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Psych and Substance Abuse Disorders Frequent and Persistent in US Mothers With HIV
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Third International Workshop on HIV and Women, January 14-15, 2013, Toronto
Mark Mascolini
More than one third of HIV-positive mothers in a 22-site US study had a psychiatric or substance abuse disorder at their initial visit [1]. The psychiatric disorder rate was higher than in a national general population of US women but did not differ from prevalence in an HIV-negative comparison group recruited at the same sites.
This analysis involved 1223 HIV-positive mothers enrolled in a prospective cohort study, Surveillance Monitoring for ART Toxicities (SMARTT), at 22 sites across the United States and Puerto Rico. A comparison group of 128 HIV-negative mothers came from 9 of these sites and had economic and social backgrounds similar to the HIV-positive women.
Participants provided sociodemographic and health information and completed the Client Diagnostic Questionnaire (CDQ), a validated screening interview for psychiatric disorders. In the HIV-positive group, 689 women (56%) completed a follow-up CDQ 1 to 3 years after their initial CDQ.
Two thirds of women in the HIV-positive and negative groups were black, while the HIV group included a significantly higher proportion of Hispanics (35% versus 26%, P = 0.04). One third of HIV-positive mothers were 35 or older, compared with 20% of the HIV-negative group (P = 0.001). A lower proportion of the HIV group completed high school (66% versus 81%, P < 0.001), and a lower proportion with HIV was employed (38% versus 55%, P < 0.001).
More HIV-positive than negative women had 1 or 2 functional limitations (26% versus 13%) or 3 or more limitations (9% versus 5%) (P < 0.001). One in 10 HIV-positive women used alcohol or illicit substances during pregnancy, and these rates were higher than in HIV-negative women (6% for alcohol, P = 0.21; 3% for illicit substances, P = 0.01). Few women in either group (11% and 7%, P = 0.18) had received mental health treatment.
At their initial evaluation, 35% of HIV-positive and negative mothers who enrolled in the study by January 2012 screened positive for a psychiatric or substance abuse disorder. HIV-positive and negative mothers also had similar rates of any psychiatric disorder (about 30%) and any substance abuse disorder (about 9%). Prevalence of any disorder was higher in both groups than were US national 12-month prevalence estimates of DSM-IV psychiatric disorders (35% versus 26%).
The most prevalent disorder in HIV-positive and negative mothers was posttraumatic stress disorder (23% and 21%). Less frequently detected problems were anxiety disorders (12% with HIV and 13% without HIV), depressive disorders (12% and 8%, P = 0.19), substance abuse disorders (9% and 9%), and psychosis (4% and 2%, P = 0.48).
Among mothers with HIV, five factors were independently associated with having any psychiatric or substance abuse disorder, at the following adjusted odds ratios (aOR) and 95% confidence intervals (CI):
-- Younger than 35 years old: aOR 1.39 (95% CI 1.09 to 1.75), P = 0.01
-- Single parenthood: aOR 1.35 (95% CI 1.08 to 1.68), P = 0.01
-- 3 or more functional limitations: aOR 3.57 (95% CI 2.49 to 5.14), P < 0.001
-- Alcohol use during pregnancy: aOR 1.61 (95% CI 1.11 to 2.34), P = 0.01
-- Illicit substance use during pregnancy: aOR 1.91 (95% CI 1.27 to 2.88), P = 0.002
Among the 689 HIV-positive mothers who had follow-up screening, 93 (13.5%) had new disorders, 93 (13.5%) had remitting disorders, and 145 (21%) had persisting disorders. Four factors were independently associated with persisting disorders:
-- Annual household income below $20,000: aOR 2.44 (95% CI1.33 to 4.76), P = 0.01
-- 3 or more functional limitations: aOR 9.14 (95% CI 3.97 to 22.03), P < 0.001
-- Alcohol use during pregnancy: aOR 4.01 (95% CI 1.85 to 8.83), P < 0.001
-- Illicit substance use during pregnancy: aOR 2.46 (95% CI 1.12 to 5.46), P < 0.03
A history of trauma was frequent in study participants with and without HIV. But childhood physical abuse was more common in women with HIV (P = 0.02), as was sexual abuse during childhood (P = 0.02).
The investigators believe their findings raise concern that the disorders identified "will exacerbate existing health problems and prevent adequate health-promoting behaviors for mothers with HIV, especially those with persistent disorders."
"Early identification of disorders and access to culturally sensitive, evidence-based treatments are essential to the well-being of [HIV-positive] mothers and families," the researchers stressed, "yet rates of mental health treatment are low."
Reference
1. Malee K, Mellins CA, Huo Y, et al. Prevalence and persistence of psychiatric and substance abuse disorders among mothers living with HIV. Third International Workshop on HIV and Women, January 14-15, 2013, Toronto. Abstract O_06.
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