Abstract:

OBJECTIVE

Mental health disorders are prevalent in HIV-infected populations, ranging from 43-56%, compared to about 30% of the general population. This comorbidity may exacerbate the progression to HIV/AIDS by increasing viral load, reducing CD4 count, and reducing adherence to ARVs. Despite the well established relationship between mental health and HIV/AIDS, and the World Health Organization (WHO) recommendation that attention to the psychosocial needs (which includes the prevention and treatment of mental health problems) of people with AIDS should be an integral part of HIV care, mental healthcare is yet to be integrated into primary care HIV treatment programmes in South Africa and other poor resource countries.

DESIGN AND PROCEDURE

The Rorschach inkblot test was conducted on a convenience sample of four South African HIV positive participants. Furthermore, a situational analysis was conducted from 2011-2013 to determine the context of mental health/HIV services in the Tshwane-Metsweding area, South Africa.

RESULTS AND RECOMMENDATIONS

Outcomes suggest that there is a high rate of psychological comorditity in HIV infected individuals (such as mood disorders, personality disorders etc.), that there is a need to further develop and pilot test appropriate materials and models of delivery of mental healthcare within the parameters of affordability, acceptability and availability, and to advocate for the advancement of mental health and HIV policy integration.

KEY TERMS

HIV, AIDS, mental health, South Africa, Rorschach inkblot test, systems strengthening, policy advancement

References:

1.      Adewuya, A. O., Afolabi, M. O., Ola, B. A., Ogundele, O. A., Ajibare, A. O. & Oladipo, B. F. (2007). Psychiatric disorders among the HIV-positive population in Nigeria: a control study. Journal of Psychosomatic Research, 63: 203-206.

2.      American Psychiatric Association. (2013). Diagnostic and statitical manual of mental disorders (5^th ed.). American Psychiatric Publishing: Washington, DC.

3.      Atkinson, J. H. & Grant, I. (1994). Natural history of neuropsychiatric manifestations of HIV disease. Psychiatric Clinics of North America, 17: 17-33.

4.      Berkman, L.F., Blumenthal, J., Burg, M., Carney, R.M., Catellier, D., Cowan, M.J., Czajkowski, S.M., DeBusk, R., Hosking, J., Jaffe, A., Kaufmann, P.G., Mitchell, P., Norman, J., Powell, L.H., Raczynski, J.M. & Schneiderman, N. (2003). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA, 289: 3106-16.

5.      Burnam, M. A., Bing, E. G., Morton, S. C., Sherbourne, C., Fleishman, J. A., London, A. S., Vitiello, B., Stein, M., Bozzette, S. A. & Shapiro, M. F. (2001). Use of mental health and substance abuse treatment services among adults with HIV in the United States. Archives of General Psychiatry, 58: 729-736.

6.      Butcher J.A. (1992). Introduction to the special section on assessment in psychological treatment: a necessary step for effective intervention. Psychological Assessment, 9: 331-333.

7.      Chisholm, D., Flisher, A.J., Lund, C., Patel, V., Saxena, S., Thornicroft, G. &Tomlinson M. (2007). Scale up services for mental disorders: a call for action. Lancet, 370(9594): 1241-1252.

8.      Collins, P. Y., Berkman, A., Mestry, K. & Pillai, A. (2009). HIV prevalence among men and women admitted to a South African public psychiatric hospital. AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 21: 863-867.

9.      Dube, B., Benton, T., Crues, D. G. & Evans, D. L. (2005). Neuropsychiatric manifestations of HIV infection and AIDS. Journal of Psychiatry neuroscience, 30, 237-246.

10.  Epping-Jordan, J.E., Pruitt, S.D., Bengoa, R. & Wagner, E.H. Improving the quality of health care for chronic conditions. 2004. Quality & Safety Health Care, 13: 299-305.

11.  Exner, J. E. (2003). The Rorschach: a comprehensive system. Basic foundations and principles of interpretation (4th ed.). New York: Wiley.

12.  Freeman, M., Nkomo, N., Kafaar, Z. & Kelly, K. (2007). Factors associated with prevalence of mental disorder in people living with HIV/AIDS in South Africa. AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 19: 1201-1209.

13.  Glassman, A.H., O'Connor, C.M., Califf, R.M., Swedberg, K., Schwartz, P., Bigger, J.T., Krishnan, K.R., Van Zyl, L.T., Swenson, J.R., Finkel, M.S., Landau, C., Shapiro, P.A., Pepine, C.J., Mardekian, J., Harrison, W.M. &Barton, D. (2002). Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA, 288: 701-709.

14.  Huprich, S.K. (2006). Rorschach assessment of personality disorders. New Jersey: Lawrence Erlbaum Associates, Inc., Publishers.

15.  Katon, W.J., Von Korff, M., Lin, E.H., Simon, G., Ludman, E., Russo, J., Ciechanowski, P., Walker, E. &Bush, T. (2004). The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Archives General Psychiatry, 61:1042-1049.

16.  Laperriere, A., Ironson, G.H., Antoni, M.H., Pomm, H., Jones, D., Ishii, M., Lydston, D., Lawrence, P., Grossman, A., Brondolo, E., Cassells, A., Tobin, J.N., Schneiderman, N. &Weiss, S.M. (2005). Decreased depression up to one year following CBSM+ intervention in depressed women with AIDS: the smart/EST women’s project. Journal of Health Psychology, 10:223-231.

17.  Lechner, S.C., Antoni, M.H., Lydston, D., LaPerriere, A., Ishii, M., Devieux, J., Stanley, H., Ironson, G., Schneiderman, N., Brondolo, E., Tobin, J.N. &Weiss S. (2003). Cognitive-behavioral interventions improve quality of life in women with AIDS. Journal of Psychosomatic Research, 54:253-261.

18.  Lin, E.H., Katon, W., Rutter, C., Simon, G.E., Ludman, E.J., Von Korff, M., Young, B., Oliver, M., Ciechanowski, P.C., Kinder, L. &Walker, E. (2006). Effects of enhanced depression treatment on diabetes self-care. Annals of Family Medicine, 4:46-53.

19.  Lustman, P.J., Freedland, K.E., Griffith, L.S. & Clouse, R.E. (2000). Fluoxetine for depression in diabetes: a randomized double-blind placebo-controlled trial. Diabetes Care, 23:618-23.

20.  Maj, M., Janssen, R., Starace, F., Zaudig, M., Satz, P., Sughondhabirom, B., Luabeya, M., Riedel, R., Ndetei, D., Calil, H. M., Bing, E. G., Louis, M. S. & Sartorius, N. (1994). WHO Neuropsychiatric AIDS Study, Cross-sectional Phase I: study design and psychiatric findings. Archives of General Psychiatry, 51:39-49.

21.  Maling, S., Todd, J., Van der Paal, L., Grosskurth, H. & Kinyanda, E. (2011). HIV-1 seroprevalence and risk factors for HIV infection among first-time psychiatric admissions in Uganda. AIDS Care, 23: 171-178.

22.  Mast, T. C., Kigozi, G., Wabwire-mangen, F., Black, R., Sewankambo, N., Serwadda, D., Gray, R., Wawer, M. & Wu, A. W. (2004). Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, Uganda. AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 16: 81-94.

23.  Marwick, K. F. M. & Kaaya, S.F. (2010). Prevalence of depression and anxiety disorders in HIV-positive outpatients in rural Tanzania. AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 22, 4: 415-419.

24.  Myer, L., Smit, J., Roux, L. L., Parker, S., Stein, D. J. & Seedat, S. (2008). Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care and STDs, 22: 147-158.

25.  Nakimuli-Mpungu, E., Musisi, S., Mpungu, S. K. & Katabira, E. (2006). Primary mania versus HIV-related secondary mania in Uganda. Am J Psychiatry, 163:1349-1354.

26.  Nakimuli-Mpungu, E., Mutamba, B., Othengo, M. & Musisi, S. (2009). Psychological distress and adherence to highly active anti-retroviral therapy (HAART) in Uganda: a pilot study. Africa Health Sciences, S1: S2-7.

27.  Olley, B. O., Gxamza, F., Seedat, S., Theron, H., Taljaard, J., Reid, E., Reuter, H. & Stein, D. J. (2003). Psychopathology and coping in recently diagnosed HIV/AIDS patients - the role of gender. South African Medical Journal, 93: 928-931.

28.  Olley, B. O., Seedat, S. & Stein, D. J. (2006). Persistence of psychiatric disorders in a cohort of HIV/AIDS patients in South Africa: a 6-month follow-up study. Journal of Psychosomatic Research, 61: 479-484.

29.  Osborn, R.L. &Demoncada, A.C. (2006). Feuerstein M. Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. International Journal of Psychiatry in Medicine, 36:13-34.

30.  Owe-Larsson, B., Sall, L., Salamon, E. & Allgulander, C. (2009). HIV infection and psychiatric illness. African Journal of Psychiatry, 12:115-128.

31.  Patel, V., Araya, R., Chatterjee, S., Chisholm, D., Cohen, A., De Silva, M., Hosman, C., McGuire, H., Rojas, G. &Van Ommeren, M. (2007). Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet, published online Sept 4. DOI:10.1016/S0140-6736(07)61240-9.

32.  Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M. R. & Rahman, A. (2007). No health without mental health. The Lancet, 370:859-877.

33.  Rabkin, J.G., Wagner, G.J. & Rabkin. R. (1999). Fluoxetine treatment for depression in patients with HIV and AIDS: a randomized, placebo-controlled trial. American Journal of Psychiatry, 156:101-107.

34.  Rabkin, J.G., Rabkin, R., Harrison, W. & Wagner, G. (1994). Effect of imipramine on mood and enumerative measures of immune status in depressed patients with HIV illness. American Journal of Psychiatry, 151: 516-23.

35.  Rees, K., Bennett, P., West, R., Davey, S.G. & Ebrahim, S. (2004). Psychological interventions for coronary heart disease. Cochrane Database System Review; 2: CD002902.

36.  Säll, L., E Salamon, E., Allgulander, C. & Owe-Larsson, B. (2009). Psychiatric symptoms and disorders in HIV infected mine workers in South Africa: A retrospective descriptive study of acute first admissions. African Journal of Psychiatry, 12: 206-212.

37.  Saxena, S., Thornicroft, G., Knapp, M. & Whiteford, H. (2007).^a Global Mental Health 2: Resources for mental health: scarcity, inequity, and inefficiency. Lancet, 370: 878–89

38.  Stein, D. J., Chiu, W. T., Hwang, I., Kessler, R.C., Sampson, N., Alonso, J., Borges, G., Bromet, E., Bruffaerts, R., De Girolamo, G., Florescu, S., Gureje, O., He, Y., Kovess-Masfety, V., Levinson, D., Matschinger, H., Mneimneh, Z., Nakamura, Y., Ormel, J., Posada-Villa, J., Sagar, R., Scott, K.M., Tomov. T., Viana, M.C., Williams, D.R. & Nock, M.K. (2010). Cross-national analysis of the associations between traumatic events and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS One, 5: e10574.

39.  Thom, R.F.M. (2008). Depression and anxiety in HIV infected individuals attending HIV treatment facilities at various sites in South Africa: occurrence and related factors. A descriptive-analytic study. Unpublished doctoral thesis. University of Witwatersrand, Johannesburg: South Africa.

40.  World Health Organisation. (2009). Mental health systems in selected low- and middle-income countries: a WHO-AIMS cross-national analysis. Geneva: World Health Organization.