Okhai Hajra, Winston Alan, Post Frank, Boffito Marta, Mallon Patrick, Vera Jaime, Williams Ian, Sachikonye Memory, Johnson Margaret, Anderson Jane, Prechtl Christina, Sabin Caroline
Institute for Global Health, University College London, London, UK.
National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU), Blood-borne and Sexually Transmitted Infections at University College London, London, UK.
HIV Med. 2025 Mar;26(3):465-478. doi: 10.1111/hiv.13753. Epub 2024 Dec 19.
Depressive symptoms are highly prevalent among people with HIV, which can negatively impact HIV-related outcomes. We explore the cascade of mental healthcare for people with HIV experiencing depressive symptoms.
People with HIV who were part of the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study (2013-2016) were included. A Patient Health Questionnaire-9 (PHQ-9) score ≥10 or Center for Epidemiologic Studies Depression Scale (CES-D) ≥16 was defined as moderate/severe depressive symptoms. Diagnosed depression and access to mental healthcare were self-reported. A cascade of mental healthcare was explored, defining individuals experiencing depressive symptoms; those among them reporting a diagnosis of depression; and of this latter group, the proportion reporting accessing mental healthcare. Demographic, social and clinical characteristics were assessed at each step using logistic regression.
Of the 1009 participants (65.5% ≥50 years, 85.8% male, 85.1% white), 387 (38.4%) individuals were experiencing depressive symptoms, over half of whom (54.3%) reported a diagnosis of depression. Only 43.3% of individuals with diagnosed depression reported accessing mental healthcare. Men [odds ratio = 0.62, 95% confidence interval (CI): 0.42-0.92], people in a relationship (0.44, 0.33-0.59), those who were employed (0.28, 0.21-0.38) and those with university qualifications (0.54, 0.40-0.72) were less likely to experience depressive symptoms. Heterosexuals (0.30, 0.14-0.64) were less likely to report a diagnosed depression, whereas smokers were more likely to have a diagnosed depression (1.75, 1.10-2.77). Older individuals (2.36, 1.31-4.28) were less likely to have accessed mental healthcare.
Our findings suggest the presence of unmet mental healthcare needs for people with HIV. We hope these findings will inform policies to streamline mental health services for people with HIV.
