Young adults with depression are at increased risk of sexually transmitted disease

Sexually transmitted diseases (STDs) and depression impact millions of individuals each year in the United States, with direct medical costs exceeding $41 billion. While the interactions of these conditions are poorly understood, they are increasingly addressed in primary care whereas historically they have been addressed separately. 

We analyzed data associated with the 18-25 year age group from the 2014 National Survey of Drug Use and Health, a cross-sectional survey of the civilian, non-institutionalized US population aged ≥12 years for factors associated with past year diagnosis of STD (STDy). Independent variables included participant demographics; lifetime diagnosis of major depressive episode (MDE); participant behaviors associated with STD risk (patient-provided); and medical record data associated with mental illness treatment (clinically-observed). 

Of 18,142 participants, the prevalence of MDE and STD was 15.3% and 2.4%, respectively, with significant differences by gender and race. MDE was associated with increased risk of STDy among females (odds ratio [OR]=1.61; 95% confidence interval [CI]=1.18-2.20), males (OR=2.32; CI=1.15-4.70), those of white race (OR=3.02; CI=2.02-4.53), and lower income levels and insurance status. Univariate modeling found that receiving mental health treatment, and use of marijuana, alcohol, and illegal drugs were each associated with significantly increased STDy. 

In a multivariate logistic regression, receiving mental health treatment became protective for STDy (AOR=0.55; CI=0.32-0.95]). Individuals with a history of depression are at increased risk of STDy, with this risk modified by factors readily ascertained within primary care. As depression treatment is increasingly incorporated into primary care there are means to more effectively target intervention resources.

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By:  Jenkins WD1, Botchway A2.

• 1Population Health Science Program, Southern Illinois University School of Medicine, 801 N. Rutledge St, Springfield, IL 62794-9664, United States. Electronic address: wjenkins@siumed.edu.
• 2Center for Clinical Research, Southern Illinois University School of Medicine, 801 N. Rutledge St, Springfield, IL 62794-9664, United States. 
• Prev Med. 2016 Apr 4. pii: S0091-7435(16)30042-1. doi: 10.1016/j.ypmed.2016.03.020

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Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study

PURPOSE:

There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status.

METHODS:

Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case-control design to determine if medical and/or mental health disparities exist in the TG veteran population.

RESULTS:

In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups.

CONCLUSION:

This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.

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By:  Brown GR1,2, Jones KT3.

• 1 Psychiatry Service, Mountain Home Veterans Affairs Medical Center , Johnson City, Tennessee.
• 2 Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University , Johnson City, Tennessee.
• 3 Office of Health Equity , Veterans Health Administration, Washington, District of Columbia.
• LGBT Health. 2016 Apr;3(2):122-31. doi: 10.1089/lgbt.2015.0058. Epub 2015 Dec 16. 

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A Longitudinal Study of Mental Health Symptoms in Young Prisoners: Exploring the Influence Of Personal Factors & the Correctional Climate

BACKGROUND:

Despite the high prevalence rate of mental health problems among young prisoners, little is known about the longitudinal course and covariates of their mental health symptoms during incarceration, especially the influence of the correctional climate. The current study aimed: (1) to examine changes in young prisoners' mental health symptoms during incarceration, (2) to identify personal factors associated with their mental health symptoms and perceptions of the correctional climate, and (3) to test the incremental effect of perceptions of the correctional climate on mental health symptoms.

METHODS:

Data were obtained from a sample of 75 youths (aged 17 to 22 years) detained in a Portuguese young offender prison. Data were gathered 1, 3, and 6 months after their admission in this facility. Socio-demographic, clinical and criminological variables were collected. Mental health symptoms and perceptions of the correctional climate were assessed through self-report assessment tools. Linear and logistic (multi-level) regressions and tests for differences between means were performed to analyze the data.

RESULTS:

Overall, mental health symptoms marginally declined by the sixth month in prison. Prisoners with a history of mental health treatment were more likely to have increased symptoms. Higher levels of mental health symptoms were associated with a history of mental health treatment, remand status, and a lower educational level. Better perceptions of the correctional climate were associated with Black race and participation in prison activities. A negative perception of the correctional climate was the strongest covariate of young prisoners' mental health symptoms and had incremental validity over that of personal variables.

CONCLUSIONS:

The results highlight that both characteristics of the prisoners and of the prison environment influence young prisoners' mental health. Prison management can try to reduce young prisoners' mental health problems by developing scientific procedures for their mental health assessment and creating a more beneficial correctional climate.

Level and Changes in Mental Health Symptoms over Time in Prison

	Month 1 (n = 70)	Month 3 (n = 58)	Month 6 (n = 49)
BSI Subscale	Mean (SD)	Mean (SD)	Mean (SD)	Mean difference/Contrast
Somatizationa	0.76 (0.82)	0.75 (0.74)	0.62 (0.70)	χ 2 = 6.70*
				M6 vs. M3*
Obsessive-compulsive	1.21 (0.70)	1.26 (0.81)	1.06 (0.78)	χ 2 = 6.97*
				M6 vs. M3*
Interpersonal sensitivitya	1.04 (0.83)	1.09 (0.77)	0.97 (0.86)	ns
Depression	1.28 (0.78)	1.26 (0.86)	1.12 (0.83)	ns
Anxietya	0.93 (0.79)	0.86 (0.72)	0.77 (0.71)	ns
Hostilitya	0.96 (0.69)	0.99 (0.89)	0.93 (0.74)	ns
Phobic anxietya	0.68 (0.67)	0.63 (0.67)	0.52 (0.65)	χ 2 = 5.88†
				M6 vs. M1†
Paranoid ideationa	1.25 (0.69)	1.34 (0.88)	1.31 (0.85)	ns
Psychoticisma	1.09 (0.78)	1.10 (0.77)	1.07 (0.89)	ns
GSIa	1.04 (0.63)	1.03 (0.65)	0.93 (0.65)	χ 2 = 5.87†
				M6 vs. M3†

Note. SD Standard deviation, M1 Month 1, M3 Month 3, M6 Month 6, ns not significant, BSI Brief Symptom Inventory, GSI Global Severity Index

a Distribution normalized through square root transformation. Descriptive statistics are based on the original data. Mean differences analyses are based on the transformed variables

† p < .10, * p < .05, two-tailed

Full article at:   http://goo.gl/FbBGHB

By:  Gonçalves LC1, Endrass J2,3, Rossegger A1,4, Dirkzwager AJ5.

• 1Department of Mental Health Services, Office of Corrections, Canton of Zurich, Hohlstrasse 552, P.O. Box 8090, Zurich, Switzerland.
• 2Department of Mental Health Services, Office of Corrections, Canton of Zurich, Hohlstrasse 552, P.O. Box 8090, Zurich, Switzerland. Jerome.Endrass@uni-konstanz.de.
• 3Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464, Konstanz, Germany. Jerome.Endrass@uni-konstanz.de.
• 4Department of Psychology, University of Konstanz, Universitätsstrasse 10, 78464, Konstanz, Germany.
• 5Netherlands Institute for the Study of Crime and Law Enforcement, 71304, 1008 BH, Amsterdam, Netherlands. 
• BMC Psychiatry. 2016 Apr 6;16(1):91. doi: 10.1186/s12888-016-0803-z.

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Poor CD4 Count Is a Predictor of Untreated Depression in HIV-Positive African-Americans

AIM:

To determine if efforts to improve antiretroviral therapy (ART) adherence minimizes the negative impact of depression on human immunodeficiency virus (HIV) outcomes.

METHODS:

A cross-sectional study of a clinic-based cohort of 158 HIV seropositive (HIV+) African Americans screened for major depressive disorder (MDD) in 2012. CD4 T lymphocyte (CD4+) counts were obtained from these individuals. Self-report on adherence to ART was determined from questionnaire administered during clinic visits. The primary outcome measure was conditional odds of having a poorer CD4+ count (< 350 cells/mm(3)). Association between CD4+ count and antidepressant-treated or untreated MDD subjects was examined controlling for self-reported adherence and other potential confounders.

RESULTS:

Out of 147 individuals with available CD4+ T lymphocyte data, 31% hadCD4+ count < 350 cells/mm(3) and 28% reported poor ART adherence. As expected the group with > 350 cells/mm(3) CD4+ T lymphocyte endorsed significantly greater ART adherence compared to the group with < 350 cells/mm(3) CD4+ T lymphocyte count (P < 0.004). Prevalence of MDD was 39.5% and 66% of individuals with MDD took antidepressants. Poor CD4+ T lymphocyte count was associated with poor ART adherence and MDD. Adjusting for ART adherence, age, sex and education, which were potential confounders, the association between MDD and poor CD4+ T lymphocyte remained significant only in the untreated MDD group.

CONCLUSION:

Therefore, CD4+ count could be a clinical marker of untreated depression in HIV+. Also, mental health care may be relevant to primary care of HIV+ patients

Demographic and behavioral characteristics of study participants with or without depression

Characteristics	No MDD	MDD treated	MDD untreated	P
	(n = 89)	(n = 38)	(n = 20)
	(%)	(%)	(%)
Gender
Male	63.27	50	60	0.35
Female	36.73	50	40
Age groups
> 55	24.49	5	15	0.12
35-55	62.24	77.5	70
< 35	13.27	17.5	15
Monthly income
0-200	32.61	30.77	33.33	0.32
204-670	17.39	25.64	5.56
672-739	21.74	30.77	27.78
743-2650	28.26	12.82	33.33
Educational status
No college	70.59	78.57	72.73	0.73
College	29.41	21.43	27.27
Accommodation
Yes	60.42	72.50	70	0.35
No	39.58	27.50	30
HIV treatment adherence
No	26.53	25	45	0.51
Yes	48.98	52.50	40
Unknown	24.49	22.50	15
Substance abuse
No	41.84	30	45	0.37
Yes	58.16	70	55
Problem drinking
No	72.45	53.85	45	0.02
Yes	27.55	46.15	55

HIV: Human immunodeficiency virus; MDD: Major depressive disorder.

Full article at:   http://goo.gl/7ob6Eo

By:  Amanor-Boadu S1, Hipolito MS1, Rai N1, McLean CK1, Flanagan K1, Hamilton FT1, Oji V1, Lambert SF1, Le HN1, Kapetanovic S1, Nwulia EA1.

1Sasraku Amanor-Boadu, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States

World J Psychiatry. 2016 Mar 22;6(1):128-35. doi: 10.5498/wjp.v6.i1.128. eCollection 2016.

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Factors associated with Consistent Condom Use among Internally Displaced Women in Leogane, Haiti

OBJECTIVES:

Scant research has examined factors associated with condom use among internally displaced women in postdisaster settings, such as in postearthquake Haiti. The study objective was to examine social ecological factors associated with consistent condom use among internally displaced women in postearthquake Haiti.

METHODS:

A cross-sectional survey was conducted in 2012 with a peer-driven recruitment sample of internally displaced women in Leogane, Haiti. Peer health workers administered tablet-based structured interviews to a convenience sample of 175 internally displaced women.

RESULTS:

The 128 participants who reported being sexually active in the last 4 weeks were included in the analyses. Two-thirds (65.2%) reported consistent condom use in the last month. In multivariate logistic regression analyses controlled for age and income, participants that reported sex work, depression, higher number of sex partners and shorter relationship duration had lower odds of consistent condom use in the past month. Participants who reported no experiences of intimate partner violence, lower self-rated health, higher sexual relationship power and more meals per day, had a higher likelihood of reporting consistent condom use.

CONCLUSIONS:

This research provides the first assessment of contextual factors associated with consistent condom use among women displaced from a natural disaster such as Haiti's 2010 earthquake. Findings demonstrate the importance of social ecological approaches to understand intrapersonal (eg, sex work and depression), interpersonal (eg, relationship power, intimate partner violence and relationship duration) and structural (eg, food insecurity) factors associated with internally displaced women's condom use. Results can inform future sexual health research and interventions in international disaster contexts.

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By:  Logie CH1, Daniel C2, Wang Y3.

• 1Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
• 2Faculty of Social Work, Adelphi University, Garden City, New York, USA.
• 3Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada. 
• Sex Transm Infect. 2016 Mar 31. pii: sextrans-2015-052400. doi: 10.1136/sextrans-2015-052400.

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Depression & HIV Risk among Men Who Have Sex with Men in Tanzania

Studies have shown high rates of depression among men who have sex with men (MSM) in developed countries. Studies have also shown association between depression and HIV risk among MSM. However, very little research has been done on depression among African MSM. 

We assessed depression and HIV risk among a sample of MSM in Tanzania. We reviewed data on 205 MSM who were recruited from two Tanzanian cities using the respondent driven sampling method. Demographic and behavioral data were collected using a structured questionnaire. HIV and sexually transmitted infections data were determined from biological tests. Depression scores were assessed using the Patient Health Questionnaire (PHQ-9). For the analysis, depression scores were dichotomized as depressed (PHQ > 4) and not depressed (PHQ ≤ 4). Bivariate and multivariable Poisson regression analyses were conducted to assess factors associated with depression. 

The prevalence of depression in the sample was 46.3%. The mean (±SD) age of the sample was 25 (±5) years. In bivariate analysis, depression was associated with self-identifying as gay (p = .001), being HIV positive (p < .001: <8% of MSM knew they were HIV infected) and having a high number of sexual partners in the last 6 months (p = .001). 

Depression was also associated with sexual (p = .007), physical (p = .003) and verbal (p < .001) abuse. In the Poisson regression analysis, depression was associated with verbal abuse (APR = 1.91, CI = 1.30-2.81). Depression rates were high among MSM in Tanzania. It is also associated with abuse, HIV and HIV risk behaviors. Thus, reducing the risk of depression may be helpful in reducing the risk of HIV among MSM in Africa. 

We recommend the colocation of mental health and HIV preventive services as a cost-effective means of addressing both depression and HIV risk among MSM in Africa.

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By:  Ahaneku H1, Ross MW2, Nyoni JE3, Selwyn B1, Troisi C4, Mbwambo J5, Adeboye A6, McCurdy S6.

• 1 Department of Epidemiology, Human Genetics and Environmental Sciences , The University of Texas School of Public Health , Houston , TX , USA.
• 2 Department of Family Medicine and Community Health , University of Minnesota , Minneapolis , MN , USA.
• 3 Department of Sociology and Anthropology , University of Dar es Salaam , Dar es Salaam , Tanzania.
• 4 Department of Management, Policy and Community Health , The University of Texas School of Public Health , Houston , TX , USA.
• 5 Department of Psychiatry , Muhimbili University of Health Sciences , Dar es Salaam , Tanzania.
• 6 Department of Health Promotion and Behavioral Sciences , The University of Texas School of Public Health , Houston , TX , USA
• AIDS Care. 2016 Mar;28 Suppl 1:140-7. doi: 10.1080/09540121.2016.1146207. 

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Exposure to Violence & Psychological Well-Being Over Time in Children Affected by HIV/AIDS in South Africa & Malawi

Many of the risk factors for violence against children are particularly prevalent in families and communities affected by HIV/AIDS. Yet, in sub-Saharan Africa, where HIV rates are high, efforts to prevent or address violence against children and its long-lasting effects are hampered by a lack of evidence. 

We assessed the relationship between violence exposure and mental health among HIV-affected children attending community-based organisations in South Africa (n = 834) and Malawi (n = 155, total sample n = 989) at baseline and 12-15-month follow-up. Exposure to violence in the home and in the community was high. HIV-negative children who lived with an HIV-positive person experienced most violence overall, followed by HIV-positive children. Children unaffected by HIV experienced least violence (all p < .05). 

Interpersonal violence in the home predicted child depression, trauma symptoms, lower self-esteem, and internalising and externalising behavioural problems, while exposure to community violence predicted trauma symptoms and behavioural problems. Harsh physical discipline predicted lower self-esteem and behavioural problems for children. Exposure to home and community violence predicted risk behaviour. Over time, there was a decrease in depressed mood and problem behaviours, and an increase in self-esteem for children experiencing different types of violence at baseline. This may have been due to ongoing participation in the community-based programme. 

These data highlight the burden of violence in these communities and possibilities for programmes to include violence prevention to improve psychosocial well-being in HIV-affected children.

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By:  Skeen S1,2, Macedo A3, Tomlinson M1, Hensels IS3, Sherr L3.

• 1 Department of Psychology , Stellenbosch University , Stellenbosch , South Africa.
• 2 Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa.
• 3 Department of Infection and Population Health , University College London , London , UK.
• AIDS Care. 2016 Mar;28 Suppl 1:16-25. doi: 10.1080/09540121.2016.1146219.

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Depression, Posttraumatic Stress & Alcohol Misuse in Young Adult Veterans: The Transdiagnostic Role of Distress Tolerance

BACKGROUND:

Alcohol misuse is common among young adult veterans, and is commonly associated with depression and posttraumatic stress disorder (PTSD). In fact, rates of comorbid depression, PTSD, and problem drinking are high in this population. Although distress tolerance, the capacity to experience and withstand negative psychological states, has been examined as a potential transdiagnostic factor that accounts for the development of mental health disorders, problem drinking, and the comorbidity between these presenting concerns, its role has not been evaluated in a veteran population.

METHODS:

Young adult veterans were recruited for an online survey related to alcohol use. Participants (n=783) completed self-report measures of alcohol use, depression and PTSD symptoms, and distress tolerance. Mediation models were conducted to examine whether distress tolerance mediated the relationship between (1) probable PTSD, (2) probable depression, and (3) comorbid probable PTSD and depression with alcohol misuse. Moderated mediation models were conducted to examine gender as a moderator.

RESULTS:

Significant bivariate associations were observed among mental health symptoms, distress tolerance, and alcohol misuse. Distress tolerance significantly mediated the relationship between probable depression and PTSD (both alone and in combination) and alcohol misuse. Evidence of moderated mediation was present for probable PTSD and probable comorbid PTSD and depression, such that the indirect effect was stronger among males.

CONCLUSIONS:

These results suggest that distress tolerance may be a transdiagnostic factor explaining the comorbidity of depression and PTSD with alcohol misuse in young adult veterans. These findings may inform screening and intervention efforts with this high-risk population.

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By:  Brooks Holliday S1, Pedersen ER2, Leventhal AM3.

• 1RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States. Electronic address: holliday@rand.org.
• 2RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, United States.
• 3University of Southern California, Los Angeles, CA 90089, United States. 
• Drug Alcohol Depend. 2016 Apr 1;161:348-55. doi: 10.1016/j.drugalcdep.2016.02.030. Epub 2016 Feb 27.

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