Psychiatric hospitalization among youth at high risk for HIV

ABSTRACT

Youth at-risk for HIV are also at-risk for mental health disorders and psychiatric hospitalization. Understanding the association between engagement in HIV prevention, concurrent risk behaviors, and psychiatric hospitalization may lead to improvements in integrated prevention and mental health treatment efforts. Youth at-risk for HIV, aged 14–24 years old, predominantly Black/African American and Latinx (75%) were recruited through youth-serving clinics and community sites in Los Angeles (n = 839) and New Orleans (n = 647). We compared youth with and without histories of psychiatric hospitalization on engagement in HIV prevention, concurrent risk behaviors, and demographic characteristics. We examined predictors of hospitalization using multiple imputations for missing data. Hospitalized youth (30%) were more involved in HIV programs, but were less likely to use PrEP/PEP or condoms than non-hospitalized youth. The odds of hospitalization were higher for transgender/gender nonconforming youth relative to cisgender youth; the OR was increased after adjustment for concurrent risk behaviors. Hospitalization was associated with homelessness, trauma, incarceration, substance use, and involvement in substance abuse treatment programs. There is a continuing need to integrate the diagnosis and treatment of mental health disorders into HIV prevention programs to better address multiple challenges faced by vulnerable youth.

KEYWORDS:

• Psychiatric hospitalization
• mental health disorder
• engagement in HIV prevention
• risk behaviors
• vulnerable youth

Acknowledgements

We would like to thank the study participants for their time commitment in participating in the Adolescent Trials Network (ATN) CARES study and acknowledge the ATN CARES Team members: Sue Ellen Abdalian, Elizabeth Mayfield Arnold, Robert Bolan, Yvonne Bryson, W. Scott Comulada, Ruth Cortado, M. Isabel Fernandez, Risa Flynn, Tara Kerin, Jeffrey Klausner, Marguerita Lightfoot, Norweeta Milburn, Karin Nielsen, Manuel Ocasio, Wilson Ramos, Cathy Reback, Mary Jane Rotheram-Borus, Dallas Swendeman, Wenze Tang, Panteha Hayati Rezvan, and Robert E. Weiss.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval and consent to participate

The University of California Los Angeles (UCLA) Institutional Review Board approved the study protocol (IRB #16-001674-AM-00006), with registration at Clinicaltrials.gov (#NCT03134833). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent/assent was obtained from all participants in this study.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to identifiable data but are available from the corresponding author on reasonable request

Authors’ contributions

PHR participated in conducting the investigation, performed the analysis, and drafted the manuscript. RR participated in conducting the investigation and writing the manuscript. MIF conceived of the idea for the manuscript and participated in writing of the manuscript. WSC participated in overseeing the analysis plan and revised the manuscript. SJL, MJR, EMA, and DS participated in designing the study and helped in writing of the manuscript. All authors participated in the preparation of the manuscript, and read and approved the final manuscript.

Additional information

Funding

The following funding agencies supported the investigators to work on the topic of adolescent HIV prevention and treatment strategies, but were not involved in the preparation, review, or approval of this manuscript: the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN; U19HD089886) of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) with support of the National Institute of Mental Health (NIMH), National Institute on Drug Abuse (NIDA), and National Institute on Minority Health and Health Disparities (NIMHD); National Institute of Mental Health (NIMH) (T32MH109205) and the UCLA Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) grant (P30MH58107).