Skip to main content

Advertisement

SpringerLink
Log in

Use of HIV and Psychotropic Medications among Persons with Serious Mental Illness and HIV/AIDS

  • Original Paper
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

Persons with serious mental illness (SMI) have higher rates of co-morbid HIV disorders compared to the general population. There are concerns that the SMI/HIV population may be receiving fewer HIV and psychotropic medications due to problems of access and concerns by providers associated with following complex medication regimes. The purpose of this study was to examine any disparity in medication treatment of the SMI/HIV population by comparing medication use and continuity of prescription fills to groups that had HIV or SMI only versus those with SMI/HIV. Study participants were adult Medicaid recipients aged 19–64 with serious mental illness and HIV receiving services in Philadelphia from 2002 through 2003. Differences between the groups in case mix characteristics, medication use rates, and continuity of psychotropic and antiretroviral medication use were compared using Chi-square, t-tests of significance, and logistic regression. Co-morbid individuals were as likely to have filled prescriptions for psychotropic and antiretroviral medications as those with a single disorder and equally persistent in their continuity of antiretroviral medication refills as those with HIV only. However, persons with co-morbid condition had lower continuity of psychotropic medication use compared to those with SMI only. Our findings suggest the need to develop an integrated medical and behavioral healthcare model to improving coordination and treatment for patients with co-occurring disorders. Future research is warranted to investigate the reasons for the discrepancy in continuity of psychotropic adherence for the SMI/HIV population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ashman, J. J., Conviser, R., & Pounds, M. B. (2002). Associations between HIV-positive individuals’ receipt of ancillary services and medical care receipt and retention. AIDS Care, 14(Suppl 1), 109–118.

    Article  Google Scholar 

  • Bagchi, A., Sambamoorthi, U., McSpiritt, E., et al. (2004). Use of antipsychotic medications among HIV-infected individuals with schizophrenia. Schizophrenia Research, 71, 435–444.

    Article  PubMed  Google Scholar 

  • Bartels, S. J. (2004). Caring for the whole person: Integrated health care for older adults with severe mental illness and medical comorbidity. Journal of the American Geriatrics Society, 52(12 Suppl), S249–S257.

    Article  PubMed  Google Scholar 

  • Bassetti, S., Battegay, M., Furrer, H., et al. (1999). Why is highly active antiretroviral therapy (HAART) not prescribed or discontinued? Swiss HIV cohort study. Journal of Acquired Immune Deficiency Syndromes, 21, 114–119.

    PubMed  CAS  Google Scholar 

  • Blank, M. B., Mandell, D. S., Aiken, L., et al. (2002). Co-occurrence of HIV and serious mental illness among Medicaid recipients. Psychiatric Services, 53, 868–873.

    Article  PubMed  Google Scholar 

  • Bogart, L. M., Kelly, J. A., Catz, S. L., et al. (2000). Impact of medical and nonmedical factors on physician decision making for HIV/AIDS antiretroviral treatment. Journal of Acquired Immune Deficiency Syndromes, 23, 396–404.

    Article  PubMed  CAS  Google Scholar 

  • Brown, S. (1997). Excess mortality of schizophrenia: A meta-analysis. British Journal of Psychiatry, 171, 502–508.

    Article  PubMed  CAS  Google Scholar 

  • Brunette, M. F., Mercer, C. C., Carlson, C. L., et al. (2000). HIV-related services for persons with severe mental illness: Policy and practice in New Hampshire community mental health. Journal of Behavioral Health Services and Research, 27, 347–353.

    Article  PubMed  CAS  Google Scholar 

  • Carey, M. P., Carey, K. B., & Kalichman, S. C. (1997). Risk for human immunodeficiency virus (HIV) infection among persons with severe mental illness. Clinical Psychology Review, 17, 271–291.

    Article  PubMed  CAS  Google Scholar 

  • Centers for Disease Control and Prevention. (2004). HIV/AIDS surveillance report 2003 (Vol. 15, pp. 1–46). Atlanta, GA: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention. http://www.cdc.gov/hiv/stats/hasrlink.html.

  • Chwastiak, L., Rosenheck, R., & Douglas, L. (2006). Impact of medical comorbidity on the quality of schizophrenia pharmacotherapy in a National VA sample. Medical Care, 44, 55–61.

    Article  PubMed  Google Scholar 

  • Corrigan, P. W. (2002). Adherence to anti-psychotic medications and health behavior theories. Journal of Mental Health, 11, 243–254.

    Article  Google Scholar 

  • Cournos, F., & McKinnon, K. (1997). HIV seroprevalence among people with severe mental illness in the United States: A critical review. Clinical Psychology Review, 17, 159–169.

    Article  Google Scholar 

  • Crystal, S., Akincigil, A., Bilder, S., et al. (2007). Studying prescription drug use and outcomes with Medicaid claims data. Medical Care, 45(Suppl), S58–S65.

    Article  PubMed  Google Scholar 

  • Crystal, S., Sambamoorthi, U., & Merzel, C. (1995). The diffusion of innovation in AIDS treatment: Zidovudine use in two New Jersey cohorts. Health Services Research, 30, 591–612.

    Google Scholar 

  • Crystal, S., Sambamoorthi, U., Moynihan, P. J., et al. (2001). Initiation and continuation of newer antiretroviral treatments among Medicaid recipients with AIDS. Journal of General Internal Medicine, 16, 850–859.

    Article  PubMed  CAS  Google Scholar 

  • Davidson, M. (2002). Risk of cardiovascular disease and sudden death in schizophrenia. Journal of Clinical Psychiatry, 63, 5–11.

    PubMed  Google Scholar 

  • Dembling, B. P., Chen, D. T., & Vachon, L. (1999). Life expectancy and causes of death in a population treated for serious mental illness. Psychiatric Services, 50, 1036–1042.

    PubMed  CAS  Google Scholar 

  • Drake, R. E., Mercer-McFadden, C., Mueser, K. T., et al. (1998). Review of integrated mental health substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24, 589–608.

    PubMed  CAS  Google Scholar 

  • Druss, B. G., Rosenheck, R. A., Desai, M. M., et al. (2002). Quality of preventive medical care for patients with mental disorders. Medical Care, 40, 129–136.

    Article  PubMed  Google Scholar 

  • Enger, C., Weatherby, L., Reynolds, R. F., et al. (2004). Serious cardiovascular events and mortality among patients with schizophrenia. Journal of Nervous and Mental Disease, 192, 19–27.

    Article  PubMed  Google Scholar 

  • Essock, S. M., Dowden, S., Constantine, N. T., et al. (2003). Blood-borne infections and persons with mental illness: Risk factors for HIV, hepatitis B, and hepatitis C among persons with severe mental illness. Psychiatric Services, 54, 836–841.

    Article  PubMed  Google Scholar 

  • Felker, B., Yazel, J. J., & Short, D. (1996). Mortality and medical comorbidity among psychiatric patients: A review. Psychiatric Services, 47, 1356–1363.

    PubMed  CAS  Google Scholar 

  • Frayne, S. M., Halanych, J. H., Miller, D. R., et al. (2005). Disparities in diabetes care: Impact of mental illness. Archives Internal Medicine, 165(22), 2631–2638.

    Article  Google Scholar 

  • Fremont, A. M., Young, A. S., Chinman, M., et al. (2007). Differences in HIV care between patients with and without severe mental illness. Psychiatric Services, 58, 681–688.

    Article  PubMed  Google Scholar 

  • Goff, D. C., Sullivan, L. M., McEvoy, J. P., et al. (2005). A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls. Schizophrenia Research, 80, 45–53.

    Article  PubMed  Google Scholar 

  • Goldman, L. S. (2000). Comorbid medical illness in psychiatric patients. Current Psychiatry Reports, 2, 256–263.

    Article  PubMed  CAS  Google Scholar 

  • Gottesman, I. I., & Groome, C. S. (1997). HIV/AIDS risks as a consequence of schizophrenia. Schizophrenia Bulletin, 23, 675–684.

    PubMed  CAS  Google Scholar 

  • Hogg, R. S., Heath, K. V., Yip, B., et al. (1998). Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA, 279, 450–454.

    Article  PubMed  CAS  Google Scholar 

  • http://actionaids.org/news/pressroom.

  • Jamieson, D. J., Duerr, A., Robert, K. S., et al. (2001). Longitudinal analysis of bacterial vaginosis: Findings from the HIV epidemiology research study. Obstetrics and Gynecology, 98, 656–663.

    Article  PubMed  CAS  Google Scholar 

  • Kaiser Family Foundation. (2009). HIV/AIDS policy fact sheet, medicaid and HIV/AIDS, February 2009. U.S. Federal Funding for HIV/AIDS.

  • Kilbourne, A. M., Brar, J. S., Drayer, R. A., et al. (2007). Cardiovascular disease and metabolic risk factors in male patients with schizophrenia, schizoaffective disorder, and bipolar disorder. Psychosomatics, 48, 412–417.

    Article  PubMed  Google Scholar 

  • Kleeberger, C. A., Phair, J. P., Strathdee, S. A., et al. (2001). Determinants of heterogeneous adherence to HIV-antiretroviral therapies in the multicenter AIDS cohort study. Journal of Acquired Immune Deficiency Syndromes, 26, 82–92.

    Article  PubMed  CAS  Google Scholar 

  • Laine, C., Newschaffer, C. J., Zhang, D., et al. (2000). Adherence to antiretroviral therapy by pregnant women infected with human immunodeficiency virus: A pharmacy claims-based analysis. Obstetrics and Gynecology, 95, 167–173.

    Article  PubMed  CAS  Google Scholar 

  • Lurie, N., Popkin, M., Dysken, M., et al. (1992). Accuracy of diagnoses of schizophrenia in Medicaid claims. Hospital & Community Psychiatry, 43, 69–71.

    CAS  Google Scholar 

  • Massad, P. M., West, A. N., & Friedman, M. J. (1990). Relationship between utilization of mental health and medical services in a VA hospital. American Journal of Psychiatry, 147, 465–469.

    PubMed  CAS  Google Scholar 

  • McKinnon, K., & Cournos, F. (1998). HIV infection linked to substance use among hospitalized patients with severe mental illness. Psychiatric Services, 49, 1269.

    PubMed  CAS  Google Scholar 

  • McQuillan, G. M., Khare, M., Karon, J. M., et al. (1997). Update on the seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988–1994. Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology, 4, 355–357.

    Article  Google Scholar 

  • Mellins, C. A., Havens, J. F., McDonnell, C., et al. (2009). Adherence to antiretroviral medications and medical care in HIV-infected adults diagnosed with mental and substance abuse disorders. AIDS Care, 21, 168–177.

    Article  PubMed  Google Scholar 

  • Minkoff, K. (1994). Models for addiction treatment in psychiatric populations. Psychiatric Annals, 24, 412–417.

    Google Scholar 

  • Mitchell, A. J., Malone, D., & Doebbeling, C. C. (2009). Quality of medical care for people with and without comorbid mental illness and substance misuse: Systematic review of comparative studies. The British Journal of Psychiatry, 194, 491–499.

    Article  PubMed  Google Scholar 

  • Nasrallah, H. A., Meyer, J. M., Goff, D. C., et al. (2006). Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: Data from the CATIE schizophrenia trial sample at baseline. Schizophrenia Research, 86, 15–22.

    Article  PubMed  Google Scholar 

  • Olfson, M., Marcus, S., Weissman, M. M., et al. (2002). National trends in the use of psychotropic medications by children. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 514–521.

    Article  Google Scholar 

  • Osborn, D. P., Nazareth, I., & King, M. B. (2006). Risk for coronary heart disease in people with severe mental illness: Cross-sectional comparative study in primary care. British Journal of Psychiatry, 188, 271–277.

    Article  PubMed  Google Scholar 

  • Palmer, N. B., Basinski, J. R., & Uldall, K. K. (2010). Psychiatric illness, access and adherence to HAART: A brief review of recent findings and implications for care. HIV Therapy, 4, 215–230.

    Article  Google Scholar 

  • Parry, C. D., Blank, M. B., & Pithey, A. L. (2007). Responding to the threat of HIV among persons with mental illness and substance abuse. Current Opinion in Psychiatry, 20, 235–241.

    PubMed  Google Scholar 

  • Perkins, D. O. (1999). Adherence to psychotropic medications. Journal of Clinical Psychiatry, 60(Suppl 21), 25–30.

    PubMed  Google Scholar 

  • Roberts, R. R., Kampe, L. M., Hammerman, M., et al. (2006). The cost of care for patients with HIV from the provider economic perspective. AIDS Patient Care and STDs, 20, 876–885.

    Article  PubMed  Google Scholar 

  • Rosenberg, S. D., Goodman, L. A., Osher, F. C., et al. (2001). Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness. American Journal of Public Health, 91, 31–37.

    Article  PubMed  CAS  Google Scholar 

  • Rosenberg, S. D., Swanson, J. W., Wolford, G. L., et al. (2003). Blood-borne infections and persons with mental illness: The five-site health and risk study of blood-borne infections among persons with severe mental illness. Psychiatric Services, 54, 827–835.

    Article  PubMed  Google Scholar 

  • Rothbard, A. B., Lee, S., & Blank, M. B. (2009a). Cost of treating seriously mentally ill persons with HI following HAART. Journal of Mental Health Policy and Economics, 12, 187–194.

    PubMed  Google Scholar 

  • Rothbard, A. B., Metraux, S., & Blank, M. B. (2003). Cost of care for Medicaid recipients with serious mental illness and HIV infection or AIDS. Psychiatric Services, 54, 1240–1246.

    Article  PubMed  Google Scholar 

  • Rothbard, A. B., Miller, K., Lee, S., et al. (2009b). Revised cost estimates of medicaid recipients with serious mental illness and HIV-AIDS. Psychiatric Services, 60, 974–977.

    Article  PubMed  Google Scholar 

  • Salsberry, P. J., Chipps, E., & Kennedy, C. (2005). Use of general medical services among Medicaid patients with severe and persistent mental illness. Psychiatric Services, 56, 458–462.

    Article  PubMed  Google Scholar 

  • Seeman, M., Lang, M., & Rector, N. (1990). Chronic schizophrenia: A risk factor for HIV? Canadian Journal of Psychiatry, 35, 765–768.

    CAS  Google Scholar 

  • Sokal, J., Messias, E., Dickerson, F. B., et al. (2004). Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services. Journal of Nervous and Mental Disease, 192, 421–427.

    Article  PubMed  Google Scholar 

  • Solomon, P. L., Tennile, J. A., Lipsott, D., et al. (2007). Rapid assessment of existing HIV prevention programming in a community mental health centre. Journal of Prevention & Intervention in the Community, 33, 137–150.

    Article  Google Scholar 

  • Soto, T. A., Bell, J., & Pillen, M. B. (2004). Literature on integrated HIV care: A review. AIDS Care, 16(Suppl), 43–55.

    Article  Google Scholar 

  • Sullivan, G., Koegel, P., Kanouse, D. E., et al. (1999). HIV and people with serious mental illness: The public sector’s role in reducing HIV risk and improving care. Psychiatric Services, 50, 648–652.

    PubMed  CAS  Google Scholar 

  • Thompson, A., Silverman, B., Dzeng, L., et al. (2006). Psychotropic medications and HIV. Clinical Infectious Diseases, 42, 1305–1310.

    Article  PubMed  CAS  Google Scholar 

  • Treisman, G. J., Angelino, A. F., & Hutton, H. E. (2001). Psychiatric issues in the management of patients with HIV infection. JAMA, 12, 2857–2864.

    Article  Google Scholar 

  • Tucker, J. S., Burnam, M. A., Sherbourne, C. D., et al. (2003). Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. The American Journal of Medicine, 114, 573–580.

    Article  PubMed  Google Scholar 

  • Turner, B. J., Fleishman, J. A., Wenger, N., et al. (2003). Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons. Journal of General Internal Medicine, 16, 625–633.

    Article  Google Scholar 

  • Turner, B. J., Newschaffer, C., Zhang, D., et al. (2000). Antiretroviral use and pharmacy-based measurement of adherence in postpartum HIV-infected women. Medical Care, 38, 911–925.

    Article  PubMed  CAS  Google Scholar 

  • Uldall, K. K., Palmer, N. B., Whetten, K., et al. (2004). Adherence in people living with HIV/AIDS, mental illness, and chemical dependency: A review of the literature. AIDS Care, 16(Suppl 1), 71–96.

    Article  Google Scholar 

  • Vitiello, B., Burnam, A., Bing, E. G., et al. (2003). Use of psychotropic medications among HIV-infected patients in the United States. American Journal of Psychiatry, 160, 547–554.

    Article  PubMed  Google Scholar 

  • Walkup, J., Blank, M. B., Gonzalez, J. S., et al. (2008). The impact of mental health and substance abuse factors on HIV prevention and treatment. Journal of Acquired Immune Deficiency Syndromes, 47(Suppl l), 15–19.

    Google Scholar 

  • Walkup, J. T., Sambamoorthi, U., & Crystal, S. (2004). Use of newer antiretroviral treatments among HIV-infected Medicaid beneficiaries with serious mental illness. Journal of Clinical Psychiatry, 65, 1180–1189.

    Article  PubMed  Google Scholar 

  • West, J. C., Wilk, J. E., Rae, D. S., et al. (2009). Medicaid prescription drug policies and medication access and continuity: Findings from ten States. Psychiatric Services, 60, 601–610.

    Article  PubMed  Google Scholar 

  • Wohler-Torres, B. A., Valverder, E. E., Anderson-Mahoney, P., et al. (2002). System barriers to HIV medical care appointment compliance: Results of the ARTAS study. International conference on AIDS, July 7–12, 14: abstract no. G12519.

Download references

Acknowledgement

This research was supported by grants from NIDA, #5-RO1-DA-015627 "HIV Prevention Program among Substance Abusing SMI", NINR #5-RO1-NR-008851 "Nursing Intervention for HIV Regimen: Adherence among SMI".

Author information

Authors and Affiliations

  1. Department of Social Welfare, Pusan National University, 30 Jangjeon-dong, Geumjung-gu, Busan, 609-735, South Korea

    Sungeun Lee

  2. Department of Psychiatry, Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market St., Philadelphia, PA, 19104, USA

    Aileen B. Rothbard, Elizabeth Noll & Michael B. Blank

  3. Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, USA

    Michael B. Blank

  4. Penn Center for AIDS Research, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA

    Michael B. Blank

Authors
  1. Sungeun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aileen B. Rothbard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Noll
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael B. Blank
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sungeun Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, S., Rothbard, A.B., Noll, E. et al. Use of HIV and Psychotropic Medications among Persons with Serious Mental Illness and HIV/AIDS. Adm Policy Ment Health 38, 335–344 (2011). https://doi.org/10.1007/s10488-010-0320-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-010-0320-1

Keywords

Search

Navigation