Department of Family Medicine, McGill University, Montreal, QC, Canada.
Harvard Medical School, Boston, MA, USA.
BMC Health Serv Res. 2024 Aug 13;24(1):923. doi: 10.1186/s12913-024-11396-z.
The prevalence of mental health conditions among women with HIV in Canada ranges between 29.5% and 57.4%, highlighting the need for accessible mental health care. We aimed to (1) describe the availability and use of mental health services among women with HIV and (2) identify characteristics associated with reporting that shortages of these services presented a problem in their care.
Baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study were analysed. Self-reported availability and use of mental health services were examined using descriptive statistics. Participants indicated whether a lack of mental health support was a problem in their care. Logistic regression models were constructed to determine associations between sociodemographic, clinical, and psychosocial characteristics and reported problematic shortages.
Of 1422 women, 26.7% (n = 380) used mental health services in the last year, which most accessed through their HIV clinic. Thirty-eight percent (n = 541) reported that a shortage of mental health support was a problem in their care. Among this subset, 22.1% (n = 119) used services at their HIV clinic, 26.5% (n = 143) reported available services but did not use them, and 51.4% (n = 277) either indicated that these services were unavailable, did not know if such services were available, or were unengaged in HIV care. Factors associated with reporting problematic shortages included rural residence [adjusted odds ratio (aOR): 1.69, 95% confidence interval (CI): 1.03-2.77], higher education level (aOR: 1.43, 95% CI: 1.02-2.02), and higher HIV stigma score (aOR: 1.03, 95% CI: 1.02-1.03). Conversely, African/Caribbean/Black identity (aOR: 0.37, 95% CI: 0.26-0.54), history of recreational drug use (aOR: 0.56, 95% CI: 0.39-0.81), and Quebec residence (aOR: 0.69, 95% CI: 0.50-0.96) were associated with lower odds of reporting service shortages.
Our findings highlight the HIV clinic as the primary location of mental health service use. However, existing services may not be sufficient to reach all patients or meet specific needs. Furthermore, the low uptake among those reporting a shortage suggests a lack of connection to services or patient knowledge about their availability. Characteristics associated with reporting shortages reflect geographic and socioeconomic disparities that must be accounted for in future service design.
加拿大 HIV 女性患者中心理健康问题的患病率在 29.5%至 57.4%之间，这突显了需要提供可及的心理健康服务。我们旨在：（1）描述 HIV 女性患者可获得和使用心理健康服务的情况；（2）确定与报告这些服务短缺对其护理构成问题相关的特征。
对加拿大 HIV 女性性与生殖健康队列研究的基线数据进行了分析。使用描述性统计数据检查了心理健康服务的可获得性和使用情况。参与者表示缺乏心理健康支持是否是其护理中的一个问题。构建逻辑回归模型以确定社会人口学、临床和心理社会特征与报告的服务短缺之间的关联。
在 1422 名女性中，26.7%（n=380）在过去一年中使用了心理健康服务，其中大多数人通过其 HIV 诊所获得服务。38%（n=541）报告说，缺乏心理健康支持是其护理中的一个问题。在这一部分人群中，22.1%（n=119）在其 HIV 诊所使用了服务，26.5%（n=143）表示有可用服务但未使用，51.4%（n=277）表示这些服务不可用、不知道是否有这些服务可用，或者未参与 HIV 护理。与报告存在服务短缺问题相关的因素包括居住在农村地区[调整后的优势比（aOR）：1.69，95%置信区间（CI）：1.03-2.77]、较高的教育水平（aOR：1.43，95%CI：1.02-2.02）和较高的 HIV 耻辱感得分（aOR：1.03，95%CI：1.02-1.03）。相反，非洲/加勒比/黑人身份（aOR：0.37，95%CI：0.26-0.54）、有消遣性药物使用史（aOR：0.56，95%CI：0.39-0.81）和魁北克居住（aOR：0.69，95%CI：0.50-0.96）与报告服务短缺的可能性较低相关。
我们的研究结果突出了 HIV 诊所作为心理健康服务使用的主要场所。然而，现有的服务可能不足以覆盖所有患者或满足特定需求。此外，报告短缺的患者中低利用率表明他们与服务的联系不足或对服务的可获得性缺乏了解。与报告短缺相关的特征反映了地理和社会经济方面的差距，这在未来的服务设计中必须加以考虑。
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