AIDS and Behavior

, Volume 22, Issue 5, pp 1530–1540 | Cite as

Factors Associated with Mood Disorder Diagnosis Among a Population Based Cohort of Men and Women Living With and Without HIV in British Columbia Between 1998 and 2012

  • Kalysha ClossonEmail author
  • Chuck Osborne
  • Danielle M. Smith
  • Sarah Kesselring
  • Oghenowede Eyawo
  • Kiffer Card
  • Paul Sereda
  • Shahab Jabbari
  • Conrado Franco-Villalobos
  • Tareq Ahmed
  • Karyn Gabler
  • Thomas Patterson
  • Mark Hull
  • Julio S. G. Montaner
  • Robert S. Hogg
  • for The Comparative Outcomes and Services utilization Trends (COAST) study
Original Paper


Using data from the Comparison of Outcomes and Service Utilization Trends (COAST) study we examined factors associated with mood disorder diagnosis (MDD) among people living with HIV (PLHIV) and HIV-negative individuals in British Columbia, Canada. MDD cases were identified between 1998 and 2012 using International Classification of Disease 9 and 10 codes. A total of 491,796 individuals were included and 1552 (23.7%) and 60,097 (12.4%) cases of MDD were identified among the HIV-positive and HIV-negative populations, respectively. Results showed HIV status was associated with greater odds of MDD among men and lower odds among women. Among PLHIV, MDD was significantly associated with: identifying as gay, bisexual or other men who have sex with men compared to heterosexuals; higher viral load; history of injection drug use; and concurrent anxiety, dysthymia, and substance use disorders. Findings highlight the need for comprehensive and holistic HIV and mental health care.


HIV Mood disorders Canada Mental health 



Author Contributions

Study concept and design: K.C., C.O., S. K., D. M. S., O.E., J. S.G. M. & R.S.H. Statistical Analysis: C. F-V. & S. J. Drafting of the manuscript was conducted by K. C., C. O, S.K. & D. M. S., with critical revisions from all authors. The principal investigator (R.S.H.) takes responsibility for the integrity and accuracy of the data, and has the final decision in the submission of the manuscript. In addition, we would like to thank Dr. Jeannie Shoveller, Dr. Kate Salters and other COAST team members and support staff for ongoing support and feedback during the preparation of this manuscript. The authors would like to thank the COAST study participants, the BC Centre for Excellence in HIV/AIDS, the BC Ministry of Health, and the institutional data stewards for granting access to the data, and Population Data BC for facilitating the data linkage process. The COAST study members and investigators include: Rolando Barrios, Guillaume Colley, Oghenowede Eyawo, Nada Gataric, Richard Harrigan, Robert Hogg (PI), Mark Hull, Scott Lear, Viviane Dias Lima, Julio Montaner, David Moore, Bohdan Nosyk, Jeannie Shoveller, Danielle Smith, Sam Wiseman, and David Whitehurst.


All inferences, opinions, and conclusions drawn from this manuscript are those of the authors and do not reflect the opinions or policies of the Data Stewards or the funders.

Compliance with Ethical Standards

Conflicts of interest

RSH has received funding from Canadian Institutes of Health, through a Foundation Award, to support this research study; RSH has held grant funding in the last 10 years from the National Institutes of Health, Canadian Institutes of Health Research, Health Canada, Merck, and the Social Sciences and Humanities Research Council of Canada. JSGM is supported with grants paid to his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and Viiv Healthcare.

Ethical Approval

Ethical approval was obtained from the University of British Columbia/Providence Health Care (#H09-02905) and Simon Fraser University (#2013s0566) research ethics boards.


  1. 1.
    Samji H, Cescon A, Hogg RS, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS ONE. 2013;8:e81355.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Patterson S, Cescon A, Samji H, et al. Life expectancy of HIV-positive individuals on combination antiretroviral therapy in Canada. BMC Infect Dis. 2015;15:274.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Garey L, Bakhshaie J, Sharp C, et al. Anxiety, depression, and HIV symptoms among persons living with HIV/AIDS: the role of hazardous drinking. AIDS Care. 2015;27:80–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Magidson JF, Blashill AJ, Safren SA, et al. Depressive symptoms, lifestyle structure, and ART adherence among HIV-infected individuals: a longitudinal mediation analysis. AIDS Behav. 2015;19:34–40.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Nanni MG, Caruso R, Mitchell AJ, et al. Depression in HIV infected patients: a review. Curr Psychiatry Rep. 2015;17:530.CrossRefPubMedGoogle Scholar
  6. 6.
    Salters KA, Irick M, Anema A, et al. Harder-to-reach people living with HIV experiencing high prevalence of all-type mental health disorder diagnosis. AIDS Care. 2016;. doi: 10.1080/09540121.2016.1227763.PubMedGoogle Scholar
  7. 7.
    Hanel G, Henningsen P, Herzog W, et al. Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study. J Psychosom Res. 2009;67:189–97.CrossRefPubMedGoogle Scholar
  8. 8.
    Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. 2013;10:e1001547.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Challacombe L. The epidemiology of HIV in Canada. Available at:
  10. 10.
    Public Health Agency of Canada. What is Depression?. Available at: Accessed 20 Apr 2016.
  11. 11.
    Statistics Canada. Mood disorders by sex, by province and territory Government of Canada, 2016.Google Scholar
  12. 12.
    Lima VD, Geller J, Bangsberg DR, et al. The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating HAART. AIDS. 2007;21:1175–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Mathers BM, Degenhardt L, Phillips B, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372:1733–45.CrossRefPubMedGoogle Scholar
  14. 14.
    Taniguchi T, Shacham E, Onen NF, et al. Depression severity is associated with increased risk behaviors and decreased CD4 cell counts. AIDS Care. 2014;26:1004–12.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Eyawo O, Franco-Villalobos C, Hull MW, et al. Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012. BMC Infect Dis. 2017;17:174.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    BC Centre for Excellence in HIV/AIDS. Drug Treatment Program and Labratory Available at:. and
  17. 17.
    Population Data BC: About Population Data BC. Available at: Accessed 31 Mar 2017.
  18. 18.
    Kisely S, Lin E, Gilbert C, et al. Use of administrative data for the surveillance of mood and anxiety disorders. Australian and New Zeland Journal of Psychiatry. 2009;43:1118–25.CrossRefGoogle Scholar
  19. 19.
    Puyat JH, Marhin WW, Etches D, et al. Estimating the prevalence of depression from EMRs. Canadian Family Psysician. 2013;59:445.Google Scholar
  20. 20.
    British Columbia Ministry of Health (2014): Consolidation File (MSP Registration & Premium Billing). Population Data BC. Data Extract. MOH (2014).
  21. 21.
    British Columbia Ministry of Health (2014): Medical Services Plan (MSP) Payment Information File. Population Data BC. Data Extract. MOH (2014).
  22. 22.
    Canadian Institute for Health Information (2014): Discharge Abstract Database (Hospital Separations). Population Data BC. Data Extract. MOH (2014).
  23. 23.
    BC Vital Statistics Agency (2014): Vital Statistics Deaths. Population Data BC. Data Extract. BC Vital Statistics Agency (2014).
  24. 24.
    Hayashi K, Dong H, Marshall BD, et al. Sex-based differences in rates, causes, and predictors of death among injection drug users in Vancouver, Canada. Am J Epidemiol. 2016;183:544–52.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    R Core Team. R: A language and environemnt for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2015.Google Scholar
  26. 26.
    Arseniou S, Arvaniti A, Samakouri M. HIV infection and depression. Psychiatry Clin Neurosci. 2014;68:96–109.CrossRefPubMedGoogle Scholar
  27. 27.
    Lopes M, Olfson M, Rabkin J, et al. Gender, HIV status, and psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2012;73:384–91.CrossRefPubMedGoogle Scholar
  28. 28.
    Heywood W, Lyons A. HIV and Elevated Mental Health Problems: Diagnostic, Treatment, and Risk Patterns for Symptoms of Depression, Anxiety, and Stress in a National Community-Based Cohort of Gay Men Living with HIV. AIDS Behav. 2016;20:1632–45.CrossRefPubMedGoogle Scholar
  29. 29.
    Pettes T, Kerr T, Voon P, et al. Depression and sexual risk behaviours among people who inject drugs: a gender-based analysis. Sexual Health. 2015;12:224–30.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Joint United Nations Programme on HIV/AIDS. Global AIDS update 2016. Geneva: UNAIDS, 2016Google Scholar
  31. 31.
    Gardner LI, Marks G, Shahani L, et al. Assessing efficacy of a retention in care intervention among HIV patients with depression, anxiety, heavy alcohol consumption and illicit drug use. Aids. 2016;30:1111–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Socias ME, Koehoorn M, Shoveller J. Gender Inequalities in Access to Health Care among Adults Living in British Columbia, Canada. Womens Health Issues. 2016;26:74–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Public Health Agency of Canada (PHAC). Population-Specific HIV/AIDS Status Report: Women; 2012 October 31st, 2016.Google Scholar
  34. 34.
    Asch SM, Kilbourne AM, Gifford AL, et al. Underdiagnosis of depression in HIV: who are we missing? J Gen Intern Med. 2003;18:450–60.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Greenberg PE, Fournier AA, Sisitsky T, et al. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015;76:155–62.CrossRefPubMedGoogle Scholar
  36. 36.
    Lepine JP, Briley M. The increasing burden of depression. Neuropsychiatr Dis Treat. 2011;7:3–7.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Sherr L, Clucas C, Harding R, et al. HIV and depression–a systematic review of interventions. Psychol Health Med. 2011;16:493–527.CrossRefPubMedGoogle Scholar
  38. 38.
    Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV epidemiology research study. JAMA. 2001;285:1466–74.CrossRefPubMedGoogle Scholar
  39. 39.
    Griffiths H Dr. Peter Centre—removing barriers to health care services. Nurs BC. 2002;34:10–4.PubMedGoogle Scholar
  40. 40.
    Kalichman SC, Rompa D, Cage M. Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. J Nerv Ment Dis. 2000;188:662–70.CrossRefPubMedGoogle Scholar
  41. 41.
    Haut ER, Pronovost PJ. Surveillance bias in outcomes reporting. JAMA. 2011;305:2462–3.CrossRefPubMedGoogle Scholar
  42. 42.
    HealthMeasures: Transforming how health is measured. Available at: Accessed 18 Mar 2017.
  43. 43.
    Pakula B, Shoveller JA. Sexual orientation and self-reported mood disorder diagnosis among Canadian adults. BMC Public Health. 2013;13:209.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    World Health Organization. Classifications of Disease. Available at: 30 Mar 2017.

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Kalysha Closson
    • 1
    • 2
    Email author
  • Chuck Osborne
    • 1
  • Danielle M. Smith
    • 3
  • Sarah Kesselring
    • 1
  • Oghenowede Eyawo
    • 1
    • 2
  • Kiffer Card
    • 1
    • 2
  • Paul Sereda
    • 1
  • Shahab Jabbari
    • 1
  • Conrado Franco-Villalobos
    • 1
  • Tareq Ahmed
    • 1
  • Karyn Gabler
    • 1
  • Thomas Patterson
    • 4
  • Mark Hull
    • 1
    • 5
  • Julio S. G. Montaner
    • 1
    • 5
  • Robert S. Hogg
    • 1
    • 2
  • for The Comparative Outcomes and Services utilization Trends (COAST) study
  1. 1.British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s HospitalVancouverCanada
  2. 2.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
  3. 3.University of CalgaryCalgaryCanada
  4. 4.University of CaliforniaSan DiegoUSA
  5. 5.University of British ColumbiaVancouverCanada

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