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Prevalence and Comorbidity of Psychiatric Diagnoses Based on Reference Standard in an HIV+ Patient Population

From the Department of Psychiatry (B.N.G.), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology (B.N.G., W.C.M.), School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Health Policy (B.W.P.), Terry Sanford Institute of Public Policy, Duke University, Durham, North Carolina; Health Inequalities Program (B.W.P.), Duke University, Durham, North Carolina; and Division of Infectious Diseases (J.J.E., W.C.M.), Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Address correspondence and reprint requests to Bradley N. Gaynes, Department of Psychiatry, CB# 7160, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160. E-mail: bradley_gaynes{at}med.unc.edu

Objective: To study the prevalence of psychiatric comorbidity based on reference standard diagnostic criteria in patients with human immunodeficiency virus (HIV). Psychiatric illness is common in patients with HIV and has been associated with negative health behaviors and poorer clinical outcomes. Among those persons with psychiatric illness, psychiatric comorbidity (multiple simultaneous diagnoses) is associated with increased psychiatric severity and higher HIV risk behaviors.

Methods: A total of 152 consecutively presenting HIV+ patients at an academic medical center in the southeastern US completed a modified Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition) that assessed mood, anxiety, and substance use disorders in the past year and past month.

Results: Fifty percent and 33% of patients had a past-year and past-month diagnosis, respectively. The most common diagnoses were mood disorders (32% past year/21% past month) followed by anxiety (21%/17%) and substance use disorders (22%/11%). Half of those with past-year disorders and 40% of those with past-month disorders met the criteria for multiple diagnoses. Of those with a mood disorder in the past month, 53% also had an anxiety or substance use disorder; of those with an anxiety disorder, 62% also had a mood or substance use disorder; and of those with a substance use disorder, 63% also had a mood or anxiety disorder. Psychiatric comorbidity was associated with younger age, White non-Hispanic race/ethnicity, and greater HIV symptomatology.

Conclusions: Comorbidity of mood, anxiety, and substance use disorders was the exception rather than the rule in this sample. Potential co-occurring disorders should be considered for HIV+ patients presenting with a psychiatric diagnosis.

Key Words: psychiatric comorbidity • prevalence • HIV • depression • anxiety • substance use

Abbreviations: HAART = highly active antiretroviral therapy; SCID = Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition).

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