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


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.


HIV Major depressive disorder Schizophrenia Life history interviews Qualitative research 



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


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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

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