Mental Health and Substance Use Among Patients in a North Carolina HIV Clinic.
BACKGROUND
The HIV/AIDS epidemic is a significant public health concern in North Carolina, and previous research has pointed to elevated mental health distress and substance use among HIV-infected populations, which may impact patients' adherence to medications. The aims of this study were to describe the prevalence of mental health and substance use issues among patients of a North Carolina HIV clinic, to examine differences by demographic characteristics, and to examine factors associated with suboptimal adherence to HIV medications.


METHODS
This study was a secondary analysis of clinical data routinely collected through a health behavior questionnaire at a large HIV clinic in North Carolina. We analyzed data collected from February 2011 to August 2012.


RESULTS
The sample included 1,398 patients. Overall, 12.2% of patients endorsed current symptomology indicative of moderate or severe levels of depression, and 38.6% reported receiving a psychiatric diagnosis at some point in their life. Additionally, 19.1% had indications of current problematic drinking, and 8.2% reported problematic drug use. Nearly one-quarter (22.1%) reported suboptimal adherence to HIV medications. Factors associated with poor adherence included racial/ethnic minority, age less than 35 years, and indications of moderate or severe depression.


CONCLUSIONS
The questionnaire was not completed systematically in the clinic, which may limit generalizability, and self-reported measures may have introduced social desirability bias.


CONCLUSIONS
Patients were willing to disclose mental health distress, substance use, and suboptimal medication adherence to providers, which highlights the importance of routinely assessing these behaviors during clinic visits. Our findings suggest that treating depression may be an effective strategy to improve adherence to HIV medications.
doctoral student, Department of Psychology and Neuroscience, Duke University, Durham, North Carolina.
Linda M
LM
Skalski
assistant research professor, Duke Global Health Institute, Duke University, Durham, North Carolina.
Melissa H
MH
Watt
research assistant, Duke Global Health Institute, Duke University, Durham, North Carolina.
Jessica C
JC
MacFarlane
assistant research professor, Duke Global Health Institute and Center for Health Policy & Inequalities Research, Duke University, Durham, North Carolina.
Rae Jean
RJ
Proeschold-Bell
associate professor of medicine, Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina.
Jason E
JE
Stout
professor, Department of Psychology and Neuroscience, Duke University; professor, Global Health Institute, Duke University; director, social and behavioral sciences, Duke Center for AIDS Research, Duke University; director of clinical psychology, Department of Psychology and Neuroscience, Duke University, Durham, North Carolina kathleen.sikkema@duke.edu.
Kathleen J
KJ
Sikkema
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003863:Depression / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D001523:Mental Disorders / Q000453:epidemiology*; D008603:Mental Health; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
D019380:Anti-HIV Agents