Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study.
BACKGROUND
Major depression can profoundly impact clinical and quality-of-life outcomes of people living with HIV, and this disease is underdiagnosed and undertreated in many HIV-positive individuals. Here, we describe the prevalence of publicly funded primary and secondary mental health service use and antidepressant use, as well as mental health care for depression in accordance with existing Canadian guidelines for HIV-positive patients with depression in Ontario, Canada.


METHODS
We conducted a prospective cohort study linking data from the Ontario HIV Treatment Network Cohort Study with administrative health databases in the province of Ontario, Canada. Current depression was assessed using the Center for Epidemiologic Depression Scale or the Kessler Psychological Distress Scale. Multivariable regressions were used to characterize prevalence outcomes.


RESULTS
Of 990 HIV-positive patients with depression, 493 (50%) patients used mental health services; 182 (18%) used primary services (general practitioners); 176 (18%) used secondary services (psychiatrists); and 135 (14%) used both. Antidepressants were used by 407 (39%) patients. Patients who identified as gay, lesbian, or bisexual, as having low income or educational attainment, or as non-native English speakers or immigrants to Canada were less likely to obtain care. Of 493 patients using mental health services, 250 (51%) received mental health care for depression in accordance with existing Canadian guidelines.


CONCLUSIONS
Our results showed gaps in delivering publicly funded mental health services to depressed HIV-positive patients and identified unequal access to these services, particularly among vulnerable groups. More effective mental health policies and better access to mental health services are required to address HIV-positive patient needs and reduce depression's impact on their lives.
The Ontario HIV Treatment Network, Toronto, Ontario, Canada.|The Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Stephanie K Y
SK
Choi
Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Eleanor
E
Boyle
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.|Centre for Addiction and Mental Health, Toronto, Ontario, Canada.|The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
John
J
Cairney
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Baycrest Health Sciences, Toronto, Ontario, Canada.
Sandra
S
Gardner
University Health Network, Toronto, Ontario, Canada.|Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Evan J
EJ
Collins
The Ontario HIV Treatment Network, Toronto, Ontario, Canada.
Jean
J
Bacon
The Ontario HIV Treatment Network, Toronto, Ontario, Canada.|Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|St. Michael's Hospital, Toronto, Ontario, Canada.
Sean B
SB
Rourke
D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006301:Health Services Needs and Demand; D006801:Humans; D015994:Incidence; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
D000928:Antidepressive Agents