by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

August 24, 2021

Featured Literature:

Sullivan MC, Wirtz MR, McKetchnie SM, et al.  The impact of depression and post-traumatic stress symptoms on physical health perceptions and functional impairment among sexual minority men living with HIV with histories of trauma.  AIDS Care.  2021 Aug 17; 1-9.  doi: 10.1080/ 09540121.2021.1967852.  PMID: 34403289

Collaborators in Massachusetts and Canada examined the relative contribution of mental health and HIV-related health indices in health perceptions and self-reported functional impairment among 79 MSM with HIV and trauma histories living in urban areas.  Participants were included if they reported sub-optimal engagement in HIV care.  In addition to a self-report assessment battery, trained clinicians appraised participants’ mental health, and recent CD4 and HIV viral load values were abstracted from electronic medical records.  On average, participants reported poor health, and functional disability was common.  48% reported childhood or adolescent sexual trauma, 56% childhood or adolescent physical abuse, 63% intimate partner violence, and 43% unwanted sexual experiences during adulthood.  Almost 52% met DSM-5 criteria for post-traumatic stress disorder (PTSD) and 42% endorsed a history of major depressive disorder.  Depression symptom severity accounted for the majority of variance in participants’ perceptions of their health, and both depression and PTSD symptom severity were influential in accounting for functional impairment.  Recent CD4 and HIV viral load did not explain significant variance in self-perceptions of health or functional disability.

Author’s Commentary:

Many PWH experience a high burden of chronic stress and trauma – sometimes involving discrimination, stigma, social and economic stressors, and/or health-related factors.  Investigators describe markedly high rates of psychological morbidity in study participants and these observations further underscore the importance of regular mental health assessments and trauma-informed approaches.  The relatively high share of variance in health-related quality of life accounted for by PTSD and depression symptom severity in this study also helps support integration of mental/behavioral health and HIV primary care to support the delivery of holistic, ‘whole person’ care.

The author has no conflicts of interest to disclose.

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