HIV risk behavior among adults with severe mental illness: a systematic review.

Risk for human immunodeficiency virus (HIV) infection among persons with severe mental illnesses.

In the United States, youth under age 25 account for nearly half of newly diagnosed sexually transmitted infections (STIs) annually, including HIV (CDC, 2005). Youth with psychiatric disorders or with a history of psychiatric hospitalizations initiate intercourse at an earlier age, are less likely to use condoms, have higher rates of STIs, have more unintended pregnancies, and have more sexual partners than adolescents without a history of mental illness (Baker & Mossman, 1991; DiClemente & Ponton, 1993; Valois, Bryant, Rivard, & Hinkle, 1997). The Social Personal Framework is a broad contextual model that posits the important role of personal attributes, peer /partner factors, family influences and the community in determining risk. It accounts for the increased risk among youth with psychiatric disorders by emphasizing the unique role of psychopathology (a personal attribute) because of its association with factors such as impulsivity, lack of judgment, cognitive misperception, sensitivity to partner rejection, sexual trauma and low self-esteem (Donenberg & Pao, 2005). Although psychopathology in general is associated with sexual risk, few studies have examined the relationship between groupings of disorders and risk. This project sought to extend previous research by documenting the additional risk associated with internalizing, externalizing, co-morbid disorders and Mania, compared to those adolescents who did not meet criteria but were in mental health treatment.

Some psychiatric disorders may be more strongly associated with sexual risk than others because of differences in behaviors or attitudes (e.g., impulsivity associated with Conduct Disorder and ADHD; poor self-esteem associated with Depressive Disorders). Cross-sectional studies indicate that externalizing behaviors are linked with early sexual debut and failure to use condoms, and the association between internalizing behaviors and sexual risk behavior is inconsistent (Abrantes, Strong, Ramsey, Kazura, & Brown, 2006; Auslander et al., 2002; Donenberg, Bryant, Emerson, Wilson, & Pasch, 2003; Lehrer, Shrier, Gortmaker SL, & Buka, 2006; Lescano, Brown, Hadley, D'Eramo, & Zimskind, 2007; Mazzaferro et al., 2006; Rhode, Noell, Ochs, & Seeley, 2001; Shrier, Harris, Sternberg, & Beardslee, 2001; Waller et al., 2006). Some longitudinal studies suggest that symptoms of conduct disorder/antisocial behavior during childhood and adolescence are the best predictor of sexual risk behaviors during adulthood (Ramrakha et al., 2007). Other studies suggest that adolescent symptoms of anxiety, post-traumatic stress, and depression are predictive of sexual risk behavior as an adult (Stiffman, Dore, Earls, & Cunningham, 1992).

We are not aware of any studies that have examined the association of Mania and sexual risk behavior in adolescents. Among adults, a history of Mania is consistently associated with sexual risk behavior, such as high rates of sexual activity, sex with prostitutes, and low rates of condom use (Meade, Graff, Griffin, & Weiss, 2008; Ramrakha, Caspi, Dickson, Moffitt, & Paul, 2000; Sacks, Dermatis, Burton, Hull, & Perry, 1994). Although Mania and Hypomania are not uncommon among adolescents, especially for youth in intensive treatment settings, the association with sexual risk behavior has not been rigorously examined.

The current study used a structured computer interview to examine the relationship between psychiatric disorders (i.e., Major Depressive (MDD), Mania, Hypomania, Generalized Anxiety (GAD), Post Traumatic Stress (PTSD), Conduct (CD), Attention Deficit Hyperactivity (ADHD) and Oppositional Defiant Disorders (ODD)) and sexual risk behaviors. Adolescents meeting criteria were compared to adolescents who did not meet criteria but were in mental health treatment. This analysis accounts for the general factors associated with the need for treatment such as stress, impairment and family dysfunction. Factors, such as the presence of alcohol use and gender, could influence sexual risk and were assessed and adjusted for in tests of risk association. We hypothesized that a lifetime or recent occurrence of vaginal/anal sex, lack of condom use at last sex, number of partners and the presence of a STI would be associated with Mania and/or Hypomania and with disorders commonly thought of as externalizing disorders (CD, ODD, and ADHD) because of characteristic impulsivity and recklessness associated with these disorders (Brown, Lourie, Zlotnick, & Cohn, 2000). We did not have a priori hypotheses for internalizing disorders (MDD, GAD, and PTSD) and their relationships with sexual risk behavior because previous studies have yielded conflicting results.

/pdf/psychiatric-disorders-and-sexual-risk-among-adolescents-in-27n0fzh6h5.pdf

Psychiatric disorders and sexual risk among adolescents in mental health treatment.

This article reviews the literature on the prevalence of mental and substance use disorders among persons living with HIV/AIDS. Drug use, both injection and non-injection, substantially increases the risk for HIV infection. While injection drug users have the highest prevalence rates for HIV, substantially elevated rates of HIV infection are also present among crack cocaine users and individuals with substance use disorders generally. Persons with HIV/AIDS and a mental and/or substance use disorder have highly variable patterns of accessing services. Persons with HIV/AIDS who have a serious mental illness are more highly involved with services than other groups. Most individuals with co-occurring disorders report some involvement with outpatient primary medical care, although ancillary services such as mental health and substance abuse treatment, transportation assistance, and case management improve involvement in medical care. Women with HIV/AIDS and co-occurring mental and substance use disorders experience unique vulnerabilities, particularly those related to exposure to traumatic events. Given the complexity of needs with which triply or multiply diagnosed individuals present, effective treatment programmes are likely to be those that provide some degree of integrated care.

Mental disorders and drug abuse in persons living with HIV/AIDS

HIV risk behavior among patients with co-occurring bipolar and substance use disorders: associations with mania and drug abuse.

Introduction: Chronic cough is associated with significant psychosocial co-morbidities. We investigated suicidal ideation, depression and anxiety and their relationship with cough severity. Methods: Consecutive patients with chronic cough at a specialist clinic prospectively completed cough severity and intensity visual analogue scales (VAS), Leicester Cough Questionnaire (LCQ), Patient Health Questionnaire (PHQ9), and Generalised Anxiety Disorder Assessment (GAD7). Case notes were reviewed for clinical characteristics. Results: 108 participants completed the assessments (Table 1); 34% and 22%&nbsp;reported symptoms of at least moderate severity of depression and anxiety (PHQ9 and GAD7&nbsp;&gt;10) respectively. Suicidal ideation was reported in 11% and was associated with younger age, worse cough severity and intensity VAS, and LCQ. Depression and anxiety symptoms were associated with cough severity VAS (r=0.46; r=0.37) and LCQ (r=-0.60; r=-0.35; all p&lt;0.01) respectively, but not with sex or diagnosis (all p&gt;0.12). Conclusion: Suicidal ideation and symptoms of depression and anxiety are common in chronic cough, and are associated with cough severity and health status. Further studies should investigate factors which influence psychological co-morbidity in chronic cough and any effective interventions.

Suicidal ideation, depression and anxiety in chronic cough

Acute psychiatric illness: Effects on HIV-risk behavior.

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Suicidal ideation, depression and anxiety in chronic cough

Acute psychiatric illness: Effects on HIV-risk behavior.