HIV and Mental Health in Ontario Evan Collins MD FRCPC Staff Psychiatrist, Immunodeficiency Clinic, University Health Network, Toronto Assistant Professor, Department of Psychiatry University of Toronto
Evan Collins: Current: Advisory Committee – Merck Past: Speakers Fees - ViiV, Janssen, Gilead, Biovail, Lilly, Novartis
Co-Morbid Mental Health Conditions Significantly More Common in HIV vs. General Population* 45 % with mental health condition Mental health conditions were the most 40.55 † 40 prevalent comorbidities in this study of physical and mental conditions. 35 30 25 21.99 20 15 10 5 0 Ontario general population HIV+ cohort *As measured by utilization of mental health services. † Statistically significant vs. Ontario general population. Kendall CE, et al. BMC Public Health 2014; 14:161.
OCS Data 2008-2014 4562 participants 2500 2000 45% 43% 1500 36% 34% 31% 1000 25% 16% 500 4562 participants 0
Prevalence of Depression in OCS 28% (95%CI:26-29%; 990/3600 participants) Demographic: 22% female; 61% MSM 13% Aboriginal; 19% ACB/Asian/Latin; 28% Immigrant 54% ODS recipient Clinical 56% past history of depression 29%Recreational drug use in last 6 months 18% Prior diagnosis of alcohol abuse 54% current smoker Stephanie K. Y. Choi , E Boyle, J Cairney, S Gardner, E Collins, Jean Bacon, Sean B. Rourke , OHTN Cohort Study Group. Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study. PLoS One. 2016.
Formal Mental Health Services Utilization Formal mental health services use outcome during 12 months following baseline interview 1) Primary mental health service use: provided by family physicians; validation algorithm by Steele, Glazier, Lin & Evans (2004) 2) Secondary mental health service use: provided by psychiatrists 3) Antidepressants: first line of treatment 4) Adequate care that met the minimal thresholds a) At least four visits to primary or secondary mental health service providers plus at least 2 months of antidepressant use or b) At least eight visits to primary or secondary mental health service providers with a minimum visit time of 20 minutes 6 Citation: Choi SKY, Boyle E, Cairney J, Gardner S, Collins EJ, Bacon J, et al. Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study. PLoS One. 2016.
Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study (Choi et al, PLoS One 2016) 600 50% 500 39% 400 300 51% 18% 18% 200 14% 493 250 100 182 176 407 135 0 HIV+ Depression n=990 Patients who identified as LGBTQ, having low income or educational attainment, non-Native english speakers or immigrants, were less likely to obtain care
Childhood Adversities and HIV Death Early death Disease, disability, and social problems Whole Life Perspective Adoption of health-risk behaviours Social, emotional, & cognitive impairments Childhood adversities Birth Source: ACE Reporter; Volum1; Number 1; April 2003 www.acestudy.org
Prevalence of Childhood Adversities in OCS Prevalence of C/A Types of Adverse Events Reporting ≥1 C/A 71% Scary traumatic 44% event Physical abuse 28% Frequent parental 49% 26% alcohol/drug use Parental divorce 23% Lengthy hospital 22% stay Lengthy parental 19% unemployment Sent away from 11% home OCS study Canadian participants Population * * Source: Patten SB Soc Psychiatry Psychiatr Epidemiol (2013) 48:927–933 2013
Childhood Adversities and Depressive Symptoms (CES-D Total Score) 30 CES-D score (mean) 20 Mean CES-D score p<0.001 10 0 0 1 2 3 4 ≥5 Number of C/A (ANOVA test: F=29.6; p<0.001)
Childhood Adversities and Depressive symptoms (CES-D Score >16) (ANOVA test: F=29.6; p<0.001)
Childhood Adversities and Health Related QoL: Multivariate Regression Modelling Depression Mental Physical Number (CES-D score) HRQOL HRQOL of C/A a (MCS score) b (PCS score) c β p β p β p (Ref) - (Ref) - (Ref) - 0 0.52 0.395 -0.77 0.251 -0.01 0.986 1 0.91 0.174 -1.44 0.053 -0.25 0.690 2 2.00 0.011 -3.20 <0.001 0.72 0.333 3 3.02 0.001 -2.61 0.006 -0.98 0.223 4 3.31 0.001 -3.15 0.004 -3.59 <0.001 ≥5 a Adjusted for age, gender, ethnicity, education, employment, substance use, CD4, VL, time, since diagnosis, and psychosocial variables b Adjusted for age, gender, ethnicity, education, employment, substance use, CD4, VL, ARV, time, since diagnosis, and psychosocial variables c Adjusted for age, gender, ethnicity, education, country of birth, employment, substance use, CD4, Nadir CD4, VL, AIDS, time since diagnosis, and psychosocial variables
• Ac kno wle dg e me nts OHTN Cohort Study (OCS) OHT N Co ho rt study pa rtic ipa nts, inte rvie we rs, da ta c o lle c to rs, re se a rc h a sso c ia te s a nd c o o rdina to rs, nurse s a nd physic ia ns who pro vide suppo rt fo r da ta c o lle c tio n OCS R e se ar c h T e am OCS Gove r nanc e Committe e Se a n B. Ro urke (PI ) K e vin Go ug h Adria n Be tts Anita C. Be no it Je ffre y Co he n Curtis Co o pe r Bre klyn Be rto zzi L e s Bo wma n Do n K ilb y F re d Cro uza t L isung u Chie za T ra c e y Co nwa y Mo na L o utfy Anita Ra c hlis Pa tric k Cupido Bria n Huskins Nic o le Mittma nn Ja ne t Ra b o ud Cla ire K e nda ll Na tha n L a c ho wsky I rving Sa lit Mic ha e l Silve rma n Jo a nne L indsa y Jo hn Ma c T a vish Ro g e r Sa ndre Ma rk Mc Ca llum Co lle e n Pric e Ro sie T he in OCS/ OHT N staff OCS Sc ie ntific Ste e r ing Committe e Ro b e rt Hudde r Ma diso n Gile s Se rg io Rue da Ann Burc he ll Ja so n Glo b e rma n Be th Ra c hlis Ba rry Ada m Da vid Bre nna n Ve ro nika Mo ra va n L uc ia L ig ht T o ny Anto nio u Adria n Be tts Go kul K a la ima ni Na hid Qure shi T ra c e y Co nwa y Curtis Co o pe r T re vo r Ha rt Mo na L o utfy Data linkage K e lly O’ Brie n Ge ra ld E va ns Pub lic He a lth L a b o ra to rie s, Pub lic He a lth Ja ne t Ra b o ud Anita Ra c hlis Onta rio F unding AI DS Bure a u, Onta rio Ministry o f He a lth a nd L o ng - T e rm Ca re
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