Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America.
PLoS One. 2023 Nov 28;18(11):e0294483. doi: 10.1371/journal.pone.0294483. eCollection 2023.
We characterized polysubstance use burden and associations with mental health problems across demographic subgroups of PWH. In 2018-2020, as part of a primary care-based intervention study, PWH in care at three medical centers in Kaiser Permanente Northern California were screened for depression (PHQ-9≥10), anxiety (GAD-2≥3), and substance use (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]≥1 per substance). We used Poisson regression to estimate prevalence ratios (PRs) comparing polysubstance use prevalence (TAPS≥1 for ≥2 substances) between PWH with positive screens for depression or anxiety vs. neither, among all PWH, and stratified by race/ethnicity and age (restricted to men), adjusting for sociodemographics, CD4, and HIV load. Screened PWH (N = 2865) included 92% men, 56% White, 19% Black, and 15% Hispanic PWH, with a median age of 55 years. Overall, polysubstance use prevalence was 26.4% (95% CI 24.9%-28.1%). PWH with depression or anxiety (n = 515) had an adjusted polysubstance use PR of 1.26 (1.09-1.46) vs. PWH with neither (n = 2350). Adjusted PRs were 1.47 (1.11-1.96), 1.07 (0.74-1.54), and 1.10 (0.85-1.41) among Black, Hispanic, and White men, respectively. Adjusted PRs did not differ by age group. Interventions should consider jointly addressing mental health and substance use problems and potential drivers, e.g. stigma or socioeconomic factors.
我们描述了多物质使用负担以及与艾滋病毒感染者（PWH）各人口统计学亚组的心理健康问题之间的关联。在 2018-2020 年，作为一项基于初级保健的干预研究的一部分，在 Kaiser Permanente 北加利福尼亚的三个医疗中心接受护理的 PWH 接受了抑郁（PHQ-9≥10）、焦虑（GAD-2≥3）和物质使用（烟草、酒精、处方药物和其他物质使用[TAPS]≥1 种物质）的筛查。我们使用泊松回归估计了患病率比（PR），比较了在所有 PWH 中，抑郁或焦虑筛查阳性的 PWH（TAPS≥1 种≥2 种物质）与既无抑郁也无焦虑的 PWH（TAPS≥1 种≥2 种物质）之间的多物质使用患病率，以及按种族/族裔和年龄（限于男性）分层，调整了社会人口统计学、CD4 和 HIV 载量。筛查出的 PWH（N=2865）包括 92%的男性、56%的白人、19%的黑人、15%的西班牙裔 PWH，中位年龄为 55 岁。总体而言，多物质使用的患病率为 26.4%（95%CI 24.9%-28.1%）。与既无抑郁也无焦虑的 PWH（n=2350）相比，有抑郁或焦虑的 PWH（n=515）的调整后多物质使用 PR 为 1.26（1.09-1.46）。黑人、西班牙裔和白人男性的调整后 PR 分别为 1.47（1.11-1.96）、1.07（0.74-1.54）和 1.10（0.85-1.41）。调整后的 PR 不因年龄组而异。干预措施应考虑共同解决心理健康和物质使用问题及其潜在驱动因素，例如耻辱感或社会经济因素。
