of Medicine, Baltimore, MD
Kelly A. Gebo, MD , Epidemiology Department, Johns Hopkins School of Medicine, Baltimore, MD
P. Todd Korthuis, MD , Oregon Health and Sciences University, Portland, OR
HIV Research Network , Johns Hopkins School of Medicine, Baltimore, MD
Background: Although co-occurring mental health disorders are highly prevalent among those with HIV, little is known about use of outpatient mental health services (MHS) and psychotropic medication in the HAART era.

Methods: During 2003, 951 patients participated in face-to-face interviews at 14 adult HIV primary care sites in the HIV Research Network. Patients were questioned about use of MHS and psychiatric medications.

Results: The sample was: 68% male, 52% Black, 14% Hispanic, median age = 46 years (20-85). 34% reported at least one outpatient MH visit and 18% reported use of psychotropic medication for a MH condition

In multivariate logistic regression, utilization of outpatient MHS was greater among disabled patients (AOR 2.03 [1.29-3.19]), current (AOR 2.06 [1.40-3.07]), and former drug use (AOR 1.66 [1.12-2.47]), the highest pain quartile (AOR 2.46 [1.56-3.88]), and those with more than seven primary care visits (AOR 1.88 [1.25-2.82]). Blacks were less likely to use MHS than whites (AOR 0.67 [0.44-1.00]).

Factors related to usage of psychiatric medications were women (AOR 1.80 [1.19-2.75]), being retired compared to employed (1.95 [1.00-3.78]), being disabled (2.60 [1.54-4.40]), and the highest quartile of pain (2.03 [1.18-3.50]) compared to the lowest. Blacks (0.30 [0.18-0.50]), Hispanics (0.40 [0.21-0.77]), and those >45 years (0.62 [0.42-0.90]) compared < 45 were less likely to use psychiatric medication.

Conclusions: In the HAART era, those with HIV appear to report high rates of MHS utilization. Interventions aimed at improving access to mental health services for Blacks, those with higher levels of pain and disability may be warranted.

Learning Objectives:
1) Describe factors associated with outpatient psychiatric care among those with HIV/AIDS 2) Describe factors associated with use of psychiatric medications among those with HIV/AIDS

Keywords: HIV/AIDS, Mental Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: M.D. from University of Michigan Residency at Langley Porter Psychiatric Institute Assistant Professor of Psychiatry University of Maryland School of Medicine
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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