STUDY: Anxiety and Mood Disorders More Prevalent in Gay and Bisexual HIV-Positive Men

By: Alex Kopel

September 16th, 2016

 

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HIV-positive gay and bisexual men are almost ten times more likely to be hospitalized because of mood and anxiety disorders than men in the general population, according to a new Australian study published in the Journal of Acquired Immune Deficiency Syndromes.

 

The research has shown that gay and bisexual men with HIV are significantly more likely to be admitted to the hospital with anxiety and mood disorders (AMDs) compared to matched HIV-negative gay and bisexual men. They also found an association between substance abuse and early mortality among hospitalized HIV-positive patients.

“Substance use was listed as the cause of death in 42 percent of deaths in the HIV-infected cohort previously hospitalized for AMDs,” said the authors of the study. “This supports previous literature which has documented a high frequency of comorbid psychiatric and drug dependence disorders in HIV-infected and GBM [gay and bisexual men] cohorts.”

More attention needs to be devoted to the identification and treatment of AMDs in gay and bisexual men, especially those with HIV, the authors recommend.

Anxiety has been known to be a common symptom of HIV-positive individuals, according to professionals in the medical community. When anxiety symptoms are severe or persistent, patients may have an anxiety disorder. These disorders include panic disorder, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). According to a 2006 study, 20 percent of HIV-infected patients receiving medical care were found to have an anxiety disorder, with 12 percent meeting the criteria for panic disorder, ten percent for PTSD, and three percent having generalized anxiety disorder.

According to the authors of the Australian study, research investigating the prevalence of AMDs has yielded varying results due to how these mental health problems are assessed and by the differences in the risk profiles of particular populations.

The investigators in Sydney designed this study to address the limitations of this earlier research. They focused on gay and bisexual men, a group known to have a higher risk of mental health problems compared to the general population. They examined the relationship between HIV status and hospitalization due to AMDs. They also assessed whether hospital admission with this type of mental health problem was predictive of death, and whether this risk differed between HIV-positive and HIV-negative men.

Participants came from two groups, one consisting of gay or bisexual HIV-positive men (557 individuals), and the other gay or bisexual HIV-negative men (1,882 individuals). The HIV-positive cohort was recruited between 1998 and 2006, whereas recruitment to the HIV-negative cohort took place between 2001 and 2004.

Information on hospital admissions with AMDs was obtained from hospital records, HIV administrative records and death registries. 

Most of the men recruited for the study were in their late thirties to mid forties. Approximately two-thirds of the men with HIV and three-quarters of HIV-negative men had a college education. Illicit drug use was very common, with over 80 percent of men in both groups reporting their use within the previous six months. Prevalence of psychological distress was massively higher among HIV-positive men compared to HIV-negative men at 60 percent compared to 1 percent.

Of the men with HIV, 74 percent reported use of combination antiretroviral therapy (cART). A significantly greater proportion of HIV-positive men were admitted to the hospital with AMDs than HIV-negative men. Hospitalization rates with a primary AMD diagnosis were 9.7 times higher among HIV-positive men compared with rates in the adult male Australian population.

Significant factors associated with hospitalization included having HIV, identifying as bisexual rather than gay/queer/homosexual, having a religious background, having previously sought support for mental health issues, and being a smoker.

After adjustment for other risk factors, hospitalization with AMDs was associated with a more than fivefold increase in mortality risk, though that did not differ by HIV status. Alcohol abuse or liver failure was listed as a primary or secondary cause of death in 42 percent of HIV-positive people hospitalized for AMDs.

“This research highlights the importance of providing more effective strategies to identify and treat AMDs in HIV-infected gay and bisexual men,” concluded the authors. “Our research suggests the importance of further examination and joint effects of substance use, neurocognitive decline and AMDs on health outcomes in HIV-infected individuals.”

The good news is that research has shown that adherence to ART therapy can markedly reduce AMDs.

The appropriate evaluation and treatment of AMDs and depression can significantly affect an HIV-positive man’s quality-of-life, as well as the risk of relapse into drug use and unwillingness to return for medical care.  Undiagnosed and untreated mental illness may also lead to HIV risk behaviors and therefore lead to riskier sex practices and the spread of HIV.

Unfortunately, AMDs and depression in HIV patients can be hard to diagnose. Authors recommend that clinicians should consider the diagnosis of an anxiety disorder when a patient presents with common somatic symptoms, such as chest pain, diaphoresis, dizziness, gastrointestinal disturbances, and/or headache, for which no underlying medical etiology can be established because those can be common symptoms of HIV.

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