Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study

Abstract

BackgroundMajor depression can profoundly impact clinical and quality-of-life outcomes of people living with HIV, and this disease is underdiagnosed and undertreated in many HIV-positive individuals. Here, we describe the prevalence of publicly funded primary and secondary mental health service use and antidepressant use, as well as mental health care for depression in accordance with existing Canadian guidelines for HIV-positive patients with depression in Ontario, Canada.MethodsWe conducted a prospective cohort study linking data from the Ontario HIV Treatment Network Cohort Study with administrative health databases in the province of Ontario, Canada. Current depression was assessed using the Center for Epidemiologic Depression Scale or the Kessler Psychological Distress Scale. Multivariable regressions were used to characterize prevalence outcomes.ResultsOf 990 HIV-positive patients with depression, 493 (50%) patients used mental health services; 182 (18%) used primary services (general practitioners); 176 (18%) used secondary services (psychiatrists); and 135 (14%) used both. Antidepressants were used by 407 (39%) patients. Patients who identified as gay, lesbian, or bisexual, as having low income or educational attainment, or as non-native English speakers or immigrants to Canada were less likely to obtain care. Of 493 patients using mental health services, 250 (51%) received mental health care for depression in accordance with existing Canadian guidelines.ConclusionsOur results showed gaps in delivering publicly funded mental health services to depressed HIV-positive patients and identified unequal access to these services, particularly among vulnerable groups. More effective mental health policies and better access to mental health services are required to address HIV-positive patient needs and reduce depression’s impact on their lives.

How HIV affects health and service use for adults with intellectual and developmental disabilities

“…In addition, while this study used a validated algorithm to identify mental health services (provided by general or family physicians), this validation work is over 10 years old, and it is possible that practices related to recording mental health service codes have evolved, especially because some primary care physicians now work with electronic medical records. Even so, other recent studies that used this algorithm have described it as a strength (Choi et al ). Similarly, we could not study use of IDD services or other supports even though increasing our knowledge of pathways into both health and social services would be advantageous for planning and service delivery.…”

Prevalence, Recurrence, and Incidence of Current Depressive Symptoms among People Living with HIV in Ontario, Canada: Results from the Ontario HIV Treatment Network Cohort Study

“…This is an important first step to inform health care providers, policy-makers, and program planners when making decisions and planning for evidence-based mental health care and support for people living with HIV in Ontario. In North America, although in past decades, efforts were made to coordinate and integrate mental health care and support in HIV care, unmet needs in mental health care and services still remain a major challenge for these individuals—half of people living with HIV are under-recognized for their depressive symptoms condition, and only half are being treated [6–9,67,68]. Several studies have revealed that mental health care in the current HIV model is not well-coordinated and integrated [69–71].…”

“…Details about the linked data source have been provided in a recent study [9]. We have obtained ethics approvals for the use of the linked data from the University of Toronto, the institutional review board at Sunnybrook Health Sciences Centre, and participating HIV clinics across Ontario (i.e., the Institutional Review Board at Sunnybrook Health Sciences Centre, Ottawa Health Science Network Research Ethics Board, The University of Western Ontario Research Ethics Board for Health Sciences Research involving Human Subjects, St. Michael's Hospital Research Ethics Board, the Research Ethics Board of Health Sciences North, Sunnybrook Health Sciences Centre Research Ethics Board, University Health Network Research Ethics Board, and Windsor Regional Hospital Research Ethics Board).…”

“…Over 50% of people living with HIV and depression do not receive treatment for their depression [2–9], and this failure to treat contributes to significant negative clinical and quality-of-life outcomes [10–14]. …”

Impact of depression and recreational drug use on emergency department encounters and hospital admissions among people living with HIV in Ontario: A secondary analysis using the OHTN cohort study

“…The RPDB, which contains Ontario vital statistics data, was used to obtain OCS participants’ dates of death [ 19 ]. Details about the linked data source have been provided in recent studies [ 5 , 20 ].…”