Causal Pathways Between Severe Mental Illness and Behaviors Related to HIV: Patient Perspectives
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.
KeywordsHIV Major depressive disorder Schizophrenia Life history interviews Qualitative research
This work was supported by the Penn Mental Health AIDS Research Center (P30-MH097488).
- Bernard, H. R., & Ryan, G. W. (2010). Analyzing qualitative data: Systematic approaches. Walnut Creek: Sage Publications.Google Scholar
- 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
- 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
- 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
- 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
- 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
- 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
- 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