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

Stephanie K Y Choi, Eleanor Boyle, John Cairney, Sandra Gardner, Evan J Collins, Jean Bacon, Sean B Rourke, OHTN Cohort Study Group

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Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Original languageEnglish
Article numbere0156652
JournalP L o S One
Volume11
Issue number6
Number of pages19
ISSN1932-6203
DOIs
Publication statusPublished - 2016

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mental health
Mental Health Services
Ontario
cohort studies
health services
Cohort Studies
Health
HIV
Depression
Mental Health
antidepressants
Health care
Canada
Antidepressive Agents
Guidelines
Delivery of Health Care
general practitioners
health policy
distress
Health Policy

Keywords

  • Journal Article

Cite this

Choi, S. K. Y., Boyle, E., Cairney, J., Gardner, S., Collins, E. J., Bacon, J., ... OHTN Cohort Study Group (2016). Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study. P L o S One, 11(6), [e0156652]. https://doi.org/10.1371/journal.pone.0156652
Choi, Stephanie K Y ; Boyle, Eleanor ; Cairney, John ; Gardner, Sandra ; Collins, Evan J ; Bacon, Jean ; Rourke, Sean B ; OHTN Cohort Study Group. / Adequacy of Mental Health Services for HIV-Positive Patients with Depression : Ontario HIV Treatment Network Cohort Study. In: P L o S One. 2016 ; Vol. 11, No. 6.
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abstract = "BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.",
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Choi, SKY, Boyle, E, Cairney, J, Gardner, S, Collins, EJ, Bacon, J, Rourke, SB & OHTN Cohort Study Group 2016, 'Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study', P L o S One, vol. 11, no. 6, e0156652. https://doi.org/10.1371/journal.pone.0156652

Adequacy of Mental Health Services for HIV-Positive Patients with Depression : Ontario HIV Treatment Network Cohort Study. / Choi, Stephanie K Y; Boyle, Eleanor; Cairney, John; Gardner, Sandra; Collins, Evan J; Bacon, Jean; Rourke, Sean B; OHTN Cohort Study Group.

In: P L o S One, Vol. 11, No. 6, e0156652, 2016.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Adequacy of Mental Health Services for HIV-Positive Patients with Depression

T2 - Ontario HIV Treatment Network Cohort Study

AU - Choi, Stephanie K Y

AU - Boyle, Eleanor

AU - Cairney, John

AU - Gardner, Sandra

AU - Collins, Evan J

AU - Bacon, Jean

AU - Rourke, Sean B

AU - OHTN Cohort Study Group

PY - 2016

Y1 - 2016

N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

AB - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

KW - Journal Article

U2 - 10.1371/journal.pone.0156652

DO - 10.1371/journal.pone.0156652

M3 - Journal article

C2 - 27280751

VL - 11

JO - P L o S One

JF - P L o S One

SN - 1932-6203

IS - 6

M1 - e0156652

ER -