Exploring the cascade of mental healthcare among people with HIV experiencing depressive symptoms in the UK and Ireland: The POPPY study

Hajra Okhai; Alan Winston; Frank Post; Marta Boffito; Patrick Mallon; Jaime Vera; Ian Williams; Memory Sachikonye; Margaret Johnson; Jane Anderson; Christina Prechtl; Caroline Sabin; POPPY study group

doi:10.1111/hiv.13753

Exploring the cascade of mental healthcare among people with HIV experiencing depressive symptoms in the UK and Ireland: The POPPY study

HIV Med. 2024 Dec 19. doi: 10.1111/hiv.13753. Online ahead of print.

Authors

Hajra Okhai^{1

2}, Alan Winston³, Frank Post⁴, Marta Boffito⁵, Patrick Mallon⁶, Jaime Vera⁷, Ian Williams¹, Memory Sachikonye⁸, Margaret Johnson⁹, Jane Anderson¹⁰, Christina Prechtl³, Caroline Sabin^{1

2}; POPPY study group

Affiliations

¹ Institute for Global Health, University College London, London, UK.
² National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU), Blood-borne and Sexually Transmitted Infections at University College London, London, UK.
³ Imperial College London, London, UK.
⁴ Kings College Hospital, London, UK.
⁵ Chelsea and Westminster Hospital, London, UK.
⁶ University College Dublin, Dublin, Ireland.
⁷ Brighton and Sussex University Hospital, Brighton, UK.
⁸ UK Community Advisory Board (UK-CAB), London, UK.
⁹ Royal Free Hospital, London, UK.
¹⁰ Homerton University Hospital, London, UK.

PMID: 39702902
DOI: 10.1111/hiv.13753

Abstract

Introduction: Depressive symptoms are highly prevalent among people with HIV, which can negatively impact HIV-related outcomes. We explore the cascade of mental healthcare for people with HIV experiencing depressive symptoms.

Methods: People with HIV who were part of the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study (2013-2016) were included. A Patient Health Questionnaire-9 (PHQ-9) score ≥10 or Center for Epidemiologic Studies Depression Scale (CES-D) ≥16 was defined as moderate/severe depressive symptoms. Diagnosed depression and access to mental healthcare were self-reported. A cascade of mental healthcare was explored, defining individuals experiencing depressive symptoms; those among them reporting a diagnosis of depression; and of this latter group, the proportion reporting accessing mental healthcare. Demographic, social and clinical characteristics were assessed at each step using logistic regression.

Results: Of the 1009 participants (65.5% ≥50 years, 85.8% male, 85.1% white), 387 (38.4%) individuals were experiencing depressive symptoms, over half of whom (54.3%) reported a diagnosis of depression. Only 43.3% of individuals with diagnosed depression reported accessing mental healthcare. Men [odds ratio = 0.62, 95% confidence interval (CI): 0.42-0.92], people in a relationship (0.44, 0.33-0.59), those who were employed (0.28, 0.21-0.38) and those with university qualifications (0.54, 0.40-0.72) were less likely to experience depressive symptoms. Heterosexuals (0.30, 0.14-0.64) were less likely to report a diagnosed depression, whereas smokers were more likely to have a diagnosed depression (1.75, 1.10-2.77). Older individuals (2.36, 1.31-4.28) were less likely to have accessed mental healthcare.

Conclusions: Our findings suggest the presence of unmet mental healthcare needs for people with HIV. We hope these findings will inform policies to streamline mental health services for people with HIV.

Keywords: HIV; depression; epidemiology; key and vulnerable populations; quality of life; social support.

Abstract

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