Exploring Mental Health Challenges in HIV Patients: Literature Review

This report presents a discussion of findings from existing literature concerning the psychological distress experienced by individuals with HIV. It examines the impact of HIV on various aspects of mental health, including anxiety, depression, and emotional well-being. The report explores the effects of antiretroviral therapy, socioeconomic factors, and stigma on mental health outcomes. It also highlights gaps in the current research, such as the need for more studies on the underlying mechanisms of mental illnesses in HIV patients and the utilization of validated assessment tools. The report emphasizes the importance of addressing psychological distress to improve the overall health and quality of life for HIV-positive individuals and suggests that future research should focus on randomized clinical trials and incorporate statistical methods to avoid bias and find out the significance in comparison to control groups.

Discussion and findings
1.0 Introduction
The chapter discusses the findings based on the literature in order to develop a concrete plan
for the possible solutions. The psychological distress due to diverse causes in HIV infected
patient’s needs to be addressed in terms of possible solutions. This is to reduce the mortality
and morbidity of the victims. Hence, the present chapter aims in discussing the findings of
the literature for the development of possible solutions.
2.0. Effect of AIDS on Psychological disorders
2.1. Effect of HIV mediated anxiety on medication/therapy
The randomized clinical trial based investigations performed by Blank et al (2011) reveal
that the longitudinal models for a period of 12 months and so gave a significant outcome in
term of viral load. The intervention group exhibited a significantly greater reduction in log
viral load (p<0.001) compared to control group indicating that the studies on long-term
basis are needed for the investigations and to elucidate the impact of HIV on mental status
of the victims. In addition to the viral load, in the proposed studies other parameters such as
a detailed type of mental health are to be incorporated. The aspects of assessing the mental
status such as anxiety were considered in the patients suffering from other diseases
(Baqutayan, 2012). Therefore, such practices can be implemented for HIV infected patients.
The outcome of the investigation (Vitiello et al., 2003) revealed that antidepressants are the most
commonly prescribed medicines (20.9%) followed by anxiolytic (16.7%), antipsychotics (4.7%), and psycho
stimulants (3.0%). It indicates that the HIV-positive victims undergo for frequent depression in the population
tested. An emphasis can be given for the investigation towards why the HIV positive patients undergo for
depression. What factors contributing for the development of symptoms and mental illness. The presence of HIV
positive in the victims not only influences the victim’s mental health, also influences the caregivers health status. In
an attempt, Kuo et al., (2014) evaluated the South African based caregivers for the assessment of psychological
status utilizing multivariate hierarchical logistic regressions. The authors found that the caregivers who are associated
with HIV positive patients can develop anxiety (p<0.001) who were living with the patients. This further increases
the risk of development of psychological symptoms for the patients. Therefore the patients require a mechanical and
moral support to come out from the ‘continuous’ thinking on the HIV and its symptoms. An insight can be devised
from the available sources that no source is describing the factors and causes contributing for the assessment of
1

mental status in HIV positive patients. Hence, it would be desired to focus an investigation to study the underlying
mechanisms utilizing randomized clinical trials.
2.2. Effect of HIV mediated depression on medication/therapy
The inclusion of patients from diverse study groups can avoid the bias and help in understanding how the
depression does affect the medication in HIV patients. The patients with intervention for 6 months showed a lower
extent of depression (mean difference -3.7) and a lower tendency of suicidal behavior (-18%) (Pence et al., 2015).
The investigation (Mitzel et al., 2015) revealed that the there exist an association between HIV-related stigma and
adherence. The symptoms of depression are strongly related to the HIV adherence while the stigma did not. The
outcome gave an insight for the importance of treating depressive symptoms in interventions aiming to improve
medication adherence among HIV-infected patients. The investigation did not reveal about the types of design
employed however the outcome showed a significant impact in terms of stigma-related experiences. It was positive
with depressive symptoms and negative towards adherence. Similar to preceding outcomes and methods, the
investigators did not cover other psychological disorders. Turan et al., (2015) proved the relation
between internalized stigma and self-reported suboptimal anti retroviral therapy. It was
based on the relation between the depressive symptoms and low extent of social support,
the investigators concluded that there exist an association between internalized stigma and
suboptimal adherence. From the available results, it can be understood that t he studies were
utilizes depression and the investigators are trying to establish correlation between stigma and depressive symptoms.
Most of the evidences are based on a single center so it is desirable to have the findings from multicenter studies. In
addition, other aspects of mental status have not been captured. Therefore, the proposed study should focus on
anxiety and other mental illness.
2.3. Effect of HIV/AIDS on emotion
From emotional aspects perceptive, Okulicz et al., (2009) investigated the role of viral load on
the reduction of victim immunity utilizing elite and viremic controllers. The outcome reveals
that the elite controllers had favorable time for the development of AIDS (P=0.048) in
comparison to viremic controllers. The researchers have not addressed the emotional
aspects of the patients. The use of multiple drug regimens can increase the life span of
victims and possibly reduce the emotional distress of the patients (Mocroft et al., 2002). In
an attempt, the researchers (Mocroft et al., 2002) proved as the ‘dropping’ rate was
decreased (P<0.001) with the use of drugs. Moneyham et al., (1997), explain the possible
mechanisms involved in emotional distress. The investigators opined that the physiological
mediators influence the HIV-related stress on emotional distress. No insight is provided in terms of
possible approaches for reduction of emotion by physiological and pharmacological interventions.
2

Another cause for emotional behavior could be stigma related effects and was correlated with age
(Wei et al., 2016). The stigma and age interaction term was significant for negative emotions for
the total sample, with higher age associated with greater experience of negative emotions. This
suggests that the effect of perceived stigma on negative emotions is moderated by age in HIV-
affected individuals. The multiple linear regressions suggest that there exist an emotional regulation
partially mediated the relationship between negative emotions and both types of stigma, including
enacted stigma and perceived stigma (Wei et al., 2016). One source (Asikhia & Mohangi, 2015)
is describing about the interventions to reduce the emotional distress in schoolchildren.
There was a high prevalence of psychological, behavioral and emotional problems and that the
school support provided to them (teachers' support, the general school environment and the degree of
discrimination, labeling and bullying that exists in the school) was not sufficient (Asikhia &
Mohangi, 2015). The available sources neither discussing the etiology of emotional aspects in HIV
victims nor proposing the strategies of intervention. Therefore, focus can be given to find out the
factors and establish a link between the emotional distress and HIV utilizing randomized trials.
2.4. Effect of socioeconomic conditions on anxiety in HIV infected patients
The education level, status and position of employment and status of individual in society can
certainly influence the medical interventions and on the disease management. Robinson et al.,
(2015) revealed that no investigation dealt with psychological interventions. However, the
researchers evaluated the performance of vocational training and pharmacological
interventions. Among the studies, the vocational intervention could not infer a significant
outcome due to lack of adequate data. The pharmacological interventions showed diverse
outcome due to differences in the studies. The individuals with positive HIV and employment
showed a significant improvement in terms of mitigation compared to those without adequate
socioeconomic condition. Another report from Peltzer & Pengpid (2013) reveals that the
income, level of education, and employment/occupational status was significantly and
positively associated with the level of adherence of treatment. About 73.2% of studies
showed a positive outcome in terms of adherence of therapy. Despite of positive outcome it
appears that the available evidence does not provide conclusive support for the existence of a
clear association between socio-economic status and adherence to anti retroviral therapy in
adult patients infected with HIV (Peltzer & Pengpid, 2013). Another report describes the
relationship between socioeconomic status and HIV infection (Ogunmola et al., 2014)
utilizing an analytical case-control study and logistic regression model. The outcome reveals
that HIV positive patients with secondary school levels of education and all categories of
monthly income showed statistically significant relationships with HIV infection (P=0.018
3

and P<0.05, respectively). It indicates that there exists a relationship between socioeconomic
status and HIV infection However, no report precisely dealt with the assessment of mental
illnesses in HIV infected patients.
3.0 Discussion
From the outcome of the sources, it can be understood that no single report is available to
address the issues pertaining to the impact of HIV mediated mental illness in patients with
positive HIV. Few articles dealt with depression and emotional distress. As no articles are
available to cover the diverse mental illness in HIV victims, there is a scope to investigate the
mental status of patients with HIV. The proposed research should address the trend of mental
illnesses and elucidate the possible underlying mechanisms. Despite of availability of
advanced tools (Duncan et al., 2015) no study utilizes the validated tools. The proposed study
may be conducted by incorporating statistical methods in the study design to avoid bias and
find out the significance in comparison to control groups. Certain statistical concepts are
incorporated in HIV dynamics in AIDS research (Wu, 2005) however, the objectives are
different. Such concepts may be incorporated in proposed research.
4

References
Asikhia O.A., & Mohangi K., 2015. ‘A case study of school support and the psychological,
emotional and behavioural consequences of HIV and AIDS on adolescents’. SAHARA
J. Vol, 12. No, pp, 123-33
Baqutayan, S. M. S, 2012. ‘The effect of anxiety on breast cancer patients’. Indian Journal of
Psychological Medicine, vol. 34, no. 2, 119–123. http://doi.org/10.4103/0253-
7176.101774
Blank M.B., Hanrahan N.P., Fishbein M., Wu E.S., Tennille J.A., Ten H.T.R., Kutney-Lee
A.M., Gross R., Hines J.M., Coyne J.C & Aiken L.H, 2011. ‘A randomized trial of a
nursing intervention for HIV disease management among persons with serious
mental illness’ Psychiatr Serv. vol. 62. no. 11, pp.1318-24.
Duncan C., Laura W., Ahmed N., Angus B., Boffito M., Bower M., Dunn D., Edwards
S., Emerson C., Fidler S., Fisher M., Horne R., Khoo S., Leen C., Mackie N.,
Marshall N., Monteiro F., Nelson M., Orkin C., Palfreeman A., Pett S., Phillips
A., Post F., Pozniak A., Reeves I., Sabin C., Trevelion R., Walsh J., Wilkins
E., Williams I., & Winston A., 2015 ‘British HIV Association guidelines for the
treatment of HIV-1-positive adults with antiretroviral therapy 2015’ Retrieved from
http://www.bhiva.org/documents/Guidelines/Treatment/2015/2015-treatment-
guidelines.pdf
Kuo C., Cluver L., Casale M., & Lane T. 2014. ‘Cumulative effects of HIV illness and
caring for children orphaned by AIDS on anxiety symptoms among adults caring for
children in HIV-Endemic South Africa. AIDS Patient Care and STDs, Vol. 28, No.
6, pp. 318-326.
Mitzel L.D., Vanable P.A., Brown J.L., Bostwick R.A., Sweeney S.M., & Carey M.P., 2015. ‘Depressive
symptoms mediate the effect of HIV-related stigmatization on medication adherence among HIV-infected
men who have sex with men. AIDS Behav. Vol, 9. No, 8, pp. 1454-9.
Mocroft A., Brettle R., Kirk O., Blaxhult A., Parkin J.M., Antunes F., Francioli P.,
D'Arminio Monforte A., Fox Z & Lundgren J.D. 2002. ‘Changes in the cause of
death among HIV positive subjects across Europe: results from the EuroSIDA
study’. AIDS. Vol, 16. No, 12, pp. 1663-71.
Moneyham L., Seals B., Sowell R., Hennessy M., Demi A., & Brake S., 1997. ‘The impact
of HIV on emotional distress of infected women: cognitive appraisal and coping as
mediators’. Sch Inq Nurs Pract. Vol, 11. No, 2, pp. 125-45
5

Ogunmola, O. J., Oladosu, Y. O., & Olamoyegun, M. A. (2014). Relationship between
socioeconomic status and HIV infection in a rural tertiary health center. HIV/AIDS
(Auckland, N.Z.), vol, 6, 61–67. http://doi.org/10.2147/HIV.S59061
Okulicz J.F., Marconi V.C., Landrum M.L., Wegner S., Weintrob A., Ganesan A., Hale B.,
Crum-Cianflone N., Delmar J., Barthel V., Quinnan G., Agan B.K., & Dolan M.J.,
2009. 'Clinical outcomes of elite controllers, viremic controllers, and long-term
nonprogressors in the US Department of Defense HIV natural history study'. J Infect
Dis Vol, 200, No. 11, pp.1714-23.
Peltzer, K., & Pengpid, S. (2013). Socioeconomic factors in adherence to HIV Therapy in
low- and middle-income countries. Journal of Health, Population, and Nutrition, vol,
31, no, 2, 150-170
Pence B.W., Gaynes B.N., Adams J.L., Thielman N.M., Heine A.D., Mugavero M.J.,
McGuinness T., Raper J.L., Willig J.H., Shirey K.G., Ogle M., Turner E.L., &
Quinlivan E.B., 2015. ‘The effect of antidepressant treatment on HIV and
depression outcomes: results from a randomized trial’. AIDS. Vol, 29. No, 15, pp.
1975-86
Robinson R., Okpo E., & Mngoma N., 2015, ‘Interventions for improving employment
outcomes for workers with HIV’. Cochrane Database of Systematic Reviews, No, 5.
Art. No.: CD010090. DOI: 10.1002/14651858.CD010090.pub2.
Turan, B., Smith, W., Cohen, M. H., Wilson, T. E., Adimora, A. A., Merenstein, D.,
Adebola A., Eryka L.W., Antonina G. F., Lisa M., Phyllis C.T., Sheri D. W., &
Turan, J. M. (2016). Mechanisms for the Negative Effects of Internalized HIV-
Related Stigma on Antiretroviral Therapy Adherence in Women: The Mediating
Roles of Social Isolation and Depression. Journal of Acquired Immune Deficiency
Syndromes’ Vol, 72. No, 2, pp, 198–205.
Vitiello B., Burnam M.A., Bing E.G., Beckman R & Shapiro M.F, 2003. ‘Use of
psychotropic medications among HIV-infected patients in the United States’ Am J
Psychiatry. Vol 160. No. 3, pp. 547-54.
Wei W., Li X., Harrison S., Zhao J., & Zhao G., 2016. 'The relationships between HIV
stigma, emotional status, and emotional regulation among HIV-affected children in
rural China' AIDS Care. Vol, 28, Suppl 2, pp.161-7
Wu H (2005) Statistical methods for HIV dynamic studies in AIDS clinical trials. Stat
Methods Med Res. Vol, 14, no, 2, pp. 171-92.
6