title: Do HIV-positive women receive depression treatment that meets best practice guidelines?
abstract: 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 Research and Quality to define adequate depression treatment. We identified those who: (1) reported clinically significant depressive symptoms (CSDS) using Centers for Epidemiological Studies-Depression Scale 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 self-rated 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 reported role impairment, and addressing the specific needs and concerns of African American and Hispanic/Latina women.
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, 4th Floor, M/C 912, Chicago, IL, 60612, USA, cook@ripco.com.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Cook
authors.forename: Jane K
authors.initials: JK
authors.lastname: Burke-Miller
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Grey
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cocohoba
authors.forename: Chenlong
authors.initials: C
authors.lastname: Liu
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Schwartz
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Golub
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Steigman
authors.forename: Mardge H
authors.initials: MH
authors.lastname: Cohen
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D019985:Benchmarking; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006282:Health Personnel; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D020380:Needs Assessment; D015995:Prevalence; D057566:Self Report; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D016387:Women's Health / Q000208:ethnology; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents; D000928:Antidepressive Agents