How collaborative care can combat depression in patients living with HIV
With advancements made in HIV medication, more people are living longer with HIV rendering it a chronic disease for those on therapy.
Depression is a prevalent mental health disorder that can have a profound impact on an individual’s overall health.1-2 Depression is associated with diminished health status and increased healthcare utilization, leading to increased healthcare costs.3 Major depression is common among those living in poverty, as well as those who suffer from a chronic disease, such as cancer, heart failure, or chronic infections.4-5 With advancements made in HIV medication, more people are living longer with HIV rendering it a chronic disease for those on therapy.6 Major depression is prevalent in people living with HIV, with over 50% of people living with HIV reporting depressive symptoms in the past week in some studies.7-9 Additionally, engaging depressed people living with HIV with mental health care has been difficult, with one study indicating that 82% of people living with HIV with depression were not receiving any treatment.10 In people living with HIV, depressive symptoms have been associated with reduced HIV self-management behaviors, such as medication adherence and engagement in care, which can lead to increased morbidity and mortality.11-19
Evidence-based treatment strategies for reducing depressive symptoms include medication, psychotherapy, and self-management strategies.8 Effective treatment of depression leads to fewer depressive symptoms, increased medication adherence, and HIV viral suppression.18-19 Primary care clinics often provide some form of depression treatment yet only a minority of individuals in these settings are accurately diagnosed. Further, of those that are treated, few receive adequate dosing or duration of medication or psychotherapy.20-22 A recent study reported that 45% of people living with HIV had residual depressive symptoms despite taking an antidepressant, indicating that pharmacologic depression management alone may not always be clinically efficacious.23 Recent studies have investigated the use of self-management techniques, such as behavioral activation plans and self-monitoring techniques as an adjuvant treatment method. These studies have yielded promising results, with patients feeling more empowered and in control of their own care.22 Self-care and self-management strategies can not only increase patient engagement but also build their capacity to manage their own mental health crises.
As HIV has become a chronic disease, the use of collaborative care model for treating depression in HIV primary care is promising and should be investigated.
The collaborative care model has been shown to improve the process of delivering mental health care, depression outcomes, and physical health outcomes in primary care settings. Key aspects of this model include routine screening with a standardized scale, regular re-measurement to track treatment response, intensification of treatment based on response, care managers to assist with engagement in care and facilitation of treatment, use of an electronic registry to help monitor patients and track outcomes, and regular consultation with a psychiatrist for treatment recommendations.22, 24-25 In a review of the collaborative care model, researchers found it resulted in enhanced quality of care and improved depression-based outcomes, such as increased anti-depressant medication adherence and a decrease in depressive symptoms.22 The collaborative care model for depression also improves depressive outcomes in patients with chronic disease, such as diabetes and coronary artery disease. As HIV has become a chronic disease, the use of collaborative care model for treating depression in HIV primary care is promising and should be investigated.