The Relationship of Manic Episodes and Drug Abuse to Sexual Risk Behavior in Patients with Co-Occurring Bipolar and Substance Use Disorders: a 15-Month Prospective Analysis
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- Meade, C.S., Fitzmaurice, G.M., Sanchez, A.K. et al. AIDS Behav (2011) 15: 1829. doi:10.1007/s10461-010-9814-9
Risky sexual behavior is common among individuals with bipolar and substance use disorders. This 15-month prospective study examined the effects of between-subject differences and within-subject changes in mood symptoms and drug use on sexual risk behavior among 61 patients with both disorders. Participants completed five post-treatment follow-up assessments at 3-month intervals. Using a multivariate mixed-effects model analysis, more average weeks of mania (between-subject difference) was associated with greater sexual risk, but change in weeks of mania (within-subject change) was not; depression was unrelated to sexual risk. In addition, within-subject increases in days of cocaine use predicted increases in sexual risk. Results underscore the importance of substance abuse treatment and suggest that bipolar patients with active and/or recurrent mania are in need of targeted HIV prevention services. Further research is needed to test whether individual differences in impulsivity may explain the association between mania and sexual risk.