Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Clinical and Molecular Epidemiology of Emerging and Re-emerging Infectious Diseases Research Cluster, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Int AIDS Soc. 2021 Feb;24(2):e25668. doi: 10.1002/jia2.25668.
To assess the burden of depression, anxiety and suicidality; and to determine the impact of integrated mental health and HIV services on treatment outcomes among Thai adolescents and young adults living with HIV (AYHIV).
A multicentre prospective cohort study was conducted among AYHIV (15 to 25 years), and age- and sex-matched HIV-uninfected adolescents and young adults (HUAY). The Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item scales (GAD-7) were used as screening tools for depressive and anxiety symptoms respectively. History of lifetime and recent suicidal ideations/attempts were ascertained. Elevated mental health screening scores were defined as having either significant depressive symptoms (PHQ-9 ≥9), significant anxiety symptoms (GAD-7 ≥10) or suicidality (lifetime; and recent [within two weeks]). Participants meeting these criteria were referred to psychiatrists for confirmatory diagnosis and mental health services. Follow-up assessment with PHQ-9 and GAD-7 was performed one year after psychiatric referral.
From February to April 2018, 150 AYHIV and 150 HUAY were enrolled, median age was 19.0 (IQR:16.8 to 21.8) years and 56% lived in urban areas. Among AYHIV, 73% had HIV RNA <50 copies/mL, and median CD4 count was 580 (IQR:376 to 744) cells/mm . At enrolment, 31 AYHIV (21%; 95%CI:14% to 28%) had elevated mental health screening scores; 17 (11%) significant depressive symptoms, 11 (7%) significant anxiety symptoms and 21 (14%) suicidality. Seven AYHIV (5%) had all three co-existing conditions. These prevalences were not substantially different from HUAY. Urban living increased risk, whereas older age decreased risk of elevated mental health screening scores (p < 0.05). All AYHIV with elevated mental health screening scores were referred to study psychiatrists, and 19 (13%; 95%CI: 8% to 19%) had psychiatrist-confirmed mental health disorders (MHDs), including adjustment disorder (n = 5), major depression (n = 4), anxiety disorders (n = 2), post-traumatic stress disorder (n = 1) and mixed MHDs (n = 4). One year after psychiatric referral, 42% of AYHIV who received mental health services demonstrated an absence of significant mental health symptoms from the reassessments, and 26% had an improved score.
With the significant burden of MHDs among AYHIV, an integration of mental health services, including mental health screenings, and psychiatric consultation and referral, is critically needed and should be scaled up in HIV healthcare facilities.
评估抑郁、焦虑和自杀意念的负担；并确定综合心理健康和艾滋病毒服务对泰国感染艾滋病毒的青少年和青年（AYHIV）治疗结果的影响。
对 AYHIV（15 至 25 岁）和年龄及性别匹配的未感染艾滋病毒的青少年和青年（HUAY）进行了一项多中心前瞻性队列研究。使用患者健康问卷 9 项（PHQ-9）和广泛性焦虑障碍 7 项量表（GAD-7）作为筛查工具，分别筛查抑郁和焦虑症状。确定了终生和近期自杀意念/企图的历史。心理健康筛查评分升高定义为有显著抑郁症状（PHQ-9≥9）、显著焦虑症状（GAD-7≥10）或自杀意念（终生；和近期[两周内]）。符合这些标准的参与者被转介给精神科医生进行确认诊断和心理健康服务。在精神病学转介后一年进行 PHQ-9 和 GAD-7 的随访评估。
从 2018 年 2 月至 4 月，共纳入 150 名 AYHIV 和 150 名 HUAY，中位年龄为 19.0（IQR：16.8 至 21.8）岁，56%居住在城市地区。在 AYHIV 中，73%的 HIV RNA<50 拷贝/ml，中位数 CD4 计数为 580（IQR：376 至 744）细胞/mm。在入组时，31 名 AYHIV（21%；95%CI：14%至 28%）心理健康筛查评分升高；17 名（11%）有显著抑郁症状，11 名（7%）有显著焦虑症状，21 名（14%）有自杀意念。7 名 AYHIV（5%）同时存在这三种情况。这些患病率与 HUAY 没有显著差异。城市居住增加了风险，而年龄较大则降低了心理健康筛查评分升高的风险（p<0.05）。所有心理健康筛查评分升高的 AYHIV 都被转介给研究精神科医生，其中 19 名（13%；95%CI：8%至 19%）被精神科医生确诊为精神健康障碍（MHD），包括适应障碍（n=5）、重度抑郁症（n=4）、焦虑症（n=2）、创伤后应激障碍（n=1）和混合 MHD（n=4）。在精神病学转介一年后，接受心理健康服务的 AYHIV 中有 42%的人从重新评估中没有明显的心理健康症状，26%的人评分有所改善。
AYHIV 中存在严重的精神健康障碍负担，因此迫切需要整合心理健康服务，包括心理健康筛查以及精神科咨询和转介，并应在艾滋病毒保健设施中推广。
