Perceived mental health status of drug users with HIV: concordance between caregivers and care recipient reports and associations with caregiving burden and reciprocity

Abstract

Because caregivers' monitoring of care recipients' mental health status likely facilitates provision of needed forms of assistance, the current study examines relationship factors associated with agreement in caregiver- and recipient self-reports of recipients' mental health status. Participants were former or current injection drug using persons with HIV/AIDS and their main caregivers (N = 258 dyads). Care recipients completed the Center for Epidemiologic Studies Depression scale and caregivers responded to a single item rating their recipients' mental health. Nearly two-thirds (64.7 %) of dyads agreed on care recipients' mental health status (κ = .26, p < .001). More secondary stressors of care, less reciprocity, and care recipients' greater physical limitations, substance use, and younger age predicted greater agreement on recipients' having poorer mental health. Greater secondary stressors and lower income were associated with less agreement on care recipients' mental health. Findings, which suggest that promoting reciprocity and alleviating secondary stressors of caregiving may help facilitate these caregivers' improved assessment of their care recipients' mental health status, have implications to dyadic approaches to promote drug users' HIV health outcomes.

Figure I

Associations between mental health concordance ratings and caregiver-reported secondary stressors of caregiving, recipient-reported reciprocity, and recipients’ physical limitations, current substance use, income, and age (Beacon study; N = 257). Notes: Ovals denote latent factors; Rectangles denote measured variables. Due to model complexity, only significant paths are shown, although all paths between predictors and outcome were estimated. Estimates reflect Adjusted Odds Ratios (AORs), 95% Confidence Intervals (CI), and p-values. *p<.05, **p<.01, ***p<.001. All estimates are compared to the reference category, which is the group in which dyads agreed that recipient had good mental health status. Model statistics: Sample-Size Adjusted Bayesian Information Criterion (aBIC) = 6466.48, BIC = 6682.06, AIC = 6440.73, Loglikelihood = −3152.36, Number of Free Parameters = 68. Note: CFI, RMSEA, and SRMR not available for this model.