Sociodemographic and clinical factors associated with use of depression treatment among people with HIV in the United States: An electronic health records-based cohort study.

BACKGROUND

Depression is highly prevalent among people with HIV (PWH), and treatment is critical. We examined associations between sociodemographic and clinical characteristics, focusing on alcohol use and smoking, with use of depression treatment.

METHODS

Electronic health record data from an integrated healthcare system in Northern California were used to identify PWH who had a primary care visit (index) between 1/1/2014-12/31/2020 and a depression diagnosis within 6 months of the index date. Outcomes included separate indicators for outpatient mental health (MH) encounters and antidepressant prescription fills in the year post index.

RESULTS

Among 3078 PWH, 24.7 % (761) had a depression diagnosis; of those, 52.6 % were aged 50+, 10.5 % female, 56.1 % White, 36.4 % reported alcohol use in the past 3 months and 18.7 % reported current smoking. Seventy-six percent used depression treatment services (antidepressants [68 %] and outpatient MH [35 %]). Patients aged 50-59 years (OR = 0.52, CI = 0.34, 0.80) and 60+ years (OR = 0.27, CI = 0.14, 0.50) were less likely to have outpatient MH encounters compared to patients ≤40 years. Compared to White patients, Black (OR = 0.37, CI = 0.23, 0.59) and Hispanic (OR = 0.48, CI = 0.31, 0.75) patients were less likely to have antidepressant prescription fills, and Black (OR = 0.47, CI = 0.28, 0.77), Hispanic (OR = 0.58, CI = 0.35, 0.94) and Asian (OR = 0.48, CI = 0.25, 0.93) patients were less likely to use any depression treatment. Neither alcohol use nor smoking were associated with depression treatment.

CONCLUSIONS

We found substantial demographic disparities in use of depression treatment services among PWH and depression. Facilitating access to mental health care for older and racial and ethnic minority patients should be prioritized.