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Psychiatric Disorders and Drug Use Among Human Immunodeficiency Virus–Infected Adults in the United States
Eric G. Bing, MD, PhD, MPH;
M. Audrey Burnam, PhD;
Douglas Longshore, PhD;
John A. Fleishman, PhD;
Cathy Donald Sherbourne, PhD;
Andrew S. London, PhD;
Barbara J. Turner, MD, MSEd;
Ferd Eggan, MA;
Robin Beckman, MPH;
Benedetto Vitiello, MD;
Sally C. Morton, PhD;
Maria Orlando, PhD;
Samuel A. Bozzette, MD, PhD;
Lucila Ortiz-Barron, MD;
Martin Shapiro, MD, PhD
Arch Gen Psychiatry. 2001;58:721-728.
Background There have been no previous nationally representative estimates of the
prevalence of mental disorders and drug use among adults receiving care for
human immunodeficiency virus (HIV) disease in the United States. It is also
not known which clinical and sociodemographic factors are associated with
these disorders.
Subjects and Methods We enrolled a nationally representative probability sample of 2864 adults
receiving care for HIV in the United States in 1996. Participants were administered
a brief structured psychiatric instrument that screened for psychiatric disorders
(major depression, dysthymia, generalized anxiety disorders, and panic attacks)
and drug use during the previous 12 months. Sociodemographic and clinical
factors associated with screening positive for any psychiatric disorder and
drug dependence were examined in multivariate logistic regression analyses.
Results Nearly half of the sample screened positive for a psychiatric disorder,
nearly 40% reported using an illicit drug other than marijuana, and more than
12% screened positive for drug dependence during the previous 12 months. Factors
independently associated with screening positive for a psychiatric disorder
included number of HIV-related symptoms, illicit drug use, drug dependence,
heavy alcohol use, and being unemployed or disabled. Factors independently
associated with screening positive for drug dependence included having many
HIV-related symptoms, being younger, being heterosexual, having frequent heavy
alcohol use, and screening positive for a psychiatric disorder.
Conclusions Many people infected with HIV may also have psychiatric and/or drug
dependence disorders. Clinicians may need to actively identify those at risk
and work with policymakers to ensure the availability of appropriate care
for these treatable disorders.
From the Center for AIDS Research, Education and Services and Collaborative
Alcohol Research Center, Charles R. Drew University of Medicine & Science,
Los Angeles, Calif (Dr Bing); RAND, Santa Monica, Calif (Drs Burnam, Sherbourne,
Orlando, Bozzette, and Shapiro and Ms Beckman); RAND, Santa Monica, Calif
(Dr Longshore); University of California, Los Angeles Drug Abuse Research
Center (Dr Longshore); Agency for Healthcare Research and Quality, Rockville,
Md (Dr Fleishman); Department of Sociology, Kent State University, Kent, Ohio
(Dr London); Division of General Medicine, Department of Medicine, University
of Pennsylvania, Philadelphia (Dr Turner); AIDS Coordinator's Office, City
of Los Angeles (Mr Eggan); National Institute of Mental Health, Bethesda,
Md (Dr Vitiello); RAND Statistics Group, Santa Monica, Calif (Dr Morton);
Health Services Research and Development Unit, Veterans Affairs San Diego
Healthcare System, School of Medicine, University of California, San Diego
(Dr Bozzette); College of Medicine, Michigan State University, East Lansing
(Dr Ortiz-Barron); Department of General Internal Medicine, University of
California, Los Angeles (Dr Shapiro).
Corresponding author and reprints: Eric G. Bing, MD, PhD, MPH, Center
for AIDS Research, Education and Services and Collaborative Alcohol Research
Center, Charles R. Drew University of Medicine & Science, 1651 E 120th
St, Los Angeles, CA 90059 (e-mail: erbing{at}cdrewu.edu).
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