Mental Health Interventions for People Living With HIV
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Top Contributors - Khloud Shreif, Melissa Coetsee and Kim Jackson
Introduction[edit | edit source]
Since its outbreak in the 1980’s, HIV has resulted in immense global and individual health consequences, and in some African countries, it remains the leading cause of death. The introduction and improved availability of ART (antiretroviral treatment) in recent years, has resulted in fewer people succumbing to the fatal effects of the virus [1]. With more people surviving, the prevalence of HIV has increased significantly. This brings forth the challenge of ensuring that PLWH (people living with HIV) are living good quality, functional lives. Both the effects of the virus and the side effects of ART can have detrimental effects on PLWH’s physical health (pain and energy levels) and mental health (depression and anxiety)[1].
Relationship Between HIV and Mental Health[edit | edit source]
One of the prominent elements contributing to impaired quality of life of PLWH is poor mental health. Mental health problems, such as depression and anxiety, are very common among PLWH. The prevalence rate of depression and mood disorders among PLWH is approximately 33% and the prevalence rate of anxiety disorders is about 20%[2]. This is much higher than the global prevalence of the general population which is 4.7%[3]. It is therefore clear that having HIV poses an increased risk of developing mental health disorders.
Mental health problems have been recognised as a key factor in affecting HIV treatment outcomes[4]. Poor mental health has been shown to negatively affect HIV disease progression as well as adherence to ART[5]. Those who report needing mental health care, but do not receive it, are more likely to not adhere to their ART medication compared to those who do receive mental health care support[6]. Furthermore, evidence also suggests that poor viral suppression (as a result of poor ART adherence) may again lead to an increased risk of mental health problems[6]. High levels of stress and depression have also been associated with poor disease parameters (reduced CD4 and increased viral load) - This could be related to associated poor ART adherence, or attributed to the physiological effects of stress and depression [1].
“PLWH and depression are 42% less likely to achieve good ART adherence, more likely to develop virologic failure and are more likely to have HIV progression, independent of ART adherence, than those without depression” [7]
Mental health in PLWH can be influenced by various biopsychosocial factors, including:
- Isolation
- Stigma
- Discrimination
- Low socio-economic status
- Lack of support
- Disease-related pain
- Neurological damage caused by opportunistic infections
- Neuropsychiatric side effects of some ART (Zidovudine and Abacavir have been associated with mood changes)[4].
- Food insecurity and poverty[8].
- Lack of purpose in society [8].
The World Health Organisation (WHO) describes the concept of quality of life as: “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns”. It is clear that addressing mental health in PLWH should be a priority - not only to improve psychological factors but in order to improve medication adherence and physical health - in order to ultimately improve the quality of life of PLWH.
Mental Health Intervention for PLWH[edit | edit source]
Pharmacological interventions[edit | edit source]
The majority of PLWH, live in low to middle-income countries. It is therefore important to consider results from studies that were done in these settings. In studies conducted in Uganda, full adherence to medication was low (56%)[4] and in Malawi treatment was hindered by low stock of antidepressants nationwide[4]. In addition, the evidence to support the use of antidepressants is inconclusive and it might not have many benefits over psychological interventions alone[4]. Considering the potential issues with adherence and the lack of strong evidence, pharmacological interventions might not be the most practical or cost-effective treatment in PLWH.
Psychotherapeutic interventions[edit | edit source]
Individual therapy
There is good evidence to support the effectiveness of psychotherapy for depression in PLWH in both low and high resource settings [1] [7]. The ‘active ingredients of psychotherapy that were associated with enhanced effectiveness in research studies were:
- Cognitive restructuring
- Positive coping skills
- Venting (sharing personal problems)
- Social support
- Behaviour activation[4].
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 van Luenen S, Garnefski N, Spinhoven P, Spaan P, Dusseldorp E, Kraaij V. The benefits of psychosocial interventions for mental health in people living with HIV: a systematic review and meta-analysis. AIDS and Behavior. 2018 Jan;22(1):9-42.
- ↑ Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KRR, et al. Mood Disorders in the Medically Ill: Scientific Review and Recommendations. Biological Psychiatry. 2005 Aug;58(3):175–89.
- ↑ Ferrari AJ, Somerville AJ, Baxter AJ, Norman R, Patten SB, Vos T, et al. Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychological Medicine. 2012 Jul 25;43(3):471–81.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Nakimuli‐Mpungu E, Musisi S, Smith CM, Von Isenburg M, Akimana B, Shakarishvili A, et al. Mental health interventions for persons living with HIV in low‐ and middle‐income countries: a systematic review. Journal of the International AIDS Society. 2021 Jun;24(S2).
- ↑ Nosrat S, Whitworth JW, Ciccolo JT. Exercise and mental health of people living with HIV: A systematic review. Chronic illness. 2017 Dec;13(4):299-319.
- ↑ 6.0 6.1 Scroggins S, Schacham E, Renee M. Integrating Mental Health Care Services Into HIV Comprehensive Care. The American Journal of Managed Care. 2020 Aug 1;26(8):357–60.
- ↑ 7.0 7.1 Lofgren SM, Nakasujja N, Boulware DR. Systematic review of interventions for depression for people living with HIV in Africa. AIDS and Behavior. 2018 Jan;22(1):1-8.
- ↑ 8.0 8.1 Hatcher AM, Lemus Hufstedler E, Doria K, Dworkin SL, Weke E, Conroy A, et al. Mechanisms and perceived mental health changes after a livelihood intervention for HIV-positive Kenyans: Longitudinal, qualitative findings. Transcultural Psychiatry. 2019 Jun 26;57(1):124–39.
- ↑ eNCA. Examining mental illness and HIV/Aids. Available from: http://www.youtube.com/watch?v=kJ73fAQ2hQM[last accessed 12/8/2022]
- ↑ Al Jazeera English . The psychological trauma of living with HIV in South Africa. Available from: http://www.youtube.com/watch?v=Pq7ddbQ4zuI[last accessed 12/8/2022]
