title: Use of outpatient mental health services and psychotropic medications among HIV-infected patients in a multisite, multistate study.
abstract: OBJECTIVE
  Although co-occurring psychiatric disorders are highly prevalent among those with HIV, little is known about the use of outpatient mental health services (MHS) and psychotropic medication in the highly active antiretroviral therapy (HAART) era.
  
  
  METHODS
  During 2003, 951 patients were interviewed at 14 sites in the HIV Research Network. Patients were questioned about use of MHS and psychotropic medications. Logistic regression was used to identify socio-demographic and clinical factors associated with MHS and psychotropic medication utilization.
  
  
  RESULTS
  The sample characteristics were as follows: 68% male, 52% black, 14% Hispanic, median age 46 years (range 20-85), 69% were on HAART. Approximately 34% reported at least one MHS within 6 months and 37% reported use of psychotropic medication for a mental health condition. In multivariate logistic regression, MHS was greater among disabled patients [adjusted odds ratio 2.39 (95% CI 1.53-3.72)], current [2.26 (1.53-3.35)] and former drug users [1.84 (1.24-2.73)], and those with more than seven primary care visits in the past 6 months. Blacks [0.61 (0.41-0.92)] were significantly less likely to use MHS compared to whites. Similarly, usage of psychotropic medications was greater among disabled patients [1.79 (1.14-2.82)], women [1.66 (1.13-2.43)], )] and those with more than seven primary care visits. Blacks [0.37 (0.24-0.58])] and Hispanics [0.39 (0.22-0.72)] were less likely to use a psychotropic medication. HAART utilization was not associated with MHS or psychiatric medication use.
  
  
  CONCLUSIONS
  In the HAART era, self-reported rates of mental health service and psychotropic medication utilization are high. Blacks continue to report lower use of MHS and psychotropic medication compared to whites.
authors.affiliation: Department of Psychiatry, University of Maryland, Baltimore, MD 21201, USA. shimelho@psych.umaryland.edu
authors.forename: Seth
authors.initials: S
authors.lastname: Himelhoch
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Josephs
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Chander
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D015897:Comorbidity; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs