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Use of Mental Health and Substance Abuse Treatment Services Among Adults With HIV in the United States
M. Audrey Burnam, PhD;
Eric G. Bing, MD, PhD, MPH;
Sally C. Morton, PhD;
Cathy Sherbourne, PhD;
John A. Fleishman, PhD;
Andrew S. London, PhD;
Benedetto Vitiello, MD;
Michael Stein, MD;
Samuel A. Bozzette, MD, PhD;
Martin F. Shapiro, MD, PhD
Arch Gen Psychiatry. 2001;58:729-736.
Background The need for mental health and substance abuse services is great among
those with human immunodeficiency virus (HIV), but little information is available
on services used by this population or on individual factors associated with
access to care.
Methods Data are from the HIV Cost and Services Utilization Study, a national
probability survey of 2864 HIV-infected adults receiving medical care in the
United States in 1996. We estimated 6-month use of services for mental health
and substance abuse problems and examined socioeconomic, HIV illness, and
regional factors associated with use.
Results We estimated that 61.4% of 231 400 adults under care for HIV used
mental health or substance abuse services: 1.8% had hospitalizations, 3.4%
received residential substance abuse treatment, 26.0% made individual mental
health specialty visits, 15.2% had group mental health treatment, 40.3% discussed
emotional problems with medical providers, 29.6% took psychotherapeutic medications,
5.6% received outpatient substance abuse treatment, and 12.4% participated
in substance abuse self-help groups. Socioeconomic factors commonly associated
with poorer access to health services predicted lower likelihood of using
mental health outpatient care, but greater likelihood of receiving substance
abuse treatment services. Those with less severe HIV illness were less likely
to access services. Persons living in the Northeast were more likely to receive
services.
Conclusions The magnitude of mental health and substance abuse care provided to
those with known HIV infection is substantial, and challenges to providers
should be recognized. Inequalities in access to care are evident, but differ
among general medical, specialty mental health, and substance abuse treatment
sectors.
From RAND, Santa Monica, Calif (Drs Burnam, Morton, Sherbourne, Bozzette,
and Shapiro); Center for AIDS Research, Education and Services and Collaborative
Alcohol Research Center, Charles R. Drew University of Medicine and Science,
Los Angeles, Calif (Dr Bing); Agency for Healthcare Research and Quality,
Rockville, Md (Dr Fleishman); Department of Sociology, Kent State University,
Kent, Ohio (Dr London); National Institute of Mental Health, National Institutes
of Health, Bethesda, Md (Dr Vitiello); Brown University Medical School and
Rhode Island Hospital, Providence (Dr Stein), Veterans Administration Medical
Center, La Jolla, Calif (Dr Bozzette); and the Division of General Internal
Medicine, Department of Medicine, University of California, Los Angeles (Dr
Shapiro).
Corresponding author and reprints: M. Audrey Burnam, PhD, RAND, 1700
Main St, PO Box 2138, Santa Monica, CA 90407-2138 (e-mail: aburnam{at}rand.org).
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Arch Gen Psychiatry. 2001;58(8):721-728.
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