Mental health service utilization among patients followed up in tertiary HIV/AIDS clinics in Turkey: A need for integrated care

Abstract

Objectives

Mental health (MH) care for people living with HIV (PLWH) emerges as an important unmet need, yet there are no integrated HIV-MH clinics in Turkey. Our aim is to determine MH service use and its associated factors in PLWH followed up in the HIV/AIDS outpatient clinics in Istanbul/Turkey.

Methods

A cross-sectional study was conducted at the HIV/AIDS outpatient clinics of the Infectious Diseases (ID) departments in hospitals affiliated with the ACTHIV-IST Study Group. Structured interviews were performed using questionnaires that covered psychiatric state, medical history, and help-seeking behavior.

Results

Out of 172 outpatients, 121 (70.3%) reported MH complaints after infection, and 65.6% felt a need to see MH professionals. Among those, 59% shared their MH distress with the ID team. However, only 20.7% applied to an MH service, and 16.5% received psychiatric treatment. Previous MH diagnoses (AOR = 4.11; 95%CI = 1.26–13.39), sharing the disease with the ID team (AOR = 4.18; 95%CI = 1.24–14.11), and being hospitalized due to HIV (AOR = 6.54; 95%CI = 1.21–35.39) emerged as the predictors of MH service use among those who would like to see an MH professional in logistic regression.

Conclusions

Closer contact with the healthcare system may increase the chances of PLWH receiving MH care. Thus, integrating MH services in HIV/AIDS care would help reach more PLWH who are distressed.

Keywords

HIV Mental health service use help-seeking HIV psychiatry

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References

Atkinson

Grant

Kennedy

, et al. Prevalence of psychiatric disorders among men infected with human immunodeficiency virus: a controlled study. Arch Gen Psychiatr 1988; 45: 859–864.

Remien

Stirratt

Nguyen

, et al. Mental health and HIV/AIDS: the need for an integrated response. AIDS 2019; 33: 1411–1420. DOI: 10.1097/qad.0000000000002227.

Sherbourne

Hays

Fleishman

, et al. Impact of psychiatric conditions on health-related quality of life in persons with HIV infection. Am J Psychiatr 2000; 157: 248–254.

Ickovics

Hamburger

Vlahov

, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA 2001; 285: 1466–1474.

Leserman

. HIV disease progression: depression, stress, and possible mechanisms. Biol Psychiatr 2003; 54: 295–306.

Cohen

MAA

Artz

Azeb

, et al. The definition and scope of HIV psychiatry: how to provide compassionate care. In HIV psychiatry: a practical guide for clinicians. Springer, 2021, pp. 1–22.

Gonzalez

Batchelder

Psaros

, et al. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. JAIDS Journal of Acquired Immune Deficiency Syndromes 2011; 58: 181–187.

Sin

DiMatteo

. Depression treatment enhances adherence to antiretroviral therapy: a meta-analysis. Ann Behav Med 2014; 47: 259–269.

Chander

Himelhoch

Moore

. Substance abuse and psychiatric disorders in HIV-positive patients. Drugs 2006; 66: 769–789.

10.

Ambrosioni

Levi

Alagaratnam

, et al. Major revision version 12.0 of the European AIDS Clinical Society guidelines 2023. HIV Med 2023; 24: 1126–1136.

11.

Carvalhal

. Integrating mental health care for people living with HIV. In: 2015.

12.

Carvalhal

. Integrating mental health care for people living with HIV. Health Care Current Reviews 2015; 3(10): 4172.

13.

Trickey

May

Vehreschild

J-J

, et al. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. The lancet HIV 2017; 4: e349–e356.

14.

Conteh

Latona

Mahomed

. Mapping the effectiveness of integrating mental health in HIV programs: a scoping review. BMC Health Serv Res 2023; 23: 396.

15.

Yaylali

Erdogan

Calisir

, et al. Modeling the future of HIV in Turkey: cost-effectiveness analysis of improving testing and diagnosis. PLoS One 2023; 18: e0286254.

16.

Beck

Ward

Mendelson

, et al. An inventory for measuring depression. Arch Gen Psychiatr 1961; 4: 561–571.

17.

Beck

Epstein

Brown

, et al. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56: 893–897.

18.

Hisli

. Beck Depresyon Envanterinin üniversite öğrencileri için geçerliği, güvenirliği. Psikoloji dergisi 1989; 7: 3–13.

19.

Ulusoy

Sahin

Erkmen

. Turkish version of the Beck Anxiety Inventory: psychometric properties. 1998.

20.

Faul

Erdfelder

Buchner

, et al. Statistical power analyses using G* Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009; 41: 1149–1160.

21.

Faul

Erdfelder

Lang

A-G

, et al. G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39: 175–191.

22.

Demirel

Mayda

Yıldız

, et al. Self-stigma, depression, and anxiety levels of people living with HIV in Turkey. Eur J Psychiatr 2018; 32: 182–186.

23.

Kılıçlı

Akbulut

Çakırca

. Stigma, hopelessness, depression and associated factors in people living with HIV. Harran Üniversitesi Tıp Fakültesi Dergisi; 19: 621–630.

24.

Aşçıbaşı

Uçak

Atalay

, et al. Depressive and anxiety symptoms among people living with HIV in Turkey: a cross-sectional study. Journal of Tepecik Education & Research Hospital/İzmir Tepecik Eğitim ve Araştırma Hastanesi Dergisi 2022; 32.

25.

Dahmann

Schnitzlein

. No evidence for a protective effect of education on mental health. Soc Sci Med 2019; 241: 112584.

26.

Kondirolli

Sunder

. Mental health effects of education. Health Econ 2022; 31: 22–39.

27.

Burnam

Bing

Morton

, et al. Use of mental health and substance abuse treatment services among adults with HIV in the United States. Arch Gen Psychiatr 2001; 58: 729-736. DOI: 10.1001/archpsyc.58.8.729.

28.

Filiatreau

Ebasone

Dzudie

, et al. Correlates of self-reported history of mental health help-seeking: a cross-sectional study among individuals with symptoms of a mental or substance use disorder initiating care for HIV in Cameroon. BMC Psychiatr 2021; 21: 293. DOI: 10.1186/s12888-021-03306-y.

29.

Shadloo

Amin-Esmaeili

Motevalian

, et al. Psychiatric disorders among people living with HIV/AIDS in Iran: prevalence, severity, service utilization and unmet mental health needs. J Psychosom Res 2018; 110: 24-31. DOI: 10.1016/j.jpsychores.2018.04.012.