MENTAL HEALTH
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Articles and Presentations
Trauma, Mental Health, Distrust, and Stigma Among HIV-Positive Persons: Implications For Effective Care
Psychosomatic Medicine, June 2008, Vol. 70,5, p. 531-538
Kathryn Whetten, PhD, MPH, Susan Reif, PhD, MPH, Rachel Whetten, MPH and Laura Kathleen Murphy-McMillan, BA
Health Inequalities Program, Center for Health, Policy, Law, and Management, Department of Public Policy, Duke University Durham NC K.whetten@duke.edu
Individuals living with HIV often have complicated histories, including negative experiences such as traumatic events, mental illness, and stigma. As the medical community in the United States adapts to managing HIV as a chronic disease, understanding factors such as these negative experiences that may be associated with poorer adherence to treatment regimens, greater HIV risk behavior, and lower patient quality of life becomes critical to HIV care and prevention. In less wealthy nations, these issues are also critical for addressing quality of life as well as medication adherence in the areas where antiretroviral therapies are being made available. This article presents a review of the literature regarding the following psychosocial factors as they relate to HIV/AIDS in the US and globally: traumatic events; mental illness, including depression, anxiety, and posttraumatic stress disorder; lack of trust in the healthcare system and government; and experiences of stigma among individuals with HIV disease. These factors have been found to be prevalent among individuals with HIV/AIDS, regardless of gender or race/ethnicity. Traumatic events, mental illness, distrust, and stigma have also been linked with poorer adherence to medication regimens and HIV risk behavior.
Role of Depression, Stress, And Trauma In HIV Disease Progression
Psychosomatic Medicine, June 2008, Vol. 70,5, p. 539-545
Jane Leserman, PhD
From the Departments of Psychiatry and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Address correspondence and reprint requests to Jane Leserman, Department of Psychiatry, CB 7160, Medical School Wing C, Room 233, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160. E-mail: JLes@med.unc.edu
Despite advances in HIV treatment, there continues to be great variability in the progression of this disease. This paper reviews the evidence that depression, stressful life events, and trauma account for some of the variation in HIV disease course. Longitudinal studies both before and after the advent of highly active antiretroviral therapies (HAART) are reviewed. To ensure a complete review, PubMed was searched for all English language articles from January 1990 to July 2007. We found substantial and consistent evidence that chronic depression, stressful events, and trauma may negatively affect HIV disease progression in terms of decreases in CD4 T lymphocytes, increases in viral load, and greater risk for clinical decline and mortality. More research is warranted to investigate biological and behavioral mediators of these psychoimmune relationships, and the types of interventions that might mitigate the negative health impact of chronic depression and trauma. Given the high rates of depression and past trauma in persons living with HIV/AIDS, it is important for healthcare providers to address these problems as part of standard HIV care.
Characteristics of HIV-positive patients treated in a psychiatric emergency department
Bennett WR, Joesch JM, Mazur M, Roy-Byrne P.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle WA 98104, USA. mbennett@u.washington.edu
Psychiatr Serv. 2009 Mar;60(3):398-401.
http://ps.psychiatryonline.org/cgi/content/full/60/3/398
OBJECTIVE: Knowledge about the characteristics of patients using psychiatric emergency services is expanding. However, the prevalence of HIV infection among patients treated at psychiatric emergency departments is not known, and neither are the characteristics of HIV-positive patients seen in this setting. METHODS: To estimate the prevalence and demographic and clinical correlates of HIV infection among patients utilizing psychiatric emergency services in a level 1 trauma center, the authors analyzed data from a series of 58,301 consecutive visits (28,817 unique patients). RESULTS: Of the total psychiatric emergency visits, 2.0% were by HIV-positive patients, who were more likely to be male, homeless, or African American. These patients were also more likely to show dementia or to be suicidal, abusing substances, or coping with borderline personality disorder. CONCLUSIONS: More precise description of HIV-positive patients visiting psychiatric emergency departments may help elucidate the needs of this population and help plan for improvements in care in this setting.
PMID: 19252056 [PubMed - in process]