Format

Send to

Choose Destination
AIDS Behav. 2019 Mar;23(3):592-601. doi: 10.1007/s10461-018-2282-3.

The Depression Treatment Cascade: Disparities by Alcohol Use, Drug Use, and Panic Symptoms Among Patients in Routine HIV Care in the United States.

Author information

1
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA. diprete@email.unc.edu.
2
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA.
3
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, USA.
4
Department of Psychiatry, University of California, San Diego, San Diego, USA.
5
The Fenway Institute, Fenway Health, Boston, USA.
6
Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, USA.
7
Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA.
8
Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.

Abstract

Little is known about disparities in depression prevalence, treatment, and remission by psychiatric comorbidities and substance use among persons living with HIV (PLWH). We conducted a cross-sectional analysis in a large cohort of PLWH in routine care and analyzed conditional probabilities of having an indication for depression treatment, receiving treatment, receiving indicated treatment adjustments, and achieving remission, stratified by alcohol use, illicit drug use, and panic symptoms. Overall, 34.7% (95% CI 33.9-35.5%) of participants had an indication for depression treatment and of these, 55.3% (53.8-56.8%) were receiving antidepressants. Among patients receiving antidepressants, 33.0% (31.1-34.9%) had evidence of remitted depression. In a subsample of sites with antidepressant dosage data, only 8.8% (6.7-11.5%) of patients received an indicated treatment adjustment. Current drug users (45.8%, 95% CI 43.6-48.1%) and patients reporting full symptoms of panic disorder (75.0%, 95% CI 72.9-77.1%) were most likely to have an indication for antidepressant treatment, least likely to receive treatment given an indication (current drug use: 47.6%, 95% CI 44.3-51.0%; full panic symptoms: 50.8%, 95% CI 48.0-53.6%), or have evidence of remitted depression when treated (22.3%, 95% CI 18.5-26.6%; and 7.3%, 95% CI 5.5-9.6%, respectively). In a multivariable model, drug use and panic symptoms were independently associated with poorer outcomes along the depression treatment cascade. Few differences were evident by alcohol use. Current drug users were most likely to have an indication for depression treatment, but were least likely to be receiving treatment or to have remitted depression. These same disparities were even more starkly evident among patients with co-occurring symptoms of panic disorder compared to those without. Achieving improvements in the depression treatment cascade will likely require attention to substance use and psychiatric comorbidities.

KEYWORDS:

Alcohol drinking; Anxiety disorders; Depression; Drug users; HIV infections

PMID:
30288684
PMCID:
PMC6408290
[Available on 2020-03-01]
DOI:
10.1007/s10461-018-2282-3
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center