Pence Brian Wells, Miller William C, Whetten Kathryn, Eron Joseph J, Gaynes Bradley N
Center for Health Policy, Duke University, Durham, NC 27708, USA.
J Acquir Immune Defic Syndr. 2006 Jul;42(3):298-306. doi: 10.1097/01.qai.0000219773.82055.aa.
Mood and anxiety disorders, particularly depression, and substance abuse (SA) commonly co-occur with HIV infection. Appropriate policy and program planning require accurate prevalence estimates. Yet most estimates are based on screening instruments, which are likely to overstate true prevalence.
Large academic medical center in Southeast.
A total of 1,125 patients, representing 80% of HIV-positive patients seen over a 2.5-year period, completed the Substance Abuse-Mental Illness Symptoms Screener, a brief screening instrument for probable mood, anxiety, and SA disorders. Separately, 148 participants in a validation study completed the Substance Abuse-Mental Illness Symptoms Screener and a reference standard diagnostic tool, the Structured Clinical Interview for DSM-IV.
Using the validation study sample, we developed logistic regression models to predict any Structured Clinical Interview for DSM-IV mood/anxiety disorder, any SA, and certain specific diagnoses. Explanatory variables included sociodemographic and clinical information and responses to Substance Abuse-Mental Illness Symptoms Screener questions. We applied coefficients from these models to the full clinic sample to obtain 12-month clinic-wide diagnosis prevalence estimates.
We estimate that in the preceding year, 39% of clinic patients had a mood/anxiety diagnosis and 21% had an SA diagnosis, including 8% with both. Of patients with a mood/anxiety diagnosis, 76% had clinically relevant depression and 11% had posttraumatic stress disorder.
The burden of psychiatric disorders in this mixed urban and rural clinic population in the southeastern United States is comparable to that reported from other HIV-positive populations and significantly exceeds general population estimates. Because psychiatric disorders have important implications for clinical management of HIV/AIDS, these results suggest the potential benefit of routine integration of mental health identification and treatment into HIV service sites.
情绪与焦虑障碍，尤其是抑郁症，以及物质滥用（SA）常与HIV感染同时出现。恰当的政策和项目规划需要准确的患病率估计。然而，大多数估计基于筛查工具，这可能高估了真实患病率。
东南部的大型学术医疗中心。
共有1125名患者，占2.5年期间所诊治的HIV阳性患者的80%，完成了物质滥用-精神疾病症状筛查器，这是一种用于筛查可能的情绪、焦虑和物质滥用障碍的简短筛查工具。另外，148名参与验证研究的参与者完成了物质滥用-精神疾病症状筛查器和一种参考标准诊断工具——《精神疾病诊断与统计手册》第四版（DSM-IV）结构化临床访谈。
利用验证研究样本，我们建立了逻辑回归模型，以预测任何《精神疾病诊断与统计手册》第四版情绪/焦虑障碍、任何物质滥用以及某些特定诊断。解释变量包括社会人口统计学和临床信息以及对物质滥用-精神疾病症状筛查器问题的回答。我们将这些模型的系数应用于整个诊所样本，以获得全诊所12个月的诊断患病率估计值。
我们估计，在前一年，39%的诊所患者有情绪/焦虑诊断，21%有物质滥用诊断，其中8%两者都有。在有情绪/焦虑诊断的患者中，76%有临床相关抑郁症，11%有创伤后应激障碍。
在美国东南部这个城乡混合的诊所人群中，精神障碍的负担与其他HIV阳性人群报告的负担相当，且显著超过一般人群的估计值。由于精神障碍对HIV/AIDS的临床管理具有重要意义，这些结果表明将心理健康识别和治疗常规纳入HIV服务场所可能带来益处。
