Prevalence, Comorbidity, and Correlates of Psychiatric and Substance Use Disorders and Associations with HIV Risk Behaviors in a Multisite Cohort of Women Living with HIV.

We used the World Health Organization's Composite International Diagnostic Interview to determine the prevalence, comorbidity, and correlates of lifetime and 12-month behavioral health disorders in a multisite cohort of 1027 women living with HIV in the United States. Most (82.6%) had one or more lifetime disorders including 34.2% with mood disorders, 61.6% with anxiety disorders, and 58.3% with substance use disorders. Over half (53.9%) had at least one 12-month disorder, including 22.1% with mood disorders, 45.4% with anxiety disorders, and 11.1% with substance use disorders. Behavioral health disorder onset preceded HIV diagnosis by an average of 19 years. In multivariable models, likelihood of disorders was associated with women's race/ethnicity, employment status, and income. Women with 12-month behavioral health disorders were significantly more likely than their counterparts to engage in subsequent sexual and substance use HIV risk behaviors. We discuss the complex physical and behavioral health needs of women living with HIV

Prevalence, Comorbidity, and Correlates of Psychiatric and Substance Use Disorders and Associations with HIV Risk Behaviors in a Multisite Cohort of Women Living with HIV.

We used the World Health Organization's Composite International Diagnostic Interview to determine the prevalence, comorbidity, and correlates of lifetime and 12-month behavioral health disorders in a multisite cohort of 1027 women living with HIV in the United States. Most (82.6%) had one or more lifetime disorders including 34.2% with mood disorders, 61.6% with anxiety disorders, and 58.3% with substance use disorders. Over half (53.9%) had at least one 12-month disorder, including 22.1% with mood disorders, 45.4% with anxiety disorders, and 11.1% with substance use disorders. Behavioral health disorder onset preceded HIV diagnosis by an average of 19 years. In multivariable models, likelihood of disorders was associated with women's race/ethnicity, employment status, and income. Women with 12-month behavioral health disorders were significantly more likely than their counterparts to engage in subsequent sexual and substance use HIV risk behaviors. We discuss the complex physical and behavioral health needs of women living with HIV

Random regression analysis of changes in health self-efficacy among adults with serious mental illnesses pre- and post-health screening, controlling for sex, age, race, education, and study site (N = 457).

<p>¹ Unstandardized random regression estimate (SuperMix) where sign indicates direction of effect.</p><p>² Higher score indicates better perceived ability to engage in health practices, min/max = 0–28</p><p>³ Higher scores indicates higher perceived competence for health maintenance, min/max = 4–28</p><p>⁴ Higher score indicates greater internal control over one’s health, min/max = 6–36</p><p>⁵ Higher score indicates greater control of powerful others over one’s health, min/max = 6–36</p><p>⁶ Higher score indicates greater role of chance in one’s health, min/max = 6–36</p><p>Random regression analysis of changes in health self-efficacy among adults with serious mental illnesses pre- and post-health screening, controlling for sex, age, race, education, and study site (N = 457).</p

Results of health risk assessments and comparison with U.S. population (N = 457)¹.

<p>¹ Variation in sample size due to missing values (i.e., refusals and nonreactive tests)</p><p>² National Health and Nutrition Examination Survey (Flegal et al., 2012)</p><p>³ National Health and Nutrition Examination Survey 2009–2010 (Carroll et al., 2012)</p><p>⁴ National Health and Nutrition Examination Survey 2007–2009 (CDC, 2011)</p><p>⁵ National Health and Nutrition Examination Survey 2009–2010 (Yoon et al., 2012)</p><p>⁶ National Survey on Drug Use and Health 2006 (SAMHSA, 2008)</p><p>⁷ National Survey on Drug Use and Health 2010 (SAMHSA, 2010)</p><p>⁸ National Health and Nutrition Examination Survey III (Ford et al., 2004)</p><p>Results of health risk assessments and comparison with U.S. population (N = 457)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0123552#t002fn001" target="_blank">¹</a>.</p

Characteristics of adults with serious mental illnesses screened for common health conditions by U.S. state and total (N = 457)¹.

<p>¹ Variations in N due to missing data</p><p>² Question not asked at this site</p><p>Characteristics of adults with serious mental illnesses screened for common health conditions by U.S. state and total (N = 457)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0123552#t001fn001" target="_blank">¹</a>.</p

Randomized Controlled Trial of Peer-Led Recovery Education using Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES)

Objective: The purpose of this study was to test the efficacy of a peer-led, mental illness education intervention called Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES). Method: Subjects were recruited from outpatient community mental health settings in eight Tennessee communities. Using a single-blind, randomized controlled trial design, 428 individuals with serious mental illness (SMI) were interviewed at baseline and assigned to BRIDGES or to a services as usual wait list control condition. Two-and-one-half hour classes were taught once a week for 8 weeks by peers who were certified BRIDGES instructors. Subjects were followed-up at immediate post-intervention and 6-months later. The primary outcome was self-perceived recovery, measured by the Recovery Assessment Scale (RAS). A secondary outcome was hopefulness as assessed by the State Hope Scale (SHS). An exploratory hypothesis examined the impact of depressive symptoms on both recovery outcomes. Results: Eighty six percent of participants were followed up. On average, participants attended five sessions. Intent-to-treat analysis using mixed-effects random regression found that, compared to controls, intervention participants reported: 1) significantly greater improvement in total RAS scores as well as subscales measuring personal confidence and tolerable symptoms; and 2) significantly greater improvement in hopefulness as assessed by the agency subscale of the SHS. While study subjects with high levels of depressive symptoms had significantly poorer outcomes, outcomes were superior for BRIDGES participants regardless of depressive symptoms. Conclusions: Peer-led mental illness education improves participants’ self-perceived recovery and hopefulness over time, even controlling for severity of depressive symptoms. Keywords: illness self-management; recovery education; peer-led educatio

Do HIV-Positive Women Receive Depression Treatment that Meets Best Practice Guidelines?

This study addressed whether psychopharmacologic and psychotherapeutic treatment of depressed HIV+ women met standards defined in the best practice literature, and tested hypothesized predictors of standard-concordant care. 1,352 HIV-positive women in the multi-center Women’s Interagency HIV Study were queried about depressive symptoms and mental health service utilization using standards published by the American Psychiatric Association and the Agency for Healthcare Quality and Research to define adequate depression treatment. We identified those who: 1) reported clinically significant depressive symptoms (CSDS) using Centers for Epidemiological Studies – Depression Scale (CES-D) scores of ≥ 16; or 2) had lifetime diagnoses of major depressive disorder (MDD) assessed by World Mental Health Composite International Diagnostic Interviews plus concurrent elevated depressive symptoms in the past 12 months. Adequate treatment prevalence was 46.2% (n=84) for MDD and 37.9% (n=211) for CSDS. Multivariable logistic regression analysis found that adequate treatment was more likely among women who saw the same primary care provider consistently, who had poorer role functioning, who paid out-of-pocket for healthcare, and who were not African American or Hispanic/Latina. This suggests that adequate depression treatment may be increased by promoting healthcare provider continuity, outreaching individuals with lower levels of role impairment, and addressing the specific needs and concerns of African American and Hispanic/Latina women