Professor Frances K. Barg, PhD, MEd is a professor in the Department of Family Medicine and Community Health, a senior fellow in the Center for Public Health Initiatives at the University of Pennsylvania School of Medicine, a Professor of Epidemiology and a senior scholar in the Center for Clinical Epidemiology and Biostatistics, associated faculty in the Department of Anesthesia and Critical Care and a Professor in the Department of Anthropology at the University of Pennsylvania. She is the Director of the Mixed Methods Research Lab (MMRL) which was founded in 2010.
BACKGROUND: The sources of risk and direction of effects between HIV infection and mental illness are not well understood. Yet, understanding this relationship is important for prevention and treatment for people with these complex, co-occurring conditions. A now established body of research documents that persons with mental illness are at increased risk for contracting and transmitting HIV. Furthermore, a recent study showed that prevalence of HIV was four times higher among persons receiving mental health services in two US cities. The goal of this study was to conduct preliminary work to enable us to identify the causal pathways between the development of symptoms of a severe mental illness (SMI) such as schizophrenia or major depression and the onset of behaviors that contribute to HIV infection.
METHODS: Persons who attended a community mental health center in a large northeastern US city who have a diagnosis of HIV and a SMI participated in open-ended, semi-structured qualitative interviews and completed standardized instruments to assess depression status, risk behaviors and mental and physical function. A grounded theory approach was used for qualitative data analysis. Simple frequencies were generated from responses to the standardized instruments and were used to characterize the sample.
RESULTS: Twenty-six men and women with major depressive disorder (n=11) or schizophrenia (n=15) participated in this study. We found that there were explicitly different pathways in the relationship between HIV and mental illness symptoms in individuals who reported bipolar/psychotic spectrum symptoms compared to those who only reported depression symptoms. There were also important common underlying risk factors dating back to childhood among all participants regardless of psychiatric diagnosis.
CONCLUSION: While further research needs to be done to generalize these findings, we will discuss implications for counseling and communication for primary care and public health professionals as well as for infectious disease specialists who care for these individuals.
Dr. Billy Tsima +267 355 5564, email; billy.tsima@mopipi.ub.bw