Results of anxiety and depression

screening as part of routine HIV care

Marie Jose Kleene Nurse Practitioner

Barcelona8 September 2018

Kees Brinkman

Guido van den Berk

Erik van Gorsel

Jeroen Lijmer

Ineke Schouten

Daoud Ait Moha

Disclosure

Conflict of Interest : none

Background

• More attention for health related QoL in general

• Anxiety and depression frequent comorbidities in HIV

• More focus on mental health disorders

Mortality :causes of death HIV patients OLVG 2011-2016

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

trombosis

respiratory failure

cva

pneumonia

sepsis

livercirrosis

other

unknown

suicide

cvd

oncology

N=121

Suicide

Suicide remains an important cause of death in OLVG

(12%)

Methods

• Standard evaluation mental health in hiv care

path (VBHiC)

• Hospital Anxiety Depression Scale (HADS)

• Retrospective data collection• november 2016-december 2017

• OLVG cohort (>3000 patients)

• All patients with complete HADS score

• Analysis of outcomes

Hospital & Anxiety Depression Scale

HADS

• 14 items

• - 2 subscales 7 items each

• Scores range from 0 to 42

• Higher scores represent more distress

• > 15 points ( total scale) potential mental disorder

• Protocol: HADS > 15 needs action = “referral”

depression

Anxiety

Example: HADS in invidual patient

HADS = 27

questionnairesnovember 2016 - december 2017

• > 1800 questionnaires distributed

• 1091 complete questionnaires (response rate 60.3%)

• 1032 male (94.6 %)

• median age 50.9 yrs (range 20-81)

HADS evaluation

N=1091

HADS <12

N=665

HADS 12-15

N=128HADS >15

N=298(27.3%)

not referred

N=242(81.2%)

referred

N=56(18.79%)

no psychiatric

diagnosis

N=4(1.34%)

ongoing

N=4( 1.34%)

new psychiatric

diagnosis

N=48(16.11%)

discussed:

no referral

N=110( 36.9%)

not discussed

N=83(27.9%)

care elsewhere

N=49(16.4%)

New diagnoses HADS score>15, n=48

0

2

4

6

8

10

12

14

16

18

20

Diagnoses

Discussion/ limitations

• Not all questionnaires are returned by patients

• More analysis on missing scores necessary

• In 83 of the cases the score was not discussed during the

outpatient visits

Conclusion

• Screening on mental health in HIV patients is feasible

• An elevated HADS score > 15 was observed (27.3%).

• Regular assessment of mental health leads to earlier

recognition of psychiatric disorders.

• In most other cases the HADS initiated a conversation

between doctor and patient about his/her mental health.

:acknowledgements:

OLVG HIV care teamKees Brinkman

Guido van den Berk

Ineke Schouten

Jos Frissen

Willem Blok

Jan Veenstra

Kamilla Lettinga

Klaas Hoeksema

Narda van der Meche

Anneke Brouwer

Susanne Wijnands

Angelique Toonen

Gijs Geerders

Maria Knapen

Lisette Mulder

Daoud Ait Moha

Ineke Grolle