Utilization of psychiatric services among low-income HIV-infected patients with psychiatric comorbidity

Abstract

Introduction: HIV-infected individuals face a tremendous burden of psychiatric comorbidity. This study evaluates a community health care system's effort to screen for psychiatric disorders among patients at an HIV clinic and evaluate adherence to psychiatric service utilization. Methods: Standardized screening measures were used to identify participants who met diagnostic symptom criteria for post-traumatic stress disorder (PTSD), acute stress disorder (ASD) and depression. All participants who screened positive were referred for psychiatric follow-up. Rates of utilization were measured and barriers to adherence were investigated. Results: Of the 210 participants, 118 patients met screening criteria for PTSD, ASD, and/or depression, and 116 of these had medical records available for review. Of the 116 patients with psychiatric comorbidity, 46.6% saw a psychiatrist and/or were prescribed a psychiatric medication. Thirty-two percent of Latinos, 40.5% of African Americans, and 38.5% of heterosexuals utilized referred psychiatric services, and these rates were significantly less than their counterparts. One hundred patients were seen by a social worker. Discussion: While a large burden of psychiatric comorbidity exists among this population of HIV-positive patients, only half adhered to recommended psychiatric services referrals. Further research is warranted to examine cost-effective interventions to maximize psychiatric screening, referral, and follow-up with mental health services in this vulnerable population.

Keywords:

• psychiatric services utilization
• HIV and psychiatric comorbidity
• post-traumatic stress disorder
• acute stress disorder
• major depressive disorder

Acknowledgements

This research was supported by funds from the Universitywide AIDS Research Program of the University of California, Grant Number CR01-ST-090; Co-Principal Investigators: Dennis M. Israelski, MD, and Cheryl Koopman, PhD. We also wish to express our appreciation for the contributions of Malik Muhammed and Patricia Garcia to this research.

Part of this data was presented at the American Psychosomatic Society Annual Conference held March 2010 in Portland, Oregon.