The Depression Treatment Cascade: Disparities by Alcohol Use, Drug Use, and Panic Symptoms Among Patients in Routine HIV Care in the United States

DiPrete, Bethany L.; Pence, Brian W.; Bengtson, Angela M.; Moore, Richard D.; Grelotti, David J.; O’Cleirigh, Conall; Modi, Riddhi

doi:10.1007/s10461-018-2282-3

Cited by 13 publications

(15 citation statements)

References 47 publications

(76 reference statements)

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“…To our surprise, only 32% of participants requiring further psychiatric assessment following screening with DASS-21 received referrals to see a psychiatrist/psychologist. Of note and contrary to prior reports of significant drop outs in clinic attendance for mental health services following referrals [22,23], we found that the majority of participants who received referrals to the psychiatric clinic met their appointments. The management of mental health among participants showed a clear lapse in screening practices and recognition of the need for referrals by HIV care providers.…”

Section: Prevalent Psychiatric Symptomscontrasting

confidence: 99%

A retrospective analysis of the care cascades for non‐communicable disease and mental health among people living with HIV at a tertiary‐care centre in Malaysia: opportunities to identify gaps and optimize care

Ying

Raj

et al. 2020

J Int AIDS Soc

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Introduction: The rapidly growing epidemic of non-communicable diseases (NCDs) including mental health among aging people living with HIV (PLWH) has put a significant strain on the provision of health services in many HIV clinics globally. We constructed care cascades for specific NCDs and mental health among PLWH attending our centre to identify potential areas for programmatic improvement. Methods: This was a follow-up study of participants recruited in the Malaysian HIV & Aging study (MHIVA) from 2014 to 2016 at the University Malaya Medical Centre (n = 336). PLWH on suppressive antiretroviral therapy (ART) for a minimum of 12 months were invited to participate. At study entry, all participants underwent screening for diabetes (DM), hypertension (HTN) and dyslipidaemia; and completed assessments using the depression, anxiety and stress scale (DASS-21). Screening results were recorded in medical charts and clinical management provided as per standard of care. A subsequent review of medical records was performed at 24 months following study completion among participants who remained on active followup. Treatment pathways for NCD treatment and psychiatric referrals were assessed based on local practice guidelines to construct the care cascade. Results: A total of 329 participants (median age = 43 years, 83% male, 100% on ART) completed follow-up at 24 months. The prevalence of diabetes was 13%, dyslipidaemia 88% and hypertension 44%, whereas 23% presented with severe/extremely severe symptoms of depression, anxiety and/or stress. More than 50% of participants with dyslipidaemia and hypertension were not diagnosed until study screening, whereas over 80% with prevalent psychiatric symptoms were not previously recognized clinically. Suboptimal control of fasting lipids, sugar and blood pressure were found in the majority of participants despite optimal HIV treatment outcomes maintained over this same period. Only 32% of participants with severe/extremely severe mental health symptoms received psychiatric referrals and 83% of these attended their psychiatry clinic appointments. Conclusions: Systematic screening must be introduced to identify NCDs and mental health issues among PLWH followed by proper linkage and referrals for management of screen-positive cases. Assessment of factors associated with attrition at each step of the care cascade is critically needed to improve health outcomes in our aging patients.

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Section: Prevalent Psychiatric Symptomscontrasting

confidence: 99%

A retrospective analysis of the care cascades for non‐communicable disease and mental health among people living with HIV at a tertiary‐care centre in Malaysia: opportunities to identify gaps and optimize care

Ying

Raj

et al. 2020

J Int AIDS Soc

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“…Instead, nurses in our study appeared to be more influenced by clinical characteristics rather than sociodemographic characteristics. For example, we found that alcohol use symptoms were positively associated with detection of depressive symptoms, in contrast with findings from other settings (DiPrete et al ., 2019). Interestingly, perceived stress and depressive symptom severity were both independently associated with detection of depressive symptoms, suggesting that PHC-based CNPs may interpret signs of stress as indicators of depression.…”

Section: Discussionmentioning

confidence: 99%

Patient-level predictors of detection of depressive symptoms, referral, and uptake of depression counseling among chronic care patients in KwaZulu-Natal, South Africa

et al. 2020

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Background Integration of depression treatment into primary care could improve patient outcomes in low-resource settings. Losses along the depression care cascade limit integrated service effectiveness. This study identified patient-level factors that predicted detection of depressive symptoms by nurses, referral for depression treatment, and uptake of counseling, as part of integrated care in KwaZulu-Natal, South Africa. Methods This was an analysis of baseline data from a prospective cohort. Participants were adult patients with at least moderate depressive symptoms at primary care facilities in Amajuba, KwaZulu-Natal, South Africa. Participants were screened for depressive symptoms prior to routine assessment by a nurse. Generalized linear mixed-effects models were used to estimate associations between patient characteristics and service delivery outcomes. Results Data from 412 participants were analyzed. Nurses successfully detected depressive symptoms in 208 [50.5%, 95% confidence interval (CI) 38.9–62.0] participants; of these, they referred 76 (36.5%, 95% CI 20.3–56.5) for depression treatment; of these, 18 (23.7%, 95% CI 10.7–44.6) attended at least one session of depression counseling. Depressive symptom severity, alcohol use severity, and perceived stress were associated with detection. Similar factors did not drive referral or counseling uptake. Conclusions Nurses detected patients with depressive symptoms at rates comparable to primary care providers in high-resource settings, though gaps in referral and uptake persist. Nurses were more likely to detect symptoms among patients in more severe mental distress. Implementation strategies for integrated mental health care in low-resource settings should target improved rates of detection, referral, and uptake.

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“…The mechanisms by which depression might impact viral suppression are not elucidated in this study; however, previous studies have suggested that depression may interact with substance use to decrease ART adherence and increase risk of viral nonsuppression (such that depression is only associated with viral nonsuppression in the presence of substance use) [47,48]. Among PWH in routine clinical care, moderate-to-severe depressive symptoms or current antidepressant treatment (collectively, taken as an indication for depression treatment) was associated with panic symptoms and current drug use (excluding marijuana) [49]. Failure to achieve remission on antidepressants was associated with high-risk alcohol use, panic symptoms and current drug use [49].…”

Section: Discussionmentioning

confidence: 53%

“…Among PWH in routine clinical care, moderate-to-severe depressive symptoms or current antidepressant treatment (collectively, taken as an indication for depression treatment) was associated with panic symptoms and current drug use (excluding marijuana) [49]. Failure to achieve remission on antidepressants was associated with high-risk alcohol use, panic symptoms and current drug use [49]. However, in our study, adjusting for recent alcohol and substance use did not change our results, suggesting they were not entirely explained by an interaction between depression and substance use.…”

Section: Discussionmentioning

confidence: 99%

Depression and HIV viral nonsuppression among people engaged in HIV care in an urban clinic, 2014–2019

Lesko

Hutton

Fojo

et al. 2021

Aids

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The aim of this study was to describe the risk of viral nonsuppression across the depression care cascade.Design: A clinical cohort study.Methods: We used depressive symptoms (PHQ-8 ! 10) self-reported on computerassisted surveys, clinical diagnoses of depression in the medical record in the prior year and pharmacologic (any prescription for an antidepressant) and psychologic treatments for depression (attendance at at least two mental health visits in the prior year) to classify patients into groups: no history of depression; prior depression diagnosis; current indication for depression treatment (symptoms or clinical diagnosis); and treated depression (stratified by presence of persistent symptoms). We associated position in the depression care cascade with viral nonsuppression (>200 copies/ml) 7 days before to 6 months after the index self-report of depressive symptoms.Results: History of depression [adjusted risk difference (aRD) relative to no history ¼ 5.9%, 95% confidence interval (95% CI): 1.5-10.3] and current depression (symptoms or diagnosis) in the absence of treatment (aRD relative to no current depression or depression treatment ¼ 4.8%, 95% CI: 1.8-7.8) were associated with a higher risk of viral nonsuppression than no history of depression. Depression treatment mitigated this association (aRD ¼ À0.4%, 95% CI: À2.5 to 1.7). Conclusion:The relationship between depression care cascade and viral suppression is complex. Untreated depression and clinically unrecognized depressive symptoms were both related to viral nonsuppression. Treated depression was not associated with viral nonsuppression; however, a high proportion of treated patients still had depressive symptoms. Depression treatment should be titrated if patients' symptoms are not responsive and patients with a history of depression should be monitored for ART adherence.

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The Depression Treatment Cascade: Disparities by Alcohol Use, Drug Use, and Panic Symptoms Among Patients in Routine HIV Care in the United States

Cited by 13 publications

References 47 publications

A retrospective analysis of the care cascades for non‐communicable disease and mental health among people living with HIV at a tertiary‐care centre in Malaysia: opportunities to identify gaps and optimize care

A retrospective analysis of the care cascades for non‐communicable disease and mental health among people living with HIV at a tertiary‐care centre in Malaysia: opportunities to identify gaps and optimize care

Patient-level predictors of detection of depressive symptoms, referral, and uptake of depression counseling among chronic care patients in KwaZulu-Natal, South Africa

Depression and HIV viral nonsuppression among people engaged in HIV care in an urban clinic, 2014–2019

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