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

• Published in: PloS one 2016-06, Vol.11 (6), p.e0156652-e0156652
• Main Authors: Choi, Stephanie K Y, Boyle, Eleanor, Cairney, John, Gardner, Sandra, Collins, Evan J, Bacon, Jean, Rourke, Sean B
• Format: Article
• Language: English
• Subjects: Adequacy; Adolescent; Adult; Analysis; Antidepressants; Antidepressive Agents - therapeutic use; At risk populations; Biology and Life Sciences; Bisexuality; Care and treatment; Cohort analysis; Depression (Mood disorder); Depression - drug therapy; Depression - epidemiology; Depression - etiology; Depression - psychology; Drug therapy; Epidemiology; Female; Guidelines; Health care; Health policy; Health services; Health Services Needs and Demand; HIV; HIV Infections - complications; HIV Infections - psychology; HIV Infections - virology; HIV positive; HIV-1 - isolation & purification; Human immunodeficiency virus; Humans; Immigrants; Incidence; Male; Medical diagnosis; Medicine and Health Sciences; Mental depression; Mental disorders; Mental health; Mental Health Services - standards; Middle Aged; Ontario - epidemiology; Patients; Prospective Studies; Psychiatric Status Rating Scales; Psychological aspects; Risk Factors; Social Sciences; Socioeconomic Factors; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0156652

Major 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. We 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. Of 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. Our 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.