Pasha Atena, Qiao Shan, Zhang Jiajia, Cai Ruilie, He Buwei, Yang Xueying, Liang Chen, Weissman Sharon, Li Xiaoming
Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.
BMJ Public Health. 2025 Sep 8;3(2):e002173. doi: 10.1136/bmjph-2024-002173. eCollection 2025.
Despite the profound impact of the COVID-19 pandemic on people living with HIV (PLWH) mental health, large-scale, real-world data on mental healthcare utilisation and associated factors among PLWH remain limited. This study explores mental healthcare utilisation and associated factors among PLWH during the COVID-19 pandemic.
Using a retrospective cohort design, we identified and included 4575 PLWH through computational phenotyping based on relevant Observational Medical Outcomes Partnership Common Data Model concept sets from the All of Us programme between March 2018 and March 2022. Mental healthcare utilisation was measured using the yearly count of mental healthcare visits and compared between pre-pandemic (2018-2020) and during the pandemic (2020-2022). Incidence rate ratios (IRRs) from the Poisson generalised linear mixed models were used to examine associations between mental healthcare utilisation, history of COVID-19 infection, demographic factors, pre-existing chronic conditions and socioeconomic status.
Annual number of mental healthcare visits among PLWH decreased significantly during the pandemic compared with pre-pandemic (IRR=0.89, p<0.001). COVID-19 infection (IRR=1.35, p<0.001), pre-existing comorbidities (one comorbidity: IRR=5.49; two or more: IRR=10.4, p<0.001) and Medicaid health insurance (IRR=1.29, p=0.007) were associated with a higher number of visits. Middle-aged group participants (aged 30-39: IRR=2.35, p=0.002; 40-49: IRR=3.49, p<0.001 and 50-64: IRR=2.07, p=0.004) had higher visit numbers compared with the youngest group (18-29 years). Compared with white participants, black or African American (IRR=0.71, p=0.002) and those with employer-sponsored or union-sponsored insurance (IRR=0.54, p<0.001) had fewer visits.
This study reveals a decrease in mental healthcare utilisation and diverse experiences of mental healthcare among PLWH during the COVID-19 pandemic. Addressing these disparities is crucial, particularly during public health emergencies.
尽管新冠疫情对艾滋病毒感染者（PLWH）的心理健康产生了深远影响，但关于PLWH心理健康护理利用情况及相关因素的大规模真实世界数据仍然有限。本研究探讨了新冠疫情期间PLWH的心理健康护理利用情况及相关因素。
采用回顾性队列设计，我们基于2018年3月至2022年3月期间“我们所有人”计划中相关的观察性医疗结果合作组织通用数据模型概念集，通过计算表型分析识别并纳入了4575名PLWH。心理健康护理利用情况通过心理健康护理就诊的年度计数来衡量，并在疫情前（2018 - 2020年）和疫情期间（2020 - 2022年）进行比较。使用泊松广义线性混合模型的发病率比（IRR）来检验心理健康护理利用情况、新冠病毒感染史、人口统计学因素、既往慢性病和社会经济地位之间的关联。
与疫情前相比，疫情期间PLWH的年度心理健康护理就诊次数显著减少（IRR = 0.89，p < 0.001）。新冠病毒感染（IRR = 1.35，p < 0.001）、既往合并症（一种合并症：IRR = 5.49；两种或更多：IRR = 10.4，p < 0.001）和医疗补助健康保险（IRR = 1.29，p = 0.007）与更高的就诊次数相关。中年组参与者（30 - 39岁：IRR = 2.35，p = 0.002；40 - 49岁：IRR = 3.49，p < 0.001；50 - 64岁：IRR = 2.07，p = 0.004）与最年轻组（18 - 29岁）相比，就诊次数更高。与白人参与者相比，黑人或非裔美国人（IRR = 0.71，p = 0.002）以及那些拥有雇主赞助或工会赞助保险的人（IRR = 0.54，p < 0.001）就诊次数较少。
本研究揭示了新冠疫情期间PLWH心理健康护理利用情况的下降以及心理健康护理的不同经历。解决这些差异至关重要，尤其是在公共卫生紧急事件期间。
