http://www.hivcareforyouth.org/adol?page=md-module&mod=01-04-01

Addressing Psychosocial Comorbidities among HIV-Infected Youth

What to Look For

Youth with HIV/AIDS are at greater risk of psychiatric morbidity during childhood and early adolescence, compared with the general pediatric population, and a diagnosis of major depression is seen with increasing frequency during adolescence. 40 Youth with psychiatric illness also may be more vulnerable to HIV infection as decreased self-esteem and self-efficacy may prevent them from protecting themselves. Providers should assess all HIV-infected adolescent patients for psychiatric disturbances, including:

  • Substance use
  • Depression
  • Anxiety
  • Posttraumatic stress disorder
  • Mood dysregulation
  • Adjustment disorders
  • Bereavement
  • Dysthymia
  • Attention deficit disorder
  • Psychosis

Standardized screening tools (see Toolbox) and in-person interviews can aid in the identification of these key psychiatric comorbidities. Comorbid conditions such as depression and substance use can exacerbate nonadherence to HIV treatment and consequently undermine the patient's HIV treatment.

One of the greatest health disparities in the United States is the lack of mental health and substance abuse treatment services for youth, specifically those from impoverished or low socioeconomic backgrounds. In 2002, it was estimated that 1.4 million 12-17 year olds required substance abuse treatment; however, only 7% of substance abuse treatment centers provided services for patients younger than 18, so only 10% of the 1.4 million young people requiring services actually received them. 41 The paucity and affordability of mental health and substance abuse services pose secondary risks of HIV infection, untreated mental health issues, academic failure, and homelessness. Interventions to address and to treat a patient's comorbid conditions may well lead to improvement in medical and psychiatric outcomes. 424344

References

  1. Gaughan DM, Hughes MD, Oleske JM. et al. Psychiatric hospitalizations among children and youths with human immunodeficiency virus infection. Pediatrics. 2004 Jun;113(6):e544-51.
  2. Drug and Alcohol Services Information System Report. Facilities Primarily Serving Adolescents: 2002. Washington: Office of Applied Studies, Substance Abuse and Mental Health Services Administration; 2003.
  3. Mellins CA, Brackis-Cott E, Dolezal C, et al. Psychiatric disorders in youth with perinatally acquired human immunodeficiency virus infection. Pediatr Infect Dis J. 2006 May;25(5):432-7.
  4. Asarnow JR, Jaycox LH, Tompson MC. Depression in youth: psychosocial interventions. J Clin Child Psychol. 2001 Mar;30(1):33-47. Review.
  5. Thompson A, Silverman B, Dzeng L, et al. Psychotropic medications and HIV. Clin Infect Dis. 2006 May 1;42(9):1305-10. Review.