Skip to main content

Screening Anxiety in the HIV Clinic

AIDS and Behavior volume 16, pages 2407–2413 (2012)Cite this article

Abstract

Individuals with HIV experience fluctuating levels of distress throughout the course of their infection. This cross-sectional study was conducted to examine the prevalence of and associations between anxiety symptoms, sociodemographic, and biomedical markers among individuals presenting for care. A total of 635 individuals were screened, the majority of whom was male and African American. Younger individuals, African Americans, individuals with less education, and those who were unemployed were more likely to express more severe anxiety symptoms. Individuals who were not currently receiving antiretroviral therapy (ART) were 1.61 times more likely to experience higher anxiety symptoms. Among individuals receiving ART, higher levels of anxiety were associated with less adherence, higher viral loads and lower CD4 cell counts. Current smokers were 1.66 times more likely to have higher rates of anxiety. When controlling for these significant factors, younger, unemployed, and less educated individuals were more likely to express more severe anxiety symptoms. These findings highlight the importance of screening and management of anxiety as an integral component of HIV care.

Resumen

Individuos con VIH experimentan niveles fluctuantes de estres durante el curso de su enfermedad. El siguiente estudio de corte transversal fue realizado para examinar la prevalencia de ansiedad y la asociación entre síntomas de ansiedad, datos demográficos y marcadores biomédicos en sujetos que buscan atención en una clínica urbana de VIH. Se realizó un tamizaje en 635 sujetos, la mayoría de ellos Afro-Americanos. Veintidós por ciento de la muestra reportó síntomas de ansiedad moderada y 11 % síntomas de ansiedad severa. Bajo análisis no ajustado, aquellos de edad joven, bajo nivel de educación y desempleados reportaron con mayor frecuencia síntomas de ansiedad severa. Síntomas de ansiedad más altos fueron 1.61 veces más probables en individuos que no reciben terapia antiretroviral. El análisis no ajustado entre aquellos que reciben terapia antiretroviral, niveles más altos de ansiedad estuvieron asociados con menor adherencia, carga viral alta y niveles bajos de CD4. Niveles más altos de ansiedad fueron 1.66 veces más probables en fumadores. Después de controlar estos factores significativos, síntomas de ansiedad severa fueron reportados con mayor frecuencia en sujetos jóvenes, desempleados y con bajo nivel de educación. Estos hallazgos resaltan la importancia del tamizaje y el tratamiento de ansiedad como un componente integral en el tratamiento de VIH.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. CDC. A glance at the HIV/AIDS epidemic. Atlanta: Centers for Disease Control and Prevention; 2008. http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/incidence.htm. Cited 8 July 2008.

  2. Missouri Department of Health. HIV/AIDS Disease Surveillance. 2009. Accessed 22 Dec 2008. Report No.

  3. Scandlyn J, West J. When AIDS became a chronic disease. West J Med. 2000;172:130–3.

    PubMed  Article  CAS  Google Scholar 

  4. CDC. Incorporating HIV prevention into the medical care of persons living with HIV: Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Morbidity and Mortality Weekly Report. 2003;52(RR-12):1–24.

  5. Kessler R, Chiu W, Demler O, Walters E. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry. 2005;62(6):617–27.

    PubMed  Article  Google Scholar 

  6. Wells K, Golding J, Burnam M. Psychiatric disorder in a sample of the general population with and without chronic medical conditions. Am J Psychiatry. 1988;145(8):976–81.

    PubMed  CAS  Google Scholar 

  7. Justice AC, McGinnis KA, Atkinson JH, Heaton RK, Young C, Sadek J, et al. Psychiatric and neurocognitive disorders among HIV-positive and negative veterans in care: Veterans Aging Cohort Five-Site Study. AIDS. 2004;18(Suppl 1):S49–59.

    PubMed  Google Scholar 

  8. Treisman G, Angelino A, Hutton H. Psychiatric issues in the management of patients with HIV infection. J Am Med Assoc. 2001;286:2857–64.

    Article  CAS  Google Scholar 

  9. Atkinson J, Grant I. Natural history of neuropsychiatric manifestations of HIV disease. Psychiatr Clin North Am. 1994;17:17–33.

    PubMed  CAS  Google Scholar 

  10. Kalichman S, Heckman T, Kochman A, Sikkema K, Bergholte J. Depression and thoughts of suicide among middle-aged and older persons living with HIV/AIDS. Psychiatr Serv. 2000;51:903–7.

    PubMed  Article  CAS  Google Scholar 

  11. Polsky D, Doshi JA, Marcus S. Long-term risk for depressive symptoms after a medical diagnosis. Arch Intern Med. 2005;165:1260–6.

    PubMed  Article  Google Scholar 

  12. Pence B, Miller WC, Whetten K, Eron J, Gaynes B. Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the southeastern United States. J Acquir Immune Defic Syndr. 2006;42:298–306.

    PubMed  Article  Google Scholar 

  13. Ickovics J, Hamburger M, Vlahov D. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. J Am Med Assoc. 2001;285:1466–74.

    Article  CAS  Google Scholar 

  14. Reynolds N, Sun J, Nagaraja H, Gifford A, Wu A, Chesney M. Optimizing measurement of self-reported adherence with the ACTG adherence questionnaire: a cross-protocol analysis. J Acquir Immune Defic Syndr. 2007;46(4):402–4.

    PubMed  Article  Google Scholar 

  15. Paterson D, Swindells S, Mohr J. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.

    PubMed  CAS  Google Scholar 

  16. Spitzer R, Kroenke K, Williams J, Lowe B. A brief measure for assessing generalize anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.

    PubMed  Article  Google Scholar 

  17. Kroenke K, Spitzer R, Williams J, Monahan P, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25.

    PubMed  Google Scholar 

  18. Kroenke K, Spitzer R, Williams J. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    PubMed  Article  CAS  Google Scholar 

  19. Hartzell JD, Janke IE, Weintrob AC. Impact of depression on HIV outcomes in the HAART era. J Antimicrob Chemother. 2008;62(2):246–55.

    PubMed  Article  CAS  Google Scholar 

  20. Shacham E, Nurutdinova D, Satyanarayana V, Stamm K, Overton ET. Routine screening for depression: identifying a challenge for successful HIV care. AIDS Patient Care STDS. 2009;23(11):949–55.

    PubMed  Article  CAS  Google Scholar 

  21. Shacham E, Basta TB, Reece M. Symptoms of psychological distress among African Americans seeking HIV-related mental health care. AIDS Patient Care STDS. 2008;22(5):413–21.

    PubMed  Article  Google Scholar 

  22. Shacham E, Basta T, Reece M. Symptoms of psychological distress among African Americans seeking HIV-related mental health care. AIDS Patient Care STDS. 2008;22:413–21.

    PubMed  Article  Google Scholar 

  23. SAMHSA. Substance Abuse and Mental Health Services Administration. Cultural competence standards in managed care mental health services: four underserved/underrepresented racial/ethnic groups [Internet]. 2010.

  24. Smith S, Fredrick S, Dawson D, Goldstein R, Huang B, Grant B. Race/ethnic differences in the prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on alcohol and related conditions. Psychol Med. 2006;36:987–98.

    PubMed  Article  Google Scholar 

  25. Pence BW, Miller WC, Whetten K, Eron JJ, Gaynes BN. Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the Southeastern United States. JAIDS. 2006;42(3):298–306.

    PubMed  Article  Google Scholar 

  26. Kelly B, Raphael B, Judd F, Perdices M, Kernutt G, Burnett P, et al. Suicidal ideation, suicide attempts, and HIV infection. Psychosomatics. 1998;39(5):405–15.

    PubMed  Article  CAS  Google Scholar 

  27. Rabkin JG, McElhiney M, Ferrando SJ, Van Gorp W, Lin SH. Predictors of employment of men with HIV/AIDS: a longitudinal study. Psychosom Med. 2004;66(1):72–8.

    PubMed  Article  Google Scholar 

  28. Reece M, Basta T, Koers E. Psychological distress patterns of women and mothers presenting for HIV-related mental health care. J HIV/AIDS Soc Serv. 2004;3(2):93–109.

    Article  Google Scholar 

  29. Gurung RAR, Taylor SE, Kemeny M, Myers H. “HIV is not my biggest problem”: the impact of HIV and chronic burden on depression in women at risk for AIDS. J Soc Clin Psychol. 2004;23(4):490.

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank José Fernando Echaíz, MD for his assistance with this manuscript. This publication was partially supported by Grant Number UL1 RR024992 from the National Center for Research Resources (NCRR), specifically KL2RR024994 (ES). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

Author information

Affiliations

  1. Department of Behavioral Sciences and Health Education, School of Public Health, Saint Louis University, Room 315, 3545 Lafayette Avenue, St. Louis, MO, 63104, USA

    Enbal Shacham

  2. The Brown School of Social Work, Washington University, St. Louis, MO, USA

    Jennifer C. Morgan

  3. Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Nur F. Önen

  4. Department of Developmental Genetics, Chiba University Graduate School of Medicine, Chiba, Japan

    Toshibumi Taniguchi

  5. Division of Infectious Diseases, Department of Medicine, University of Alabama, Birmingham, AL, USA

    Edgar Turner Overton

Authors
  1. Enbal Shacham
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer C. Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nur F. Önen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Toshibumi Taniguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edgar Turner Overton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Enbal Shacham.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Shacham, E., Morgan, J.C., Önen, N.F. et al. Screening Anxiety in the HIV Clinic. AIDS Behav 16, 2407–2413 (2012). https://doi.org/10.1007/s10461-012-0238-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-012-0238-6

Keywords

  • Anxiety
  • HIV/AIDS
  • Mental health
  • Psychological distress
  • Antiretroviral adherence
  • HIV management