Mental Disorders, Illicit Substance Use High Among HIV Patients, RAND Reports Show
Nearly 50% of Americans with HIV suffer from symptoms of mental disorders -- a rate four to eight times higher than the general population -- 26% use illicit drugs other than marijuana and 12% are drug dependent, according to a report of the RAND-led HIV Cost and Services Utilization Study published in the Aug. 15 issue of Archives of General Psychiatry. The HCSUS survey is the "largest-scale scientific effort to collect information" on HIV-positive individuals, profiling nearly 2,900 adult HIV patients and screening them for symptoms of major depression, dysthymia (a type of chronic depression), generalized anxiety disorders, panic attacks and illicit drug use and dependence, as well as the use of mental health and substance abuse services. Dr. Eric Bing of the Charles R. Drew University of Medicine and Science in Los Angeles found that the presence of multiple HIV-related symptoms is a "strong predictor" of having a psychiatric disorder. He said, "HIV symptoms are likely to have a negative impact on a person's functioning and well-being, and thereby increase his or her psychological distress and anxiety." Illicit drug use may "contribute to HIV symptoms by interfering with a patient's ability to maintain good health behaviors that help maintain the immune system," he added. The report found that contrary to earlier studies that showed higher rates of psychiatric disorders in gay men, sexual orientation was unrelated to having a psychiatric disorder. Women had only "slightly higher" rates of depression and anxiety disorders than men, although they had "significantly higher" rates of dysthymia. Bing concluded in the report, "Clinicians may need to actively identify those at risk and work with policymakers to ensure the availability of appropriate care for these treatable disorders."
Majority of HIV-Positive Patients Used Mental Health or Substance Abuse Services
A second HCSUS report published in the same journal indicates that more than 60% of all adult HIV patients used mental health or substance abuse services immediately prior to the 1996-1997 survey. M. Audrey Burnam, a RAND senior behavioral scientist, and colleagues found that 1.8% were hospitalized for these problems, 3.4% received residential substance abuse treatment, 26% visited mental health specialists, 15.2% had group mental health treatment, 40.3% discussed emotional problems with medical practitioners and 29.6% used psychotherapeutic medicines. Although low-income, less-educated and minority HIV patients who needed services were less likely to receive mental health outpatient services, they were more likely to use substance abuse treatment services. HIV patients in the South in need of services were less likely to receive treatment than those in other regions. Burnam and colleagues concluded, "Inequalities in access to mental health services urge increased attention to improving outreach and services for lower socioeconomic status and minority HIV-infected populations and for those in regions that are relatively underserved, such as the South. Inequalities in access to substance abuse care [can] be understood in the context of a distinctive public substance abuse treatment system that is more responsive to disadvantaged populations, that provides better access to HIV populations in the Northeast relative to other parts of the country, but that may not attract or easily accommodate higher socioeconomic status populations or those whose HIV infection is more advanced" (RAND release, 8/14).