Is serious mental illness associated with earlier death among persons with human immunodeficiency virus (HIV)? A ten year follow up in Maryland Medicaid recipients

Abstract

Background/Objective In the general population serious mental illness (SMI) is associated with earlier mortality. The objective of this study was to determine if SMI was associated with an increased risk of death among Maryland Medicaid beneficiaries with HIV. Methods This was a retrospective cohort study of adult Maryland Medicaid recipients with HIV receiving antiretroviral therapy (ART) after January 1, 1997. SMI was defined as a specialty mental health visit and an ICD-9 diagnosis of 1) schizophrenia or related psychoses, 2) bipolar disorder or 3) major depressive disorder. Cox proportional hazards regression models were used to estimate the hazard ratios for total mortality. Analyses were adjusted for demographic characteristics, % days on ART, outpatient visits and comorbid medical conditions. Results Overall, 623 individuals received ART after treatment inception. The total number of deaths was 278, out of which 60 deaths were in the SMI group (38.5%) and 211 in the non-SMI group (45%) (p=0.05). In multivariable analysis, SMI was not associated with mortality. Increasing age, AIDS defining illness, renal failure, cerebrovascular disease, congestive heart failure, chronic liver disease and substance abuse were independently associated with mortality, while increased percent days of HIV medication use and number of outpatient medical visits were associated with improved survival. Conclusions In this sample, SMI is not associated with earlier death in patients with HIV infection. ART use and primary care engagement among HIV infected individuals are associated with improved survival irrespective of an SMI diagnosis.

The Impact of co-morbid severe mental illness and HIV upon mental and physical health and social outcomes: a systematic review

“…One group of authors carried out cross-sectional followed by longitudinal analyses of participants in HIV Research Network Sites [21,22]. In the following cases, overlap in samples cannot be ruled out: HIV-only comparison groups were obtained from the HIV Costs and Services Utilisation Study for two studies [23,24]; two studies used Veteran's Health Association data (analysing different outcomes) [25,26]; two studies used Medicaid data from a similar time period [27,28], (a further study used Medicaid data from a different time period- [29] and a group of authors carried out complimentary analyses-different time periods, new healthcare cost estimates, using Medicaid data [30,31]; two studies recruited participants from the same hospital site (Butabika National Referral Hospital, Uganda) during similar time periods but analysed different outcomes [32,33].…”

“…Thirteen studies were cohorts while the remaining seven were cross-sectional. Eight studies compared outcomes between people living with SMI and HIV and those living with SMI only [25,27,32,[34][35][36][37][38] and 16 studies compared outcomes between people living with SMI and HIV and those living with HIV only [21,23,24,27,29,[35][36][37][39][40][41][42][43][44][45][46]. 17 studies were carried out in the USA, six of which consisted of analysis of health insurance claims records data [25,27,29,34,36,37].…”

“…In the same 8 | P a g e study, although risk of death was higher for people living with schizophrenia compared to those without a mental disorder, risk of death was further elevated for the group with SMI and HIV across the two time periods considered [26]. However, in their analysis of Medicaid records from Maryland USA Chander et al found no difference in mortality between people living with SMI and HIV and those living with SMI alone [28].…”

“…Nine studies examined other co-morbidities, most commonly drug use (n=6). Findings suggest that compared to people living with HIV alone, people with SMI and HIV are more likely to have a history of IDU [21], report recent heroin/cocaine use [24] or abuse drugs and alcohol [40]. Drug and alcoholrelated disorders and disability were also more common among people with SMI and HIV compared to people living with SMI alone [30].…”

“…Four studies examined AIDS-defining illness. None of the three studies carried out in the USA found a difference in the incidence of AIDS-defining illnesses between people with SMI and HIV and those living with HIV alone [26,28,45]. However, in their Ugandan sample, Nachega et al found that people with SMI and HIV were more likely to be diagnosed with HIV-related dementia and wasting syndrome compared to those with HIV alone, although there was no difference in the odds of having toxoplasmosis [33].…”