Psychological Symptoms Among 2032 Youth Living with HIV: A Multisite Study

Abstract

This study determined the prevalence and patterns of psychological symptoms in adolescents and young adults living with HIV (YLWH) in medical care and relationships between psychological symptoms, route and duration of infection, and antiretroviral treatment (ART). A clinic-based sample of 2032 YLWH (mean age 20.3 years), recruited from 20 adolescent medicine HIV clinics, completed a cross-sectional survey of health behaviors and psychological symptoms using the Brief Symptom Inventory (BSI). Overall, 17.5% of youth reported psychological symptoms greater than the normative threshold on the Global Severity Index. A wide variety of symptoms were reported. The prevalence of clinical symptoms was significantly greater in youth with behaviorally acquired HIV compared to those with perinatally acquired infection (20.6% vs. 10.8%, OR = 2.06 in Multiple Logistic Regression (MLR)), and in those not taking ART that had been prescribed (29. 2% vs. 18.8%, OR = 1.68 in MLR). Knowing one's HIV status for more than one year and disclosure of HIV status were not associated with fewer symptoms. A large proportion of YLWH have psychological symptoms and the prevalence is greatest among those with behaviorally acquired infection. The high rate of psychological symptoms for youth not taking ART that is prescribed is a cause for concern. Symptoms do not appear to be a transient reaction to diagnosis of HIV.

Racial and socioeconomic disparities in the symptom reporting of persons living with HIV

“…Past research on symptoms among PLWH has focused on topics such as symptom experience and incidence,(23–26, 29, 30, 38, 50) as well as symptom management. (31, 36, 37, 44, 51, 52) Many of the prior studies on the symptom experience and incidence in PLWH were conducted at a single site(32–34) or were conducted before the age of cART.…”

The Impact of Youth-Friendly Structures of Care on Retention Among HIV-Infected Youth

“…19,41,42 Developing a more robust adolescent health care workforce capable of responding effectively to important adolescent health issues such as mental health illness, sexual health, and to address complex psychosocial needs may be an important approach to increase engagement in care and strengthen self-efficacy around important healthy behaviors among YLHIV. [43][44][45] Physicians in adult primary care specialties (internal medicine and family practice) generally are not required to receive adolescent or young adult-specific training, whereas all pediatric residency programs are required to have a minimum 4-week clinical experience in adolescent medicine. 46 Providers, including pediatricians, have reported feeling inadequately prepared to discuss sensitive adolescent health issues such as mental health illness, reproductive health, and violence.…”

Validity of the Brief Symptom Inventory-18 (BSI-18) for identifying depression and anxiety in young adult cancer survivors: Comparison with a Structured Clinical Diagnostic Interview.

“…This case rule was originally developed for the SCL-90-R and subsequently recommended for the BSI and BSI-18, though the manual does not present any empirical support for the case-rule as applied to the BSI-18. Following common practice for the BSI (e.g., Brown, Whiteley, Harper, Nichols, & Nieves, 2015; Endermann, 2005) users of the BSI-18 in oncology (Merport & Recklitis, 2012; Michel et al, 2010; Zabora et al, 2001; Zeltzer et al, 2009) and other populations (Hart et al, 2014; Hopp, Anderson, Krumholz, Gruber-Baldini, & Shulman, 2012; Mustanski, Garofalo, Herrick, & Donenberg, 2007; Petkus et al, 2010) commonly define overall significant symptoms on the BSI-18 using the GSI scale alone, classifying respondent with GSI t-score ≥ 63 as having clinically significant symptoms. Both the published BSI-18 case-rule criteria (t-score score ≥ 63 on the GSI, or any two of symptom scales) and the conventional case-rule of GSI t-score ≥ 63 were evaluated in this study.…”