在精神健康服務使用者中的愛滋病毒感染率是一般人的兩倍多
何塞·卡洛斯·梅希亞·阿塞里亞斯 / 2023 年 9 月 8 日 /aidsmap
馬雷克金舍 | Mareike Günsche www.aspect-us.com
最近的一項研究顯示，在倫敦南部接受心理健康服務的人感染愛滋病毒的可能性是同一地理區域一般人群的 2.5 倍。 研究人員發現，每 1000 名接受心理健康服務的人中就有 25 人被記錄為愛滋病毒診斷記錄，而一般人群中這一比例為 1000 人中的 10 人。
研究發現，2007 年至 2018 年間，在南倫敦和莫茲利 (SLaM) NHS Trust 獲得二級服務的人中有 2.5% (4,481) 在國家愛滋病毒監測數據中記錄了愛滋病毒診斷記錄。 此外，該研究提供的證據顯示，患有特定心理健康疾病的人的愛滋病毒感染率較高，例如物質障礙（3.8％）、情緒障礙（2.8％）以及神經質、壓力相關和心身障礙（2.7％ ）。
倫敦國王學院的 Margaret Heslin 博士及其同事在 BMJ Open 上發表的研究是首次嘗試測量英國心理健康服務使用者中愛滋病毒的盛行率。 先前的國際研究強調，精神疾病患者的心血管和代謝健康結果較差。 儘管如此，除了有關精神病和藥物使用障礙患者感染血源性病毒風險增加的數據外，幾乎沒有關於傳染病的證據。
2007 年至 2018 年間，181,177 名首次在 SLaM 獲得服務的人的電子記錄進行了匿名處理，並與英國衛生安全局持有的國家愛滋病毒監測數據進行了比較和匹配。 這顯示，4,481 人 (2.5%) 在接觸 SLaM 之前、期間或之後被診斷出愛滋病毒，SLaM 是該地區二級心理保健（初級保健中不提供的服務）的主要提供者。
該研究使用了人們心理健康記錄中最新的主要心理健康診斷，並納入了沒有正式心理健康診斷的人群類別。 研究參與者的平均年齡為34歲，75%的參與者是男性，34%是英國白人。
在4,481 名使用心理健康服務且有愛滋病毒診斷記錄的人中，18%（784 人）被診斷為物質障礙，15%（683 人）被診斷為情緒障礙，13%（585 人）被診斷為神經質、壓力相關和心身障礙病症診斷。 患有學習或語言障礙和自閉症等心理發展障礙的人是唯一一個盛行率低於一般人群（低於 1%）的診斷群體。
就何項疾病先被診斷而言，在研究期間首次獲得心理健康服務並被診斷出愛滋病毒的2,239 人中，33% 的人在愛滋病毒診斷前接觸過心理健康服務， 67%的人在接觸心理健康服務之前就被診斷出愛滋病毒。
必須承認的是，SLaM 在蘭貝斯和薩瑟克開展業務，這兩個地區是該國愛滋病毒感染率最高的地區。 這意味著其他地理區域的心理健康服務使用者感染愛滋病毒的可能性可能低於倫敦南部，但仍可能高於當地一般人。
心理健康診斷通常需要時間，在許多情況下，人們已接受了服務評估和檢查，但可能尚未被確定診斷。 然而，研究顯示，即使排除了 1,188 名沒有明確心理健康診斷的人（27%），感染愛滋病毒的可能性仍然高於一般人群（2.3%）。
可能需要更多的研究來探索先前記錄的心理健康診斷以及雙重診斷和共病的模式，因為該研究僅使用了人們最近的診斷。
這項研究提供了英國一個被忽視的研究領域的關鍵數據，並提供了心理健康服務使用者中愛滋病毒感染率較高的證據。 然而，性健康和心理健康之間的關聯很複雜——盛行率增加可能是因為有心理健康需求的人感染愛滋病毒的風險更高，或者愛滋病毒感染者罹患精神疾病的風險更高。
「研究人員強調需要更好地解決或支持使用心理健康服務者其性健康上的需求」。
一些社會因素和不平等現象與愛滋病毒和精神疾病的風險增加有關，從而產生了同時發生的可能性，而在考慮到這兩種情況的患病和診斷之間的時間延遲時，很難區分這種可能性。 此外，該研究報告的愛滋病毒盛行率可能被低估，因為它只考慮了已被診斷的族群。
研究人員主張在非愛滋病毒專業服務中提供愛滋病毒檢測，並強調需要更好地解決或支持使用心理健康服務者的性健康需求，包括性健康檢測、治療和預防。 他們強調了綜合愛滋病毒和精神健康服務的必要性，以及在精神健康照護計畫中了解和考慮愛滋病毒的重要性。
理想情況下，整合意味著心理健康服務可以提供常規愛滋病毒檢測以及與治療和照護的聯繫，擁有一支了解性健康的員工隊伍，並將愛滋病毒納入藥物審查和照護計畫。 同樣，愛滋病毒服務機構將擁有一支了解心理健康的員工隊伍，提供常規心理健康篩檢、提供較低階之支持、與心理健康服務聯繫，並在人們的照護計畫中考慮心理健康診斷和藥物治療。
根據不同的指導方針，其中一些事情本來就應該發生，但尚不清楚它們會發生到什麼程度。 增加和改善性健康和心理健康服務之間的整合可以減少愛滋病毒感染者和精神疾病患者群體的健康差距。
參考文獻：
Heslin M 等人。 心理健康服務使用者中愛滋病毒的盛行率：一項回顧性世代研究。 BMJ Open 13：e067337，2023（開放獲取）。 doi: 10.1136/bmjopen-2022-067337
HIV is more than twice as common in mental health service users
José Carlos Mejía Asserias / 8 September 2023 / aidsmap
Mareike Günsche | www.aspect-us.com
People who access mental health services in south London are 2.5 times more likely to have HIV than the general population in the same geographical area, according to a recent study. Researchers found that 25 in 1000 people who use mental health services had a recorded HIV diagnosis, compared with the 10 in 1000 rate in the general population.
The research found that 2.5% (4,481) of people who access secondary services at South London and Maudsley (SLaM) NHS Trust between 2007 and 2018 had a recorded HIV diagnosis in the national HIV surveillance data. Additionally, the research provided evidence of higher HIV rates for people with specific mental health diagnoses such as substance disorders (3.8%), mood disorders (2.8%) and neurotic, stress-related and psychosomatic disorders (2.7%).
This study by Dr Margaret Heslin and colleagues from King’s College London published in BMJ Open is the first-ever attempt to measure the prevalence of HIV in mental health service users in the UK. Previous international studies have highlighted poorer cardiovascular and metabolic health outcomes in people with mental ill health. Still, there is little evidence about infectious diseases apart from data on the increased risk of blood-borne viruses in people with psychosis and substance use disorders.
Between 2007 and 2018, electronic records from 181,177 people accessing services for the first time at SLaM were anonymised, compared and matched with national HIV surveillance data held by the UK Health Security Agency. This showed that 4,481 people (2.5%) had an HIV diagnosis, before, during or after their contact with SLaM, which is the main provider of secondary mental health care (services not provided in primary care) in the area.
The study used the most recent primary mental health diagnosis in people’s mental health records and included a category for people without a formal mental health diagnosis. The average age of the study participants was 34 years old, 75% of participants were men and 34% were White British.
Of the 4481 people using mental health services with a recorded HIV diagnosis, 18% (784 people) had a diagnosis of substance disorder, 15% (683) of mood disorder and 13% (585) had a neurotic, stress-related and psychosomatic disorder diagnosis. People with psychological development disorders like learning or language disorders and autism were the only group of diagnoses with a lower prevalence than the general population (less than 1%).
In terms of which diagnosis came first, of the 2239 people who both accessed mental health services for the first time and had their HIV diagnosis during the study period, 33% of them had contact with mental health services before the HIV diagnosis, and 67% of them had their HIV diagnosis before coming into contact with mental health services.
It is important to acknowledge that SLaM operates in Lambeth and Southwark, the two areas with the highest HIV rates in the country. This means the likelihood of HIV in mental health service users of other geographical areas might be lower than in south London, but potentially still higher than that of the general population in their local area.
Mental health diagnosis often takes time and, on many occasions, people are assessed and seen by the service but might have not yet been diagnosed. However, the study showed that even when removing the 1188 people (27%) who had no identified mental health diagnosis, the likelihood of HIV continued to be higher (2.3%) than that of the general population.
More research might be needed to explore previously recorded mental health diagnoses and patterns of dual diagnosis and co-morbidities, as the study only used people’s most recent diagnoses.
This study provides critical data on an overlooked area of research in the UK and presents evidence of the higher rates of HIV amongst mental health service users. However the links between sexual and mental health are complex – the increased prevalence may be because people with mental health needs have a higher risk of acquiring HIV, or that people with HIV have an increased risk of developing mental ill health.
“The researchers highlight the need to better address or support the sexual health needs of people who use mental health services.”
There are social factors and inequalities that are associated with an increased risk of both HIV and mental ill health, creating a likelihood of co-occurrence that is hard to pick apart when considering the time delay between illness and diagnosis for both conditions. Furthermore, the prevalence of HIV reported in the study might be an underestimate, as it only accounts for people who have been diagnosed.
The researchers advocate for providing HIV testing in non-HIV specialist services and highlight the need to better address or support the sexual health needs of people who use mental health services, including sexual health testing, treatment, and prevention. They highlight the need for integrated HIV and mental health services and the importance of HIV being known and considered in mental health care plans.
Ideally, integration would mean mental health services can provide routine HIV testing, and links to treatment and care, have a workforce that is aware of sexual health, and include HIV in medication reviews and care planning. Similarly, HIV services would have a workforce that is aware of mental health, provide routine mental health screening, offer low-level support, connect with mental health services, and consider mental health diagnosis and medication in people’s care plans.
Some of these things are meant to happen already according to different guidelines, but it isn’t clear to what extent they do. Increasing and improving the integration between sexual health and mental health services can reduce health disparities in the cohorts of people living with HIV and people with mental ill health.
References
Heslin M et al. Prevalence of HIV in mental health service users: a retrospective cohort study. BMJ Open 13: e067337, 2023 (open access). doi: 10.1136/bmjopen-2022-067337