患有 HIV 的母亲所患精神和物质使用障碍的流行率、发生率和持续时间。
Prevalence, incidence, and persistence of psychiatric and substance use disorders among mothers living with HIV.
机构信息
*Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; †HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY; ‡Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard School of Public Health, Boston, MA; §Department of Epidemiology, Harvard School of Public Health, Boston, MA; ‖Department of Pediatrics, University of Illinois, Chicago, IL; ¶Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA; #National Institutes of Health/National Institute of Mental Health, Bethesda, MD; **Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA; ††Department of Children's Behavioral Health, Children's of Alabama, Birmingham, AL; and ‡‡Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY.
出版信息
J Acquir Immune Defic Syndr. 2014 Apr 15;65(5):526-34. doi: 10.1097/QAI.0000000000000070.
OBJECTIVE
To evaluate prevalence, incidence, remission, and persistence of psychiatric and substance use disorders among HIV-infected mothers and identify biopsychosocial correlates.
METHODS
HIV-infected mothers (n = 1223) of HIV-exposed uninfected children enrolled in a prospective cohort study; HIV-uninfected mothers (n = 128) served as a comparison group. Mothers provided sociodemographic and health information and completed the Client Diagnostic Questionnaire (CDQ). Prevalence of any psychiatric or substance use disorder at initial evaluation was compared between the 2 groups. Incident, remitting, and persisting disorders were identified for 689 mothers with HIV who completed follow-up CDQs. We used logistic regression to evaluate adjusted associations of biopsychosocial characteristics with presence, incidence, remission, and persistence of disorders.
RESULTS
Thirty-five percent of mothers screened positive for any psychiatric or substance use disorder at initial evaluation, with no difference by maternal HIV status (P = 1.00). Among HIV-infected mothers, presence of any disorder was associated with younger age [adjusted odds ratio (aOR): 1.39; 95% CI: 1.09 to 1.75], single parenthood (aOR: 1.35; 95% CI: 1.08 to 1.68), and functional limitations (aOR: 2.29; 95% CI: 1.81 to 2.90). Incident disorders were associated with functional limitations (aOR: 1.92; 95% CI: 1.10 to 3.30). Among HIV-infected mothers with a disorder at initial evaluation (n = 238), 61% had persistent disorders. Persistent disorders were associated with lower income (aOR: 2.44; 95% CI: 1.33 to 4.76) and functional limitations (aOR: 3.19; 95% CI: 1.87 to 5.48). Receipt of treatment for any disorder was limited: 4.5% at study entry, 7% at follow-up, 5.5% at both entry and follow-up.
CONCLUSIONS
Psychiatric and substance use disorders remain significant comorbid conditions among HIV-infected mothers and require accessible evidence-informed treatment.
目的
评估感染 HIV 的母亲中精神和物质使用障碍的患病率、发病率、缓解率和持续率，并确定其生物学、心理学和社会因素相关情况。
方法
本研究纳入了前瞻性队列研究中的 1223 名 HIV 暴露但未感染儿童的 HIV 感染母亲和 128 名未感染 HIV 的母亲作为对照组。母亲们提供了社会人口统计学和健康信息，并完成了客户诊断问卷（CDQ）。比较了两组在初始评估时任何精神或物质使用障碍的患病率。对完成随访 CDQ 的 689 名 HIV 感染母亲进行了新发、缓解和持续障碍的识别。我们使用逻辑回归来评估生物学、心理学和社会特征与障碍的存在、新发、缓解和持续之间的调整关联。
结果
35%的母亲在初始评估时筛查出任何精神或物质使用障碍，而母亲的 HIV 状况没有差异（P=1.00）。在 HIV 感染的母亲中，任何障碍的存在与年龄较小[调整后的优势比（aOR）：1.39；95%置信区间（CI）：1.09 至 1.75]、单亲家庭（aOR：1.35；95%CI：1.08 至 1.68）和功能障碍（aOR：2.29；95%CI：1.81 至 2.90）有关。新发障碍与功能障碍有关（aOR：1.92；95%CI：1.10 至 3.30）。在初始评估时患有障碍的 1223 名 HIV 感染母亲中（n=238），61%的人患有持续性障碍。持续性障碍与收入较低（aOR：2.44；95%CI：1.33 至 4.76）和功能障碍（aOR：3.19；95%CI：1.87 至 5.48）有关。接受任何障碍治疗的比例有限：研究开始时为 4.5%，随访时为 7%，在开始和随访时均为 5.5%。
结论
精神和物质使用障碍仍然是感染 HIV 的母亲的重要合并症，需要提供方便获取的循证治疗。
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