A Scoping Review Investigating Relationships between Depression, Anxiety, and the PrEP Care Continuum in the United States

Abstract

Men who have sex with men and transgender women in the United States are at increased risk for HIV and may benefit from pre-exposure prophylaxis (PrEP), a once-a-day pill to prevent HIV. Due to stigma and discrimination, sexual and gender minority (SGM) populations are also at risk for depression and anxiety. This scoping review sought to identify literature addressing relationships between the PrEP care continuum, depression, and anxiety among SGM individuals and others at high risk for HIV. We conducted a systematic review of four databases (i.e., PubMed, PsycInfo, Web of Science, Google Scholar) and identified 692 unique articles that were screened for inclusion criteria, with 51 articles meeting the final inclusion criteria. Data were extracted for key study criteria (e.g., geographic location, participant demographics, study design, main findings). Results suggest that while depression and anxiety are not associated with PrEP awareness or willingness to use, they can be barriers to seeking care and to PrEP adherence. However, empirical studies show that taking PrEP is associated with reductions in anxiety. Findings suggest the need to implement mental health screenings in PrEP clinical care. In addition, addressing systemic and structural issues that contribute to mental health disorders, as well as PrEP-related barriers, is critical.

Psychological distress and adherence to anti-retroviral therapy or pre-exposure prophylaxis regimens among Urban Black gay and bisexual men (MSM)

“…addition, the significant association between those who were living with HIV and ART non-adherent experiencing psychological distress is consistent with previous documentation of mental health challenges as a barrier to ART adherence. 20 Our findings of a lack of association between PrEP adherence and psychological distress is not, however, consistent with prior studies showing an association between increased mental health challenges and adherence, although the prior studies measured depression and anxiety which limits direct comparison to these studies. 17,18,19,20,21 Many approaches have aimed to address poor mental health as a barrier to medication adherence.…”

“…20 Our findings of a lack of association between PrEP adherence and psychological distress is not, however, consistent with prior studies showing an association between increased mental health challenges and adherence, although the prior studies measured depression and anxiety which limits direct comparison to these studies. 17,18,19,20,21…”

“…20 Our findings of a lack of association between PrEP adherence and psychological distress is not, however, consistent with prior studies showing an association between increased mental health challenges and adherence, although the prior studies measured depression and anxiety which limits direct comparison to these studies. 17,18,19,20,21 Many approaches have aimed to address poor mental health as a barrier to medication adherence. A meta-analysis of 22 studies suggested that different psychosocial approaches including counseling, cognitive behavioral therapy, peer support, motivational interviewing, and relaxation may improve ART adherence by addressing the underlying psychological stressors associated with poor adherence.…”

Understanding Barriers and Facilitators of Pre-exposure Prophylaxis (PrEP) Among Transgender and Gender Diverse Adults in an Integrated Health Care System

“…Previous studies have identified mental health concerns such as depression and anxiety as barriers to PrEP uptake and adherence for transgender women [ 34 , 35 ]. In our study, more than 30% of survey respondents reported receiving diagnoses of depression and anxiety, while 9% and 4% noted diagnoses of post-traumatic stress disorder (PTSD) and bipolar disorder, respectively.…”

Study on anxiety and depression of men who have sex with men: An application of group-based trajectory model

“…Owing to physiological, socio-psychological, structural, and other factors, the risk of HIV infection in MSM is more than ten times higher than that of the general population ( Chen and Ma, 2018 ), and it is also the most rapid population of HIV infection in China at present. Several studies have pointed out that high-risk behavior and HIV infection are related to psychological problems, such as anxiety and depression ( Hanrahan et al, 2011 ; Pappin et al, 2012 ; Hill et al, 2018 ; Rogers et al, 2018 ; Miller et al, 2021 ). At present, most HIV prevention strategies for MSM are behavioral interventions, such as strengthening the condom use, promoting pre-exposure prophylaxis (PrEP), encouraging regular HIV testing, and consultation, which ignore the effect of psychological intervention in HIV prevention and control.…”