Prevalence, incidence, and persistence of psychiatric and substance use disorders among mothers living with HIV

Kathleen M Malee, Claude A Mellins, Yanling Huo, Katherine Tassiopoulos, Renee Smith, Patricia A Sirois, Susannah M Allison, Deborah Kacanek, Suad Kapetanovic, Paige L Williams, Mitzie L Grant, Daniel Marullo, Angela A Aidala, Pediatric HIVAIDS Cohort Study (PHACS), Kathleen M Malee, Claude A Mellins, Yanling Huo, Katherine Tassiopoulos, Renee Smith, Patricia A Sirois, Susannah M Allison, Deborah Kacanek, Suad Kapetanovic, Paige L Williams, Mitzie L Grant, Daniel Marullo, Angela A Aidala, Pediatric HIVAIDS Cohort Study (PHACS)

Abstract

Objective: To evaluate prevalence, incidence, remission, and persistence of psychiatric and substance use disorders among HIV-infected mothers and identify biopsychosocial correlates.

Methods: HIV-infected mothers (n = 1223) of HIV-exposed uninfected children enrolled in a prospective cohort study; HIV-uninfected mothers (n = 128) served as a comparison group. Mothers provided sociodemographic and health information and completed the Client Diagnostic Questionnaire (CDQ). Prevalence of any psychiatric or substance use disorder at initial evaluation was compared between the 2 groups. Incident, remitting, and persisting disorders were identified for 689 mothers with HIV who completed follow-up CDQs. We used logistic regression to evaluate adjusted associations of biopsychosocial characteristics with presence, incidence, remission, and persistence of disorders.

Results: Thirty-five percent of mothers screened positive for any psychiatric or substance use disorder at initial evaluation, with no difference by maternal HIV status (P = 1.00). Among HIV-infected mothers, presence of any disorder was associated with younger age [adjusted odds ratio (aOR): 1.39; 95% CI: 1.09 to 1.75], single parenthood (aOR: 1.35; 95% CI: 1.08 to 1.68), and functional limitations (aOR: 2.29; 95% CI: 1.81 to 2.90). Incident disorders were associated with functional limitations (aOR: 1.92; 95% CI: 1.10 to 3.30). Among HIV-infected mothers with a disorder at initial evaluation (n = 238), 61% had persistent disorders. Persistent disorders were associated with lower income (aOR: 2.44; 95% CI: 1.33 to 4.76) and functional limitations (aOR: 3.19; 95% CI: 1.87 to 5.48). Receipt of treatment for any disorder was limited: 4.5% at study entry, 7% at follow-up, 5.5% at both entry and follow-up.

Conclusions: Psychiatric and substance use disorders remain significant comorbid conditions among HIV-infected mothers and require accessible evidence-informed treatment.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Prevalence of Psychiatric Disorders (PD) and Substance Use Disorders (SUD) Among HIV-Infected Mothers, HIV-Uninfected Mothers and Non-Pregnant Women. For HIV-infected mothers and HIV-uninfected mothers, psychiatric disorders and substance use disorders were measured by the Client Diagnostic Questionnaire, with primary focus on Any Disorders. Disorders evaluated by the CDQ include major depression, other depression, panic disorder, general anxiety disorder, post-traumatic stress disorder, psychosis, alcohol abuse and drug abuse. For non-pregnant women of childbearing age, all diagnoses, except psychotic disorder, were made according to the DSM-IV criteria using the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). Past year diagnoses depicted in Figure 1 for non-pregnant women include Any Disorder and major depressive disorder, dysthymia, panic disorder, generalized anxiety disorder, and substance use disorders, including any alcohol use disorder, any drug use disorder, and nicotine dependence. Prevalence of PTSD and comorbidity were not evaluated. See full reference for additional available diagnoses.

References

    1. Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J of Med. 1994;331:1173–1180.
    1. Whitmore S, Zhang X, Taylor AW, et al. Estimated number of infants born to HIV-infected women in the United States and five dependent areas, 2006. J Acquir Immune Defic Syndr. 2011;57:218–222.
    1. Centers for Disease Control and Prevention. Estimated HIV incidence among adults and adolescents in the United States, 2007–2010. HIV Surveillance Supplemental Report 2012. 2012 Dec;17(4) Available at: .
    1. Mellins CA, Ehrhardt AA, Grant WF. Psychiatric symptomatology and psychological functioning in HIV-infected mothers. AIDS Behav. 1997;1(4):233–245.
    1. Mellins CA, Ehrhardt AA, Rapkin B, Havens J. Psychosocial factors associated with adaptation in HIV-infected mothers. AIDS Behav. 2000;4(4):317–328.
    1. Mellins CA, Kang E, Leu CS, et al. Longitudinal study of mental health and psychosocial predictors of medical treatment adherence in mothers with HIV disease. AIDS Patient Care STDS. 2003;17:407–416.
    1. Kapetanovic S, Christensen S, Karim R, et al. Correlates of perinatal depression in HIV-infected women. AIDS Patient Care STDS. 2009;23(2):101–108.
    1. Morrison MF, Petitto JM, Ten Have T, et al. Depressive and anxiety disorders in women with HIV infection. Am J Psychiatry. 2002;159:789–796.
    1. Taylor ER, Amodei N, Mangos R. The presence of psychiatric disorders in HIV-infected women. Journal Counseling Dev. 1996;74:345–351.
    1. Dantzer R, Kelley KW. Twenty years of research on cytokine-induced sickness behavior. Brain Behav Immun. 2007;21(2):153–60.
    1. Kiecolt-Glaser JK, Glaser R. Depression and immune function: Central pathways to morbidity and mortality. J Psychosom Res. 2002;53(4):873–6.
    1. Longone P, Rupprecht R, Manieri GA, et al. The complex roles of neurosteroids in depression and anxiety disorders. Neurochem Int. 2008;52:596–601.
    1. Raison CL, Capuron L, Miller AH. Cytokines sing the blues: Inflammation and the pathogenesis of depression. Trends Immunol. 2006;27(1):24–31.
    1. Dyer TP, Stein JA, Rice E, et al. Predicting depression in mothers with and without HIV: The role of social support and family dynamics. AIDS Behav. 2012;16:2198–2208.
    1. Leenerts MH. The disconnected self: Consequences of abuse in a cohort of low-income white women living with HIV/AIDS. Health Care Women Int. 1999;20(4):381–400.
    1. Machtinger EL, Wilson TC, Haberer JE, et al. Psychological trauma and PTSD in HIV-positive women: A meta-analysis. AIDS Behav. 2012;16:2091–2100.
    1. McIntosh RC, Rosselli M. Stress and coping in women living with HIV: A meta-analytic review. AIDS Behav. 2012;16:2144–2159.
    1. Wyatt GE, Myers HF, Loeb TB. Women, trauma and HIV: An overview. AIDS Behav. 2004;8(4):401–403.
    1. Chander G, Himelhoch S, Moore RD. Substance abuse and psychiatric disorders in HIV-positive patients: Epidemiology and impact on antiretroviral therapy. Drugs. 2006;66:769–789.
    1. Cruess DG, Douglas SD, Petitto JM, et al. Association of resolution of major depression with increased natural killer cell activity among HIV-seropositive women. Am J Psychiatry. 2005;162:2125–2130.
    1. Neblett RC, Hutton HE, Lau B, et al. Alcohol consumption among HIV-infected women: Impact on time to antiretroviral therapy and survival. J Womens Health. 2011;20:279–286.
    1. Pence BW. The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. Journal Antimicrob Chemother. 2009;63:636–640.
    1. Petry N. Alcohol use in HIV patients: What we don’t know may hurt us. Int J STD AIDS. 1999;10:561–570.
    1. Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: A systematic review. AIDS Behav. 2012;16:2119–2143.
    1. Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA. 2001;285(11):1466–1474.
    1. Havens JF, Mellins CA. Psychiatric aspects of HIVAIDS in childhood and adolescence. In: Rutter M, Taylor E, editors. Child and adolescent psychiatry. 5. Oxford, UK: Blackwell; 2008. p. 945.
    1. Leonard NR, Gwadza MV, Clelanda CM, et al. Maternal substance use and HIV status: Adolescent risk and resilience. J Adolescence. 2008;31:389–405.
    1. Malee KM, Tassiopoulos K, Huo Y, et al. Mental health functioning among children and adolescents with perinatal HIV infection and perinatal HIV exposure. AIDS Care. 2011;23(12):1533–1544.
    1. Mellins CA, Brackis-Cott E, Dolezal C, et al. Mental health of early adolescents from high-risk neighborhoods: The role of maternal HIV and other contextual, self-regulation, and family factors. J Pediatr Psychol. 2008;33 (10):1065–1075.
    1. Staroselsky A, Fantus E, Sussman R, et al. Both parental psychopathology and prenatal maternal alcohol dependency can predict the behavioral phenotype in children. Paediatr Drugs. 2009;11 (1):22–25.
    1. Aidala A, Havens J, Mellins CA, et al. Development and validation of the Client Diagnostic Questionnaire (CDQ): A mental health screening tool for use in HIV/AIDS service settings. Psychol Health Med. 2004;9:362–380.
    1. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282 (18):1737–1744.
    1. Wechsler Abbreviated Scale of Intelligence. San Antonio: The Psychological Corporation; 1999.
    1. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity and comorbidity of 12 month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–627.
    1. Vesga-Lopez O, Blanco C, Keyes K, et al. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry. 2008;65(7):805–815.
    1. Allen JG. Traumatic relationships and serious mental disorders. Chichester/New York: John Wiley & Sons; 2001.
    1. Banihashemi L, Sheu LK, Gianaros PJ. Childhood physical abuse correlates with adulthood hypothalamic and limbic forebrain activity and connectivity in response to psychological stress. Presented at: Society for Neuroscience; 2012; New Orleans.
    1. Leserman J, Pence BW, Whetten K, et al. Relation of lifetime trauma and depressive symptoms to mortality in HIV. Am J Psychiatry. 2007;164(11):1707–1713.
    1. Hien DA, Campbell AN, Killeen T, et al. The impact of trauma-focused group therapy upon HIV sexual risk behaviors in the NIDA clinical trials network “women and trauma” multi-site study. AIDS Behav. 2010;14(2):421–430.
    1. Wyatt GE, Longshore D, Chin D, et al. The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories. AIDS Behav. 2004;8(4):453–462.
    1. Tassiopoulos K, Read J, Brogly S, et al. Substance use in HIV-infected women during pregnancy: Self-report versus meconium analysis. AIDS Behav. 2010;14 (6):1269–1278.
    1. Dillard D, Bincsik A, Zebley C, et al. Integrated nested services: Delaware’s experience treating minority substance abusers at risk for HIV or HIV positive. J Evid-Based Soc Work. 2010;7(1–2):130–143.

    1. http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Integrating-Care/Health-Homes/Health-Homes.html

Source: PubMed

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