Use of outpatient mental health services and psychotropic medications among HIV-infected patients in a multisite, multistate study☆☆☆★
Received 21 November 2008; accepted 20 May 2009. published online 28 August 2009.
Abstract
Objective
Although co-occurring psychiatric disorders are highly prevalent among those with HIV, little is known about the use of outpatient mental health services (MHS) and psychotropic medication in the highly active antiretroviral therapy (HAART) era.
Methods
During 2003, 951 patients were interviewed at 14 sites in the HIV Research Network. Patients were questioned about use of MHS and psychotropic medications. Logistic regression was used to identify socio-demographic and clinical factors associated with MHS and psychotropic medication utilization.
Results
The sample characteristics were as follows: 68% male, 52% black, 14% Hispanic, median age 46 years (range 20–85), 69% were on HAART. Approximately 34% reported at least one MHS within 6 months and 37% reported use of psychotropic medication for a mental health condition. In multivariate logistic regression, MHS was greater among disabled patients [adjusted odds ratio 2.39 (95% CI 1.53–3.72)], current [2.26 (1.53–3.35)] and former drug users [1.84 (1.24–2.73)], and those with more than seven primary care visits in the past 6 months. Blacks [0.61 (0.41–0.92)] were significantly less likely to use MHS compared to whites. Similarly, usage of psychotropic medications was greater among disabled patients [1.79 (1.14–2.82)], women [1.66 (1.13–2.43)], )] and those with more than seven primary care visits. Blacks [0.37 (0.24–0.58])] and Hispanics [0.39 (0.22–0.72)] were less likely to use a psychotropic medication. HAART utilization was not associated with MHS or psychiatric medication use.
Conclusions
In the HAART era, self-reported rates of mental health service and psychotropic medication utilization are high. Blacks continue to report lower use of MHS and psychotropic medication compared to whites.
☆ Sponsorship: Supported by the National Institutes of Drug Abuse: Dr. Himelhoch (K23- DA019820) and Dr. Korthuis (K23-DA019809). Dr. Gebo is supported by the Agency for Healthcare Research and Quality (290-01-012) and Aging (R01 AG026250). Dr. Gebo also received support from the Johns Hopkins University Richard S. Ross Clinician Scientist Award.
☆☆ Disclaimer: The views expressed in this article are those of the authors. No official endorsement by DHHS, the National Institutes of Health or the Agency for Healthcare Research and Quality is intended or should be inferred.
★ Presentation: This article was accepted in poster form at the American Public Health Association Annual Meeting, San Diego, CA, November 2008.
ABSTRACT