Mental Health Diagnoses, Symptoms, and Service Utilization in US Youth with Perinatal HIV Infection or HIV Exposure

Abstract

Youth perinatally HIV infected (PHIV) or HIV exposed, but uninfected (PHEU), are aging into adolescence and adulthood with multiple complex risk factors for mental health (MH) problems and poor MH treatment utilization. Our aims were to estimate prevalence of MH diagnoses, clinically significant symptoms, and MH treatment utilization among youth with PHIV and among PHEU youth, 10-22 years old. We also aimed to identify correlates of diagnoses and treatment utilization. Analyses of data from standardized interviews, behavioral assessments, and chart review of 551 youth revealed that 36% had a previous or current MH diagnosis, with no significant HIV status group differences. Prevalence of clinically significant symptoms was 15% for both groups, of whom a third had no diagnosis, and half were not receiving treatment. Among youth with a current MH diagnosis, those with PHIV had greater utilization of services than PHEU youth (67% vs. 51%; p = 0.04). Factors associated with MH diagnoses and/or treatment utilization included caregiver characteristics, age and sex of child, HIV status, and stressful life events. Prevalence of MH diagnoses was higher than in the general population, but lower than in similar perinatally HIV-exposed cohorts, with some unmet service needs, particularly in PHEU youth. Family characteristics warrant careful consideration in early diagnosis and treatment of MH problems among youth affected by HIV.

Keywords: mental health diagnoses; mental health treatment; perinatal HIV.

FIG. 1.

Prevalence of current MH diagnoses at most recent visit. p Values for all comparisons are >0.05. MH, mental health; PHEU, perinatally HIV exposed, but uninfected; PHIV, perinatally HIV-infected.

FIG. 2.

Prevalence of current MH treatment in total cohort and among those with a diagnosis. p Values for all comparisons are >0.05. Dx, diagnosis; MH, mental health; PHEU, perinatally HIV exposed, but uninfected; PHIV, perinatally HIV-infected.

FIG. 3.

Adjusted associations of covariates with treatment utilization, by HIV status and MH diagnosis. Multivariable regression models were built separately for each group. Reference categories are as follows: HIV exposed, but uninfected, no stressful life event, per 1-year increase in age at initiating cART, CD4% <15%, household income <$20K, bioparent not primary caregiver, caregiver education >high school, caregiver FSIQ ≥85, no caregiver MH disorder, caregiver not living with spouse, and no drug use by caregiver. Other nonsignificant covariates that were not shown in plot are as follows: ethnicity, child language, caregiver marital status, and research site. cART, combination antiretroviral therapy; FSIQ, full scale intelligence quotient; MH, mental health.