Prevalence, incidence, and persistence of psychiatric and substance use disorders among mothers living with HIV.
OBJECTIVE
To evaluate prevalence, incidence, remission, and persistence of psychiatric and substance use disorders among HIV-infected mothers and identify biopsychosocial correlates.


METHODS
HIV-infected mothers (n = 1223) of HIV-exposed uninfected children enrolled in a prospective cohort study; HIV-uninfected mothers (n = 128) served as a comparison group. Mothers provided sociodemographic and health information and completed the Client Diagnostic Questionnaire (CDQ). Prevalence of any psychiatric or substance use disorder at initial evaluation was compared between the 2 groups. Incident, remitting, and persisting disorders were identified for 689 mothers with HIV who completed follow-up CDQs. We used logistic regression to evaluate adjusted associations of biopsychosocial characteristics with presence, incidence, remission, and persistence of disorders.


RESULTS
Thirty-five percent of mothers screened positive for any psychiatric or substance use disorder at initial evaluation, with no difference by maternal HIV status (P = 1.00). Among HIV-infected mothers, presence of any disorder was associated with younger age [adjusted odds ratio (aOR): 1.39; 95% CI: 1.09 to 1.75], single parenthood (aOR: 1.35; 95% CI: 1.08 to 1.68), and functional limitations (aOR: 2.29; 95% CI: 1.81 to 2.90). Incident disorders were associated with functional limitations (aOR: 1.92; 95% CI: 1.10 to 3.30). Among HIV-infected mothers with a disorder at initial evaluation (n = 238), 61% had persistent disorders. Persistent disorders were associated with lower income (aOR: 2.44; 95% CI: 1.33 to 4.76) and functional limitations (aOR: 3.19; 95% CI: 1.87 to 5.48). Receipt of treatment for any disorder was limited: 4.5% at study entry, 7% at follow-up, 5.5% at both entry and follow-up.


CONCLUSIONS
Psychiatric and substance use disorders remain significant comorbid conditions among HIV-infected mothers and require accessible evidence-informed treatment.
*Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; †HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY; ‡Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard School of Public Health, Boston, MA; §Department of Epidemiology, Harvard School of Public Health, Boston, MA; ‖Department of Pediatrics, University of Illinois, Chicago, IL; ¶Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA; #National Institutes of Health/National Institute of Mental Health, Bethesda, MD; **Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA; ††Department of Children's Behavioral Health, Children's of Alabama, Birmingham, AL; and ‡‡Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY.
Kathleen M
KM
Malee
Claude A
CA
Mellins
Yanling
Y
Huo
Katherine
K
Tassiopoulos
Renee
R
Smith
Patricia A
PA
Sirois
Susannah M
SM
Allison
Deborah
D
Kacanek
Suad
S
Kapetanovic
Paige L
PL
Williams
Mitzie L
ML
Grant
Daniel
D
Marullo
Angela A
AA
Aidala
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D009035:Mothers; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires