0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Factors Associated With Treatment Initiation for Psychiatric and Substance Use Disorders Among Persons With HIV
Derek D. Satre, Ph.D.; Gerald N. DeLorenze, Ph.D.; Charles P. Quesenberry, Jr., Ph.D.; Ailin Tsai, M.A.; Constance Weisner, Dr.P.H., M.S.W.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200064
View Author and Article Information

The authors are affiliated with the Division of Research, Kaiser Permanente, Oakland, California. Dr. Satre and Dr. Weisner are also with the Department of Psychiatry, University of California, San Francisco (UCSF). Send correspondence to Dr. Satre, Department of Psychiatry, UCSF, 401 Parnassus Ave., Box 0984, San Francisco, CA 94143 (e-mail: dereks@lppi.ucsf.edu).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  Prior studies of individuals with HIV infection have found that accessing psychiatric and substance abuse treatment when needed can improve health and prolong life, yet little is known about factors associated with treatment initiation.

Methods  In a retrospective cohort design including individuals with HIV infection (≥14 years old) in an integrated health care system in Northern California, this study included 822 patients with a major psychiatric diagnosis and 1,624 with a substance use disorder diagnosis. Data were extracted from a regional HIV registry and computerized databases.

Results  Twenty-four percent (N=198) of study patients with psychiatric diagnoses and 15% (N=245) with substance abuse or dependence received one or more specialty care visits within 12 months of diagnosis. Among patients with a psychiatric diagnosis, significant predictors of visiting a psychiatry clinic included not having an AIDS diagnosis at baseline or before the study (p=.049), having a diagnosis of major depression (p=.013), having a diagnosis of bipolar disorder (p<.001), and receiving a psychiatric diagnosis in 1996 versus later years of the study (p<.01). Among patients with a substance use disorder, significant predictors of initiating substance abuse treatment included age <30 (p=.015) and being in the HIV transmission risk group of injection drug use (p<.001).

Conclusions  Clinical, diagnostic, and demographic factors were associated with specialty care treatment initiation in this sample of individuals with HIV infection and substance use or psychiatric disorders. Developing strategies to enhance treatment initiation has the potential to improve outcomes for individuals with HIV infection.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Anchor for Jump
Table 1Demographic and clinical baseline characteristics of Kaiser Permanente Northern California HIV/AIDS Registry participants with a substance use disorder or psychiatric diagnosis
Anchor for Jump
Table 2Factors predicting initiation of substance abuse and psychiatric specialty care among HIV patients with substance use and psychiatric disorder diagnosesa
Table Footer Note

a N=1,624 participants with a substance use disorder and 822 participants with a psychiatric diagnosis

Table Footer Note

* p<.05, **p<.01, ***p<.001

+

References

Lopes  M;  Olfson  M;  Rabkin  J  et al:  Gender, HIV status, and psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Journal of Clinical Psychiatry 73:384–391, 2012
[CrossRef] | [PubMed]
 
Nurutdinova  D;  Chrusciel  T;  Zeringue  A  et al:  Mental health disorders and the risk of AIDS-defining illness and death in HIV-infected veterans.  AIDS 26:229–234, 2012
[CrossRef] | [PubMed]
 
Pence  BW;  Miller  WC;  Whetten  K  et al:  Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the Southeastern United States.  Journal of Acquired Immune Deficiency Syndromes 42:298–306, 2006
[CrossRef] | [PubMed]
 
Bing  EG;  Burnam  MA;  Longshore  D  et al:  Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States.  Archives of General Psychiatry 58:721–728, 2001
[CrossRef] | [PubMed]
 
DeLorenze  GN;  Weisner  C;  Tsai  AL  et al:  Excess mortality among HIV-infected patients diagnosed with substance use dependence or abuse receiving care in a fully integrated medical care program.  Alcoholism, Clinical and Experimental Research 35:203–210, 2011
[CrossRef] | [PubMed]
 
Altice  FL;  Kamarulzaman  A;  Soriano  VV  et al:  Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs.  Lancet 376:367–387, 2010
[CrossRef] | [PubMed]
 
Robinson-Papp  J;  Gelman  BB;  Grant  I  et al:  Substance abuse increases the risk of neuropathy in an HIV-infected cohort.  Muscle and Nerve 45:471–476, 2012
[CrossRef] | [PubMed]
 
Pence  BW:  The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS.  Journal of Antimicrobial Chemotherapy 63:636–640, 2009
[CrossRef] | [PubMed]
 
Kacanek  D;  Jacobson  DL;  Spiegelman  D  et al:  Incident depression symptoms are associated with poorer HAART adherence: a longitudinal analysis from the Nutrition for Healthy Living study.  Journal of Acquired Immune Deficiency Syndromes 53:266–272, 2010
[CrossRef] | [PubMed]
 
Carrico  AW;  Riley  ED;  Johnson  MO  et al:  Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of antiretroviral therapy utilization.  Journal of Acquired Immune Deficiency Syndromes 56:146–150, 2011
[CrossRef] | [PubMed]
 
Gonzalez  A;  Barinas  J;  O’Cleirigh  C:  Substance use: impact on adherence and HIV medical treatment.  Current HIV/AIDS Reports 8:223–234, 2011
[CrossRef] | [PubMed]
 
Antelman  G;  Kaaya  S;  Wei  R  et al:  Depressive symptoms increase risk of HIV disease progression and mortality among women in Tanzania.  Journal of Acquired Immune Deficiency Syndromes 44:470–477, 2007
[CrossRef] | [PubMed]
 
Ickovics  JR;  Hamburger  ME;  Vlahov  D  et al:  Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study.  JAMA 285:1466–1474, 2001
[CrossRef] | [PubMed]
 
Hessol  NA;  Kalinowski  A;  Benning  L  et al:  Mortality among participants in the Multicenter AIDS Cohort Study and the Women’s Interagency HIV Study.  Clinical Infectious Diseases 44:287–294, 2007
[CrossRef] | [PubMed]
 
French  AL;  Gawel  SH;  Hershow  R  et al:  Trends in mortality and causes of death among women with HIV in the United States: a 10-year study.  Journal of Acquired Immune Deficiency Syndromes 51:399–406, 2009
[CrossRef] | [PubMed]
 
Palepu  A;  Horton  NJ;  Tibbetts  N  et al:  Uptake and adherence to highly active antiretroviral therapy among HIV-infected people with alcohol and other substance use problems: the impact of substance abuse treatment.  Addiction 99:361–368, 2004
[CrossRef] | [PubMed]
 
Carrico  AW;  Bangsberg  DR;  Weiser  SD  et al:  Psychiatric correlates of HAART utilization and viral load among HIV-positive impoverished persons.  AIDS 25:1113–1118, 2011
[CrossRef] | [PubMed]
 
Yun  LW;  Maravi  M;  Kobayashi  JS  et al:  Antidepressant treatment improves adherence to antiretroviral therapy among depressed HIV-infected patients.  Journal of Acquired Immune Deficiency Syndromes 38:432–438, 2005
[CrossRef] | [PubMed]
 
Coleman  SM;  Blashill  AJ;  Gandhi  RT  et al:  Impact of integrated and measurement-based depression care: clinical experience in an HIV clinic.  Psychosomatics 53:51–57, 2012
[CrossRef] | [PubMed]
 
Hoang  T;  Goetz  MB;  Yano  EM  et al:  The impact of integrated HIV care on patient health outcomes.  Medical Care 47:560–567, 2009
[CrossRef] | [PubMed]
 
DeLorenze  GN;  Satre  DD;  Quesenberry  CP  et al:  Mortality after diagnosis of psychiatric disorders and co-occurring substance use disorders among HIV-infected patients.  AIDS Patient Care and STDs 24:705–712, 2010
[CrossRef] | [PubMed]
 
Soller  M;  Kharrazi  N;  Prentiss  D  et al:  Utilization of psychiatric services among low-income HIV-infected patients with psychiatric comorbidity.  AIDS Care 23:1351–1359, 2011
[CrossRef] | [PubMed]
 
Taylor  SL;  Burnam  MA;  Sherbourne  C  et al:  The relationship between type of mental health provider and met and unmet mental health needs in a nationally representative sample of HIV-positive patients.  Journal of Behavioral Health Services and Research 31:149–163, 2004
[PubMed]
 
Weaver  MR;  Conover  CJ;  Proescholdbell  RJ  et al:  Utilization of mental health and substance abuse care for people living with HIV/AIDS, chronic mental illness, and substance abuse disorders.  Journal of Acquired Immune Deficiency Syndromes 47:449–458, 2008
[CrossRef] | [PubMed]
 
Andersen  R;  Newman  JF:  Societal and individual determinants of medical care utilization in the United States.  Milbank Memorial Fund Quarterly: Health and Society 51:95–124, 1973
[CrossRef]
 
Satre  DD;  Knight  BG;  Dickson-Fuhrmann  E  et al:  Predictors of alcohol-treatment seeking in a sample of older veterans in the GET SMART program.  Journal of the American Geriatrics Society 51:380–386, 2003
[CrossRef] | [PubMed]
 
Dhingra  SS;  Zack  M;  Strine  T  et al:  Determining prevalence and correlates of psychiatric treatment with Andersen’s behavioral model of health services use.  Psychiatric Services 61:524–528, 2010
[CrossRef] | [PubMed]
 
Bruwer  B;  Sorsdahl  K;  Harrison  J  et al:  Barriers to mental health care and predictors of treatment dropout in the South African Stress and Health Study.  Psychiatric Services 62:774–781, 2011
[CrossRef] | [PubMed]
 
Carragher  N;  Adamson  G;  Bunting  B  et al:  Treatment-seeking behaviours for depression in the general population: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Journal of Affective Disorders 121:59–67, 2010
[CrossRef] | [PubMed]
 
Wang  PS;  Lane  M;  Olfson  M  et al:  Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication.  Archives of General Psychiatry 62:629–640, 2005
[CrossRef] | [PubMed]
 
Weisner  C;  Matzger  H;  Tam  T  et al:  Who goes to alcohol and drug treatment? Understanding utilization within the context of insurance.  Journal of Studies on Alcohol 63:673–682, 2002
[PubMed]
 
Orwat  J;  Saitz  R;  Tompkins  CP  et al:  Substance abuse treatment utilization among adults living with HIV/AIDS and alcohol or drug problems.  Journal of Substance Abuse Treatment 41:233–242, 2011
[CrossRef] | [PubMed]
 
Burnam  MA;  Bing  EG;  Morton  SC  et al:  Use of mental health and substance abuse treatment services among adults with HIV in the United States.  Archives of General Psychiatry 58:729–736, 2001
[CrossRef] | [PubMed]
 
Himelhoch  S;  Josephs  JS;  Chander  G  et al; HIV Research Network:  use of outpatient mental health services and psychotropic medications among HIV-infected patients in a multisite, multistate study.  General Hospital Psychiatry 31:538–545, 2009
[CrossRef] | [PubMed]
 
Pisu  M;  Cloud  G;  Austin  S  et al:  Substance abuse treatment in an urban HIV clinic: who enrolls and what are the benefits? AIDS Care 22:348–354, 2010
[CrossRef] | [PubMed]
 
Krieger  N:  Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology.  American Journal of Public Health 82:703–710, 1992
[CrossRef] | [PubMed]
 
Weisner  C;  Mertens  J;  Parthasarathy  S  et al:  Integrating primary medical care with addiction treatment: a randomized controlled trial.  JAMA 286:1715–1723, 2001
[CrossRef] | [PubMed]
 
Brown  C;  Barner  J;  Bohman  T  et al:  A multivariate test of an expanded Andersen Health Care utilization model for complementary and alternative medicine (CAM) use in African Americans.  Journal of Alternative and Complementary Medicine 15:911–919, 2009
[CrossRef]
 
Yoon  J;  Bernell  SL:  The role of adverse physical health events on the utilization of mental health services.  Health Services Research 48:175–194, 2013
[CrossRef] | [PubMed]
 
Chi  FW;  Satre  DD;  Weisner  C:  Chemical dependency patients with cooccurring psychiatric diagnoses: service patterns and 1-year outcomes.  Alcoholism, Clinical and Experimental Research 30:851–859, 2006
[CrossRef] | [PubMed]
 
Mertens  JR;  Lu  YW;  Parthasarathy  S  et al:  Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: comparison with matched controls.  Archives of Internal Medicine 163:2511–2517, 2003
[CrossRef] | [PubMed]
 
Garnick  DW;  Lee  MT;  Chalk  M  et al:  Establishing the feasibility of performance measures for alcohol and other drugs.  Journal of Substance Abuse Treatment 23:375–385, 2002
[CrossRef] | [PubMed]
 
Summary table of measures, product lines and changes: HEDIS 2013 measures. Washington, DC, National Committee for Quality Assurance, 2012. Available at www.ncqa.org/Portals/0/HEDISQM/HEDIS%202011/SUMMARY_TABLE_OF_MEASURES_for_HEDIS_2012.pdf.
 
Andersen  RM:  Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior 36:1–10, 1995
[CrossRef] | [PubMed]
 
Hulka  BS;  Wheat  JR:  Patterns of utilization: the patient perspective.  Medical Care 23:438–460, 1985
[CrossRef] | [PubMed]
 
Mojtabai  R;  Crum  RM:  Perceived unmet need for alcohol and drug use treatments and future use of services: results from a longitudinal study.  Drug and Alcohol Dependence 127:59–64, 2012
[CrossRef] | [PubMed]
 
McCabe  SE;  West  BT;  Hughes  TL  et al:  Sexual orientation and substance abuse treatment utilization in the United States: results from a national survey.  Journal of Substance Abuse Treatment 44:4–12, 2012
[CrossRef] | [PubMed]
 
Green-Hennessy  S:  Factors associated with receipt of behavioral health services among persons with substance dependence.  Psychiatric Services 53:1592–1598, 2002
[CrossRef] | [PubMed]
 
Hennessy  KD;  Green-Hennessy  S;  Marshall  CC:  Reported mental health specialty care in the 2010 HealthStyles Survey.  Psychiatric Services 63:306, 2012
[CrossRef] | [PubMed]
 
Kessler  RC;  Demler  O;  Frank  RG  et al:  Prevalence and treatment of mental disorders, 1990 to 2003.  New England Journal of Medicine 352:2515–2523, 2005
[CrossRef] | [PubMed]
 
Mojtabai  R:  Unmet need for treatment of major depression in the United States.  Psychiatric Services 60:297–305, 2009
[CrossRef] | [PubMed]
 
Hooshyar  D;  Goulet  J;  Chwastiak  L  et al:  Time to depression treatment in primary care among HIV-infected and uninfected veterans.  Journal of General Internal Medicine 25:656–662, 2010
[CrossRef] | [PubMed]
 
Wang  PS;  Demler  O;  Olfson  M  et al:  Changing profiles of service sectors used for mental health care in the United States.  American Journal of Psychiatry 163:1187–1198, 2006
[CrossRef] | [PubMed]
 
Mertens JR, Chi FW, Sterling S, et al. Alcohol SBIRT implementation in adult primary care: preliminary results from an integrated health care delivery system. Presented at INEBRIA, Boston, Sept 21–23, 2011
 
Satre D, DeLorenze GN, Quesenberry CP Jr, et al: Integrating substance use and psychiatric disorder treatment for patients with HIV. Presented at annual Research Society on Alcoholism Scientific Meeting, San Francisco, June 23–27, 2012
 
Unützer  J;  Katon  W;  Callahan  CM  et al:  Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial.  JAMA 288:2836–2845, 2002
[CrossRef] | [PubMed]
 
Hunkeler  EM;  Hargreaves  WA;  Fireman  B  et al:  A Web-delivered care management and patient self-management program for recurrent depression: a randomized trial.  Psychiatric Services 63:1063–1071, 2012
[CrossRef] | [PubMed]
 
Satre  DD;  Campbell  CI;  Gordon  NS  et al:  Ethnic disparities in accessing treatment for depression and substance use disorders in an integrated health plan.  International Journal of Psychiatry in Medicine 40:57–76, 2010
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 3.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 49.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 47.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 5.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 17.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles