Advertisement

Causal Pathways Between Severe Mental Illness and Behaviors Related to HIV: Patient Perspectives

  • Puneet Chawla SahotaEmail author
  • Brigid E. Cakouros
  • Rachel Russell
  • Michael Hassler
  • Michael B. Blank
  • Frances K. Barg
Original Paper

Abstract

The purpose of this study was to identify causal pathways between HIV infection and severe mental illness. Data were collected through open-ended, semi-structured interviews. An integrated approach to the analysis, using inductive and deductive coding, was used to identify patterns among respondents. Standardized instruments were used to characterize the sample in terms of risk behaviors, physical and mental functioning and depression. Twenty-six men and women with a diagnosis of HIV and unipolar depression (n = 11) or schizophrenia/schizoaffective versus bipolar disorder (n = 15) participated. For persons with unipolar depression, the HIV diagnosis often preceded depressive symptoms. For persons with schizophrenia/schizoaffective versus bipolar disorder, mania and psychosis symptoms often preceded HIV. Substance use, incarceration and adverse childhood experiences were common across diagnoses. Attention to the directionality of effects between mental illness and HIV has important implications for anticipatory guidance for infectious disease specialists, primary care providers and public health practitioners as well as policymakers.

Keywords

HIV Major depressive disorder Schizophrenia Life history interviews Qualitative research 

Notes

Acknowledgements

This work was supported by the Penn Mental Health AIDS Research Center (P30-MH097488).

References

  1. Adams, C., Zacharia, S., Masters, L., Coffey, C., & Catalan, P. (2016). Mental health problems in people living with HIV: Changes in the last two decades: The London experience 1990–2014. AIDS Care, 28(S1), 56–59.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Ahmedani, B., Peterson, E., Hu, Y., Rossom, R., Lynch, F., Lu, C., et al. (2017). Major physical health conditions and risk of suicide. American Journal of Preventive Medicine, 53(3), 308–315.CrossRefPubMedPubMedCentralGoogle Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  4. Bernard, H. R., & Ryan, G. W. (2010). Analyzing qualitative data: Systematic approaches. Walnut Creek: Sage Publications.Google Scholar
  5. Blank, M. B., Himelhoch, S. S., Balaji, A. B., Metzger, D. S., Dixon, L. B., Rose, C. E., et al. (2014). A multisite study of the prevalence of HIV with rapid testing in mental health settings. American Journal of Public Health, 104(12), 2377–2384.  https://doi.org/10.2105/AJPH.2013.301633.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001). HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health, 91(6), 915–921.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Curry, L. A., Krumholz, H. M., O’Cathain, A., Plano Clark, V. L., Cherlin, E., & Bradley, E. H. (2013). Mixed methods in biomedical and health services research. Circulation: Cardiovascular Quality and Outcomes, 6(1), 119–123.  https://doi.org/10.1161/CIRCOUTCOMES.112.967885.CrossRefGoogle Scholar
  8. Donenberg, G. R., Emerson, E., Bryant, F. B., Wilson, H., & Weber-Shifrin, E. (2001). Understanding AIDS-risk behavior among adolescents in psychiatric care: Links to psychopathology and peer relationships. Journal of the American Academy of Child and Adolescent Psychiatry, 40(6), 642–653.  https://doi.org/10.1097/00004583-200106000-00008.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Eberhart, M. G., Yehia, B. R., Hillier, A., Voytek, C. D., Blank, M. B., Frank, I., et al. (2013). Behind the cascade: Analyzing spatial patterns along the HIV care continuum. Journal of Acquired Immune Deficiency Syndromes, 64(Suppl 1), S42–51.  https://doi.org/10.1097/QAI.0b013e3182a90112.CrossRefPubMedGoogle Scholar
  10. Eisen, S. V., Normand, S. L., Belanger, A. J., Spiro, A., 3rd, & Esch, D. (2004). The revised behavior and symptom identification scale (BASIS-R): Reliability and validity. Medical Care, 42(12), 1230–1241.CrossRefPubMedGoogle Scholar
  11. Gonzalez, J. S., Batchelder, A. W., Psaros, C., & Safren, S. A. (2011). Depression and HIV/AIDS treatment nonadherence: A review and meta-analysis. Journal of Acquired Immune Deficiency Syndromes, 58(2), 181–187.  https://doi.org/10.1097/QAI.0b013e31822d490a.CrossRefPubMedGoogle Scholar
  12. Gottesman, I. I., & Groome, C. S. (1997). HIV/AIDS risks as a consequence of schizophrenia. Schizophrenia Bulletin, 23(4), 675–684.CrossRefPubMedGoogle Scholar
  13. Heywood, W., & Lyons, A. (2016). HIV and elevated mental health problems: Diagnostic, treatment, and risk patterns for symptoms of depression, anxiety, and stress in a national community-based cohort of gay men living with HIV. AIDS and Behavior, 20(8), 1632–1645.CrossRefPubMedGoogle Scholar
  14. Himelhoch, S., Brown, C. H., Walkup, J., Chander, G., Korthius, P. T., Afful, J., et al. (2009). HIV patients with psychiatric disorders are less likely to discontinue HAART. AIDS, 23(13), 1735–1742.  https://doi.org/10.1097/QAD.0b013e32832b428f.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Kessler, R. C., Birnbaum, H., Bromet, E., Hwang, I., Sampson, N., & Shahly, V. (2010). Age differences in major depression: Results from the National Comorbidity Survey Replication (NCS-R). Psychological Medicine, 40(2), 225–237.  https://doi.org/10.1017/S0033291709990213.CrossRefPubMedGoogle Scholar
  16. Littleton, J., & Park, J. (2009). Tuberculosis and syndemics: Implications for Pacific health in New Zealand. Social Science and Medicine, 69(11), 1674–1680.CrossRefPubMedGoogle Scholar
  17. McGowan, J., Brown, J., Lampe, F., Lipman, M., Smith, C., & Rodger, A. (2018). Resilience and physical and mental well-being in adults with and without HIV. AIDS and Behavior, 22, 1688–1698.CrossRefPubMedGoogle Scholar
  18. Orza, L., Bewley, S., Logie, C., Crone, E. T., Moroz, S., Strachan, S., et al. (2015). How does living with HIV impact on women’s mental health? Voices from a global survey. Journal of the International AIDS Society, 18(6S5), 1–9.Google Scholar
  19. Quinn, K. G., Reed, S. J., Dickson-Gomez, J., & Kelly, J. A. (2018). An exploration of syndemic factors that influence engagement in HIV care among black men. Qualitative Health Research.  https://doi.org/10.1177/1049732318759529.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Ramaiya, M., Sullivan, K., O’Donnell, K., Cunningham, C., Shayo, A., Mmbaga, B., et al. (2016). A qualitative exploration of the mental health and psychosocial contexts of HIV-positive adolescents in Tanzania. PLoS ONE, 11(11), e0165936.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., et al. (2003). The 16-item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): A psychometric evaluation in patients with chronic major depression. Biological Psychiatry, 54(5), 573–583.CrossRefPubMedGoogle Scholar
  22. Simoni, J. M., Safren, S. A., Manhart, L. E., Lyda, K., Grossman, C. I., Rao, D., et al. (2011). Challenges in addressing depression in HIV research: Assessment, cultural context, and methods. AIDS and Behavior, 15(2), 376–388.  https://doi.org/10.1007/s10461-010-9836-3.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Singer, M., & Clair, S. (2003). Syndemics and public health: Reconceptualizing disease in a bio-social context. Medical Anthropology Quarterly, 17(4), 423–441.CrossRefPubMedGoogle Scholar
  24. Tennille, J., Solomon, P., & Blank, M. (2010). Case managers discovering what recovery means through an HIV prevention intervention. Community Mental Health Journal, 46(5), 486–493.  https://doi.org/10.1007/s10597-010-9326-0.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Tsai, A. C., Mendenhall, E., Trostle, J., & Kawachi, I. (2017). Co-occurring epidemics, syndemics, and population health. The Lancet, 389, 978–982.CrossRefGoogle Scholar
  26. Walkup, J., Crystal, S., & Sambamoorthi, U. (1999). Schizophrenia and major affective disorder among medicaid recipients with HIV/AIDS in New Jersey. American Journal of Public Health, 89(7), 1101–1103.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Ware, J., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.School of Public HealthUniversity of California, BerkeleyBerkeleyUSA
  3. 3.Department of Family Medicine and Community Health, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Community Mental Health and Retardation ServicesPhiladelphiaUSA

Personalised recommendations