Depression in People Living with HIV and Their Unmet Needs in Mental Health Care in Ontario: A Prospective Cohort Study

Nearly 50% of HIV-positive patients have a history of suffering from depression. Although the condition is treatable, depression in these patients is under-recognized and under-treated, resulting in poorer clinical and quality-of-life outcomes. There are also gaps and disparities in accessing mental health care among these patients, but current evidence is limited to U.S. studies. The primary objectives of this thesis work were to: (1) establish the validity and reliability of self-report measurement instruments in identifying depression against DSM-IV criteria; (2) examine the burden of current depression and the underlying factors driving the burden; (3) estimate the rate of publicly-funded mental health service use and unmet needs for mental health care among HIV-positive patients with depression; and (4) examine the impact of depression on costly and preventable acute health services use in the Canadian health care system. A prospective cohort study was conducted by following a cohort of HIV-positive patients from October 1, 2007 to March 31, 2013 in the province of Ontario, Canada. I adopted a novel longitudinal linked data approach. Various regression models were employed for the analysis. Three self-report instruments (CES-D20, K10, and PHQ9) performed equally well and accurately when compared against DSM-IV criteria. With regards to the burden of depression, one in four HIV-positive patients was depressed. Half of depressed HIV-positive patients had a recurrent episode. In addition, there were delivery gaps in mental health care for depressed HIV-positive patientsâ one-half used mental health services and of these, one-half received minimally adequate care. Furthermore, HIV-positive patients with depression and/or substance use issues were associated with a 19â 70% elevated rate of emergency department (ED) admissions and a 17-67% elevated rate of potentially preventable ED admissions compared to those without these conditions. In sum, depression is highly prevalent in HIV-positive patients and is likely to be chronic and recurrent over time. There are delivery gaps in mental health care for depressed HIV-positive patients. More effective mental health care policies and better access to mental health care services are required to address the unmet needs of HIV-positive patients and reduce the impact of depression on their lives.Ph.D.2018-11-30 00:00:0