Emotional and behavioral problems and mental health service utilization of youth living with HIV acquired perinatally or later in life

Abstract

This study sought to examine predictors of psychological symptoms and psychiatric service receipt among youth with HIV. Data were from the baseline assessment of Adolescent Impact, a study of 13–21-year-old youth with HIV in three US cities. Between August 2003 and February 2005, participants completed the age-appropriate youth or adult self-report symptom checklists (Achenbach system of empirically based assessment) and reported their psychiatric treatment history. Psychiatric diagnoses were abstracted from medical records. The 164 participating youth living with HIV were Black (81%), female (52%), Heterosexually identified (62%), and perinatally HIV-infected (60%). Thirty-one percentage reported levels of internalizing (i.e., self-focused/emotional), externalizing (i.e., outwardly focused/behavioral), or overall symptoms consistent with clinical psychopathology. In multivariate analyses, questioning one's sexual identity was associated with greater internalizing problems, whereas identifying as Bisexual was associated with greater externalizing problems (p<0.05). Symptoms were not associated with HIV transmission group. Participants with ≥1 composite score within the clinical range were more likely to have received ≥1 psychiatric service (Odds ratio (OR): 2.51; 95% confidence interval (CI): 1.22, 5.13) and a psychiatric diagnosis in the past year (OR: 2.16; 95% CI: 1.09, 4.27). However, 27% with clinically elevated scores had never received psychiatric care. Results suggest that among youth with HIV, those who identify as Bisexual or Questioning are at greatest risk for emotional and behavioral problems. Despite available mental health services, some youth with HIV are not receiving needed mental health care. Enhanced evaluation, referral and mental health service linkage is needed for these high-risk youth.

Keywords:

• HIV
• youth
• adolescents
• mental health
• sexual identity

Acknowledgements

The findings and conclusions in this manuscript represent those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. The Adolescent Impact Study was funded by the Centers for Disease Control and Prevention through cooperative agreements U64CCU219448 (New York University School of Medicine), U64CCU319459 (Children's National Medical Center) and U64CCU319455 (University of Maryland School of Medicine). We acknowledge: Children's National Medical Center; Washington, DC: Lawrence D'Angelo, William Barnes, Latoya Conner, Jean Fletcher, Kathryn Platky; Yolanda Peele, Anne Sill, Connie Trexler; University of Maryland School of Medicine; Baltimore, MD: Ligia Peralta, Ricardo Lagrange, John Farley, Hibest Assefa, Maria Metcalf, Rhonda Phill; New York University Langone Medical Center, New York, NY: Sulachni Chandwani, Susan Abramowitz, David Moschel; Cornell Medical Center, New York, NY: Joseph Stavola, Christine Nguyen, Harriet Plaskow, Erika Rexhouse, Centers for Disease Control & Prevention, Atlanta, GA: Holly Clark, Krystal Hodge, Goli Vamshidar, Sivakumar Rangarajan, Zaneta Gaul, Ngozi Kamalu, Bob Yang, Mary Glenn Fowler.