Psychiatric Disorders and Drug Use Among Human Immunodeficiency Virus–Infected Adults in the United States

TLDR

No nationally representative estimates exist for the prevalence of mental disorders and drug use among adults with HIV in the United States, nor is it known which clinical or sociodemographic factors are associated, underscoring the need for active identification and policy support. The study enrolled a nationally representative sample of 2,864 HIV‑treated adults in 1996, screened them with a brief structured psychiatric instrument for disorders and drug use, and examined associated sociodemographic and clinical factors using multivariate logistic regression. Nearly half of the participants screened positive for a psychiatric disorder, about 40% reported illicit drug use (excluding marijuana), and more than 12% were drug dependent, with factors such as greater HIV symptom burden, illicit drug use, heavy alcohol consumption, unemployment or disability linked to psychiatric disorder, and younger age, heterosexual orientation, heavy alcohol use, and psychiatric disorder linked to drug dependence.

Abstract

<h3>Background</h3> There have been no previous nationally representative estimates of the prevalence of mental disorders and drug use among adults receiving care for human immunodeficiency virus (HIV) disease in the United States. It is also not known which clinical and sociodemographic factors are associated with these disorders. <h3>Subjects and Methods</h3> We enrolled a nationally representative probability sample of 2864 adults receiving care for HIV in the United States in 1996. Participants were administered a brief structured psychiatric instrument that screened for psychiatric disorders (major depression, dysthymia, generalized anxiety disorders, and panic attacks) and drug use during the previous 12 months. Sociodemographic and clinical factors associated with screening positive for any psychiatric disorder and drug dependence were examined in multivariate logistic regression analyses. <h3>Results</h3> Nearly half of the sample screened positive for a psychiatric disorder, nearly 40% reported using an illicit drug other than marijuana, and more than 12% screened positive for drug dependence during the previous 12 months. Factors independently associated with screening positive for a psychiatric disorder included number of HIV-related symptoms, illicit drug use, drug dependence, heavy alcohol use, and being unemployed or disabled. Factors independently associated with screening positive for drug dependence included having many HIV-related symptoms, being younger, being heterosexual, having frequent heavy alcohol use, and screening positive for a psychiatric disorder. <h3>Conclusions</h3> Many people infected with HIV may also have psychiatric and/or drug dependence disorders. Clinicians may need to actively identify those at risk and work with policymakers to ensure the availability of appropriate care for these treatable disorders.