HIV and Mental Health in Ontario Evan Collins MD FRCPC Staff - - PowerPoint PPT Presentation

▶

Apr 24, 2023 41 likes •174 views

HIV and Mental Health in Ontario Evan Collins MD FRCPC Staff Psychiatrist, Immunodeficiency Clinic, University Health Network, Toronto Assistant Professor, Department of Psychiatry University of Toronto Evan Collins: Current: Advisory

SLIDE 1

HIV and Mental Health in Ontario

Evan Collins MD FRCPC Staff Psychiatrist, Immunodeficiency Clinic, University Health Network, Toronto Assistant Professor, Department of Psychiatry University of Toronto

SLIDE 2

Evan Collins:

Current: Advisory Committee – Merck Past: Speakers Fees - ViiV, Janssen, Gilead, Biovail, Lilly, Novartis

SLIDE 3

Co-Morbid Mental Health Conditions Significantly More Common in HIV vs. General Population*

21.99 40.55† 5 10 15 20 25 30 35 40 45

Ontario general population HIV+ cohort

*As measured by utilization of mental health services.

†Statistically significant vs. Ontario general population.

Kendall CE, et al. BMC Public Health 2014; 14:161.

Mental health conditions were the most prevalent comorbidities in this study of physical and mental conditions. % with mental health condition

SLIDE 4

OCS Data 2008-2014

25% 31% 36% 34% 16% 43% 45% 500 1000 1500 2000 2500

4562 participants

SLIDE 5

Prevalence of Depression in OCS

 28% (95%CI:26-29%; 990/3600 participants)

 Demographic:

 22% female; 61% MSM  13% Aboriginal; 19% ACB/Asian/Latin; 28% Immigrant  54% ODS recipient

 Clinical

 56% past history of depression  29%Recreational drug use in last 6 months  18% Prior diagnosis of alcohol abuse  54% current smoker

Stephanie K. Y. Choi, E Boyle, J Cairney, S Gardner, E Collins, Jean Bacon, Sean B. Rourke , OHTN Cohort Study Group. Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study. PLoS One. 2016.

SLIDE 6

Formal Mental Health Services Utilization

Formal mental health services use outcome during 12 months following baseline interview

1) Primary mental health service use: provided by family physicians; validation algorithm by Steele, Glazier, Lin & Evans (2004) 2) Secondary mental health service use: provided by psychiatrists 3) Antidepressants: first line of treatment 4) Adequate care that met the minimal thresholds

a) At least four visits to primary or secondary mental health service providers plus at least 2 months of antidepressant use or b) At least eight visits to primary or secondary mental health service providers with a minimum visit time of 20 minutes

Citation: Choi SKY, Boyle E, Cairney J, Gardner S, Collins EJ, Bacon J, et al. Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study. PLoS One. 2016.

SLIDE 7

Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study (Choi et al, PLoS One 2016)

50% 18% 18% 14% 39% 51% 100 200 300 400 500 600 HIV+ Depression n=990

493 182 176 135 407 250 Patients who identified as LGBTQ, having low income or educational attainment, non-Native english speakers or immigrants, were less likely to obtain care

SLIDE 8

Childhood Adversities and HIV

Early death

Disease, disability, and social problems Adoption of health-risk behaviours Social, emotional, & cognitive impairments Childhood adversities Birth Death Whole Life Perspective

Source: ACE Reporter; Volum1; Number 1; April 2003 www.acestudy.org

SLIDE 9

Prevalence of Childhood Adversities in OCS

71% 49%

OCS study participants Canadian Population *

Prevalence of C/A Reporting ≥1 C/A

11% 19% 22% 23% 26% 28% 44% Sent away from home Lengthy parental unemployment Lengthy hospital stay Parental divorce Frequent parental alcohol/drug use Physical abuse Scary traumatic event

Types of Adverse Events

* Source: Patten SB Soc Psychiatry Psychiatr Epidemiol (2013) 48:927–933 2013

SLIDE 10

Childhood Adversities and Depressive Symptoms (CES-D Total Score)

10 20 30 1 2 3 4 ≥5 Mean CES-D score Number of C/A

p<0.001 CES-D score (mean) (ANOVA test: F=29.6; p<0.001)

SLIDE 11

Childhood Adversities and Depressive symptoms (CES-D Score >16)

(ANOVA test: F=29.6; p<0.001)

SLIDE 12

Childhood Adversities and Health Related QoL: Multivariate Regression Modelling

Number

f C/A

Depression (CES-D score)

Mental HRQOL (MCS score) b Physical HRQOL (PCS score) c β p β p β p (Ref)

(Ref)
(Ref)
1

0.52 0.395

0.77

0.251

0.01

0.986 2 0.91 0.174

1.44

0.053

0.25

0.690 3 2.00 0.011

3.20

<0.001 0.72 0.333 4 3.02 0.001

2.61

0.006

0.98

0.223 ≥5 3.31 0.001

3.15

0.004

3.59

<0.001

a Adjusted for age, gender, ethnicity, education, employment, substance use, CD4, VL, time, since diagnosis, and

psychosocial variables

b Adjusted for age, gender, ethnicity, education, employment, substance use, CD4, VL, ARV, time, since diagnosis,

and psychosocial variables

c Adjusted for age, gender, ethnicity, education, country of birth, employment, substance use, CD4, Nadir CD4, VL,

AIDS, time since diagnosis, and psychosocial variables

SLIDE 13

OHTN Cohort Study (OCS)

Ac kno wle dg e me nts

OCS R e se ar c h T e am

Se a n B. Ro urke (PI ) K e vin Go ug h Je ffre y Co he n Curtis Co o pe r Do n K ilb y F re d Cro uza t Mo na L

utfy

Anita Ra c hlis Nic o le Mittma nn Ja ne t Ra b o ud I rving Sa lit Mic ha e l Silve rma n Ro g e r Sa ndre

OCS Gove r nanc e Committe e

Adria n Be tts Anita C. Be no it Bre klyn Be rto zzi L e s Bo wma n L isung u Chie za T ra c e y Co nwa y Pa tric k Cupido Bria n Huskins Cla ire K e nda ll Na tha n L a c ho wsky Jo a nne L indsa y Jo hn Ma c T a vish Ma rk Mc Ca llum Co lle e n Pric e Ro sie T he in

OCS/ OHT N staff

Ro b e rt Hudde r Ma diso n Gile s Ja so n Glo b e rma n Be th Ra c hlis Ve ro nika Mo ra va n L uc ia L ig ht Go kul K a la ima ni Na hid Qure shi

Data linkage

Pub lic He a lth L a b o ra to rie s, Pub lic He a lth Onta rio

F unding

AI DS Bure a u, Onta rio Ministry o f He a lth a nd L

ng -

T e rm Ca re

OCS Sc ie ntific Ste e r ing Committe e

Se rg io Rue da Ann Burc he ll Ba rry Ada m Da vid Bre nna n T

ny Anto nio u Adria n Be tts

T ra c e y Co nwa y Curtis Co o pe r T re vo r Ha rt Mo na L

utfy

K e lly O’ Brie n Ge ra ld E va ns Ja ne t Ra b o ud Anita Ra c hlis

OHT N Co ho rt study pa rtic ipa nts, inte rvie we rs, da ta c o lle c to rs, re se a rc h a sso c ia te s a nd c o o rdina to rs, nurse s a nd physic ia ns who pro vide suppo rt fo r da ta c o lle c tio n