Predictors of HIV Infection in Older Adults

Abstract

PURPOSE: Psychiatric disorders and abnormal personality traits are commonly identified in patients complaining of fatigue, most of whom can be diagnosed to have depressive (D), anxiety (A), somatoform (S) or eating (E) disorders. This study was designed to determine the relationship between the prevalence of severe fatigue and the presence of personality pathology in individuals with these psychiatric disorders. METHODS: We analyzed 1197 referrals to an academic psychosomatic medicine outpatient unit. All patients underwent highly structured standardized psychometric and clinical assessments which allowed the categorical classification into D, A, S, and E groups. Within each group, the self-scored severity of fatigue experienced during the week preceding the evaluation was compared for patients with and without personality disorders (P). RESULTS: The one-week prevalence of severe fatigue was 38% in D (N ϭ 324) and 45% in D ϩ P (N ϭ 139), p ϭ NS; 29% in A (N ϭ 216) and 29% in A ϩ P (N ϭ 79), p ϭ NS; 33% in E (N ϭ 99) and 32% in E ϩ P (N ϭ 53), p ϭ NS; and 20% in S (N ϭ 209) and 34% in S ϩ P (N ϭ 78), p Ͻ .01. The difference in fatigue severity was ϩ 5% for D ϩ P vs D (p ϭ NS), ϩ 1% for A ϩ P vs A (p ϭ NS), Ϫ 2% for E ϩ P vs E (p ϭ NS) and 32% for S ϩ P vs S (p Ͻ .01). The greater severity of fatigue had a significant contribution to the difference in the 14-item index of somatic distress only for S vs S ϩ P (p ϭ .03) CONCLUSION: Severe fatigue may be a marker of personality pathology in patients with unexplained somatic complaints who do not suffer from depressive, anxiety or eating disorders.

Age Difference in Rates of Mental Health/Substance Abuse and Behavioral Care in HIV-Positive Adults

“…The findings in this study are congruent with previous conclusions concerning poor MH/SA health in the HIV-positive population [29][30][31][32][33][34] and the neglect of behavioral health management in HIV care. [35][36][37] The current findings elaborate upon the existing literature by examining concurrent MH/SA symptoms and behavioral health treatment rates in HIV-positive individuals across the adult lifespan.…”

“…26 Rates among older HIV-positive adults, compared to their HIV-negative counterparts, indicate that they are more likely to experience depression, alcohol abuse/dependence, and drug abuse/dependence, 33 and to have a history of alcohol abuse. 34 Despite the higher level of MH/SA conditions, behavioral health treatment rates are below optimal levels in HIV populations, 35,36 with less than 50% of HIVpositive adults who experience MH/SA symptoms treated for MH/SA conditions, regardless of having insurance coverage. 37 There is limited literature on HIV and MH/SA conditions and management rates, particularly in HIVpositive older adults.…”

Knowledge, Attitudes, and Experience regarding Hiv/Aids among Older Adult Inner-City Latinos

“…This study also did not examine the influence or prevalence of IV drug use or alcohol abuse, both linked with HIV infection in older adults (Szerlip, Desalvo, & Szerlip, 2005). It also remains unclear to what extent the participants would have responded differently to older rather than younger, or Latino rather than White, interviewers.…”