The Psychosocial Impact of HIV Infection in Gay Men, Drug Users and Heterosexuals

Abstract

The aim of this study was to establish the prevalence of current and past psychiatric morbidity in HIV seropositive asymptomatic subjects belonging to three transmission categories (gay men, intravenous drug users, and heterosexuals) compared with that found in HIV seronegative controls from the same groups. A cross-sectional, controlled study including 279 seropositive subjects belonging to groups II and III defined by the Center for Disease Control (94 gay men, 157 intravenous drug users, and 28 heterosexuals) and 159 seronegative subjects (38 gay men, 91 intravenous drug users, and 30 heterosexuals) is reported. Outcome measures included standardised, self-report questionnaires and a semistructured interview to assess current psychopathological status and past psychiatric history. In addition, a psychiatric diagnosis according to DSM-III-R criteria Axis I and II was made in the seropositive subjects. Results showed that these subjects differed very little from the controls and that overall levels of psychiatric disturbances in both groups were low and similar to those found in other life-threatening illnesses. Furthermore, intravenous drug users, regardless of HIV serological status, had the highest levels of psychological morbidity. Psychosocial distress was associated with previous and current lifestyle, independently of HIV status.

Mental disorders and drug abuse in persons living with HIV/AIDS

“…Reports of the lifetime prevalence of anxiety disorders among PLWH/A have ranged from 4% to 19% (Rabkin, 1996), which is somewhat lower than the general population estimates that range from 15% (Regier et al, 1990) to 25% (Kessler et al, 1994). Rates for adjustment disorders have generally been similar to those for anxiety disorders (Bialer et al, 1996;Dew et al, 1997;Gala et al, 1993;Lyketos et al, 1994;Rabkin, 1996).…”

“…Rates for current anxiety disorders have likewise been highly variable, ranging from under 5% (Dew et al, 1997;Gala et al, 1993;Rabkin, 1996) to between 10% and 15% Brown et al, 1992;Rabkin et al, 1997a;Sewell et al, 2000), compared with general population estimates ranging from 13% (Regier et al, 1993) to 17% (Kessler et al, 1994). Among PLWH/A, social anxiety disorder and generalized anxiety disorder are the most common anxiety disorders encountered, unlike the general population, where social anxiety disorder and simple phobias are the two most common current anxiety disorders (Kessler et al, 1994).…”

“…Studies examining the prevalence of affective disorders among PLWH/A have produced estimates that vary widely, with rates for a current depressive disorder ranging from a low of 1.4% (Bialer et al, 1996) to a high around 36% (Asch et al, 2003;Dew et al, 1997), although most studies reported rates between 10% and 20% (Gala et al, 1993;Lyketos et al, 1994;Rabkin, 1996;Rabkin et al, 1997a). National prevalence estimates for current depressive disorders range from 5% (Regier et al, 1993) to 10% (Kessler et al, 1994).…”

“…Personality disorders are not uncommon among PLWH/A, with studies typically reporting prevalence rates of 15 Á/35% (Bialer et al, 1996;Compton et al, 1995;Gala et al, 1993;Jacobsberg et al, 1995;Johnson et al, 1995Johnson et al, , 1996Perkins et al, 1993). Associated with poor outcomes for drug treatment (Brooner et al, 1993), a higher frequency of HIV risk behaviours (Brooner et al, 1990(Brooner et al, , 1993Compton et al, 1995;Gill et al, 1992), and poorer overall functioning (Johnson et al, 1995(Johnson et al, , 1996Perkins et al, 1993), personality disorder diagnoses represent significant clinical challenges.…”

Depression in HIV-infected patients

“…In fact, the IVDU population is at greater risk of psychopathology than HIV-seropositive heterosexuals, hemophiliacs, and gay men [78], and this population should be specially considered during treatment or the planning of treatment with forms of psychotherapy. Grassi et al [79] examined suicidal ideation and psychological morbidity in HIV-seropositive IVDUs compared with hepatitis C virus (HCV) IVDUs and found that suicide ideation, psychological morbidity, and anxiety and depression symptoms were not directly influenced by HIV serostatus.…”