women, mental health, and hiv · 2018. 3. 18. · what is mental health? • refers to emotional,...

Women,MentalHealth,andHIV

Together,wecanchangethecourseoftheHIVepidemic…onewomanatatime.

#onewomanatatime #thewellprojectwww.thewellproject.org

WhatisMentalHealth?

• Referstoemotional,psychological,socialwell-being• Affectsthewaypeoplethink,feel,act• Helpsdeterminehowpeoplehandlestress,relatetoothers,makechoices

• Goodmentalhealthisasenseofwell-being,confidence,self-esteem

• Mentalhealthproblemscanchangehowwellpeoplefunctionatwork/home

www.thewellproject.org

MentalHealthandHIV

• ForpeoplelivingwithHIV(PLWH),mentalhealthproblemscanaffectphysicalhealth;can– MakeithardertotakeHIVmedicationsontime– Makeithardertokeepappointments/takeadvantageofsupportnetwork

– Interferewithhealthybehaviors– Impairabilitytocopewiththestressesofdailylife

• PLWH athigherrisktodevelopmood,anxiety,cognitivedisorders– Conditionsaretreatable– Peoplewhoexperiencementalhealthproblemscangetbetterandmanyrecovercompletely!!


WhatIsDepression?

Beingdepressed:Whensomeonefeelsdown,sad,blue,unhappy,hopelessTheseareallnormalfeelings;almosteveryone experiencesthemsometimes

Ifthesefeelingsbecomeoverpowering,disabling,or

long-lasting,theymaybeasignofdepression


WhatIsDepression?

• Comparedtosadness,depressionis:– Moreintense– Lastslonger(morethan2weeks)– Interfereswithyourday-to-dayabilitytofunction– Adiagnosisbasedonhavingcertain#ofspecificsymptoms– NotanormalpartoflivingwithHIV– Cancausesomeserioushealthproblems

• Consulthealthcareproviderif:– Showingsymptomsofdepression(nextslide)– Unsureiffeelingsyouareexperiencingarenormal


SomeSymptomsofDepression

• Changesinappetiteorweight,and/orsleepingpatterns• Achesorpainsfornoclearreason• Episodesofcryingfornoclearreason• Feelingsadness,guilt,hopelessness,worthlessness• Irritability;gettingintoargumentseasily• Lackofpleasureinactivitiesthatusuallyinterestyou• Lowsexdrive• Difficultymakingdecisionsorconcentrating• Fatigueorlossofenergy• Thoughtsofharmingoneselforcommittingsuicide


SomeSymptomsofDepression

• Nottakingcareofyourselfintermsofgrooming,dressing,andpersonalhygiene

• Skippingornotgoingtowork,callinginsick• Beingverycriticalanddownonyourself• Nottalkingtoorgoingoutwithfriends• Notjoiningyourusualsocialactivitiesorhobbies• Cryingorfeelinglikecryingmoreoftenthannormal– Oftenwithoutknowingwhy

• Usingmorealcoholorotherrecreationaldrugs– Sometimessubstanceusehidesdepression (self-medicating)


WomenandDepression

Womenare2xaslikelytobedepressedthanmen –possiblydueto:• Burdenmanywomenbearasprimarycaregiver• Havinglesshouseholdincome,education,socialsupport

• Stronglinkbetweendepressionandviolenceagainstwomen(physical,sexual,oremotional)

• Depressionalsolinkedtoincreasingyoungwomen'sriskofgettingHIV


DepressioninWomenLivingwithHIV

WomenlivingwithHIV(WLHIV)evenmorelikelytosufferfromdepression• GettinganHIVdiagnosisislife-changing;canbedifficulttohearandaccept;somemayfeel:– Overwhelmed,helpless,unabletocopewithanHIVdiagnosis

– Afraidforfuturehealth,disclosingHIVstatustofriends,family

• ThestigmathatmanywomenlivingwithHIVexperiencemayleadtosocialisolationandloneliness

• Allthesefeelingsarekeyelementsofdepressionwww.thewellproject.org

DepressioninWLHIV

• ManywomenlivingwithHIVexperienceotherlargelifestressorsthatcanleadtodepression:– Racialdiscrimination– Poverty– Violence– Singleparenthood

• HIVitselfmaycontributedirectlytodepression– PeoplelivingwithHIV(PLHIV)whohaveHIVincerebral-spinalfluidthatsurroundstheirbrainandspinalcordarealmost5xmorelikelytoexperiencenew-onsetdepression


DepressionandOlderWLHIV

AsHIVtreatmentshaveimproved,moreandmoreolderwomenarelivingwithHIV• Growingolderofteninvolvesitsownlifechallengesthatcanleadtofeelingsofsadnessordepression:– Chronicdisease– Disability– Lossoflovedones

• Onestudyshowedthatmorethan6in10WLHIVages50- 76yearsold sufferedfromdepression


DepressionCanCauseSeriousProblems

StudiesshowdirectconnectionbetweendepressionandpoorerhealthforthoselivingwithHIVWLHIVwhoaredepressed:• SeekHIVcarelessoften• HavemoretroublestickingwiththeirHIVdrugregimens• Havemorerapiddiseaseprogression• Maymissdrugdoses,takewrongdose,ordoseatwrongtime• NottakingHIVdrugsregularlycanleadtothedevelopmentof

resistance,leadingCD4counttodropand/orviralloadtogoup


GettingHelpCanMakeaBigDifference

• Onestudyshowedriskofdeathcutinhalfforthosewomenwhomadecontactwithamentalhealthprovider

• Importantthatdepressionbediagnosedandtreatedasquicklyaspossible toavoidseriousproblems


TreatmentOptions

Thegoodnewsisthatdepressionistreatable• Whileitistruethatdepressioncangetbetteronitsown,thiscantakemonthsorevenyears

• TreatmentwilllikelyshortenthetimeittakestofeelbetterandmayhelpwithadherencetoHIVdrugs

• Treatingdepressioncanhelpfromlosingajob,arelationship,orevenone’slife


Psychotherapy

• Variousmentalhealthprofessionalscanprovidepsychotherapy• Talkingtoatrainedprofessionalaboutwhatyouare

experiencing• Therapistprovidessupport,helpsyouunderstandwhatis

troublingyou• Mostpsychotherapyoccursone-on-one;grouptherapycanalso

behelpfulforsome• InU.S.,mentalhealthprofessionalswhoprovidepsychotherapy

includepsychologists,psychiatrists,socialworkers,marriageandfamilytherapists,mentalhealthcounselors


AntidepressantMedications

• Oftenprescribedfordepressionoranxiety• Manyantidepressantandanti-anxietydrugscaninteractwithsomeHIVdrugs– Talktoyourproviderbeforestartinganynewmedications– GenerallysafesttypeofantidepressantsforusewithHIVdrugsisselectiveserotoninre-uptakeinhibitors(SSRIs):• Celexa (citalopram),Lexapro(escitalopram),Luvox(fluvoxamine),Prozac(fluoxetine),Paxil(paroxetine),andZoloft(sertraline)

– DONOTtakeSt.John'sWort(popularherbalantidepressant)• Affectsimmunesystem;interactswithmanyHIVdrugs


GetCheckedandTreatedforDepression

• Ifexperiencingsymptomsofdepression:– Talktoprovider– Askforreferraltoseeamentalhealthprofessional– Canimproveyourhealth,qualityoflife,includingadherence

• Whilesomedon’tbelieveinmentalhealthcare,problemsorinjuriesrequiretreatment,whethertheyarephysicalormental– Whenweexperienceemotionaldifficulty,thereisnoneedtosufferwheneffectivetreatmentisavailable


StressManagement

• Everyonedealswithacertainamountofstress• ForWLHIV,stresscanbecomeoverwhelming– Highstresscandamageyourimmunesystem, causephysical/emotionalillnesses

– ResearchshowsstresscanspeedupprogressionofHIV


PhysicalSignsofStress

• Allergies• Changeinappetite• Backpain• Highbloodpressure• Shortnessofbreath• Chestpain• Clammyhands• Morecoldsthannormal• Constipation• Diarrhea

• Dizziness• Fatigue• Headaches• Racingheartbeat• Muscletension• Nightmares• Rashes• Restlessness• Sleepingproblems• Stomachacheswww.thewellproject.org

EmotionalandBehavioralSignsofStress

Emotional• Anger• Anxiety• Denialofaproblem• Difficultymakingdecisions• Loneliness• Nervousness• Feelingpowerless• Feelingrejected• Feelingtrapped• Feelingunhappyfornoreason• Beingeasilyupset• Worryingfrequently

Behavioral• Increasingalcohol,tobacco,druguse• Nottendingtophysicalappearance• Arguingwithfriendsorfamily• Avoidingtasksandresponsibilities• Difficultyconcentrating• Cryingeasily• Beinglatetowork• Eatingtoomuchornotenough• Snappingatpeople• WatchingmoreTV• Withdrawingfromfamily/friends


DecreasingStress

• Whileyoumaynotbeabletoremoveyourstressors,rememberthatyouarehumanandunderstandyouneedhelp

• Makealistof:– Areasinwhichyoufeeloverwhelmedandneedhelp

–Whoorwhatcanhelp– Howtogetavailableservices


FindingHelp

• Medicalservices• Counseling/psychological

help• Childcare• Taxirides• Buspasses• Acupuncture• Yogaclasses

• Communitycollegeclasses• Massage• Supportgroups• Datingservicesforpeople

livingwithHIV• Freecomputers• Legalservices• Drugandalcoholprograms


Freeorlowcostservicesthatcanhelpwithstressinclude:

SocialSupport

• Forallareasofmentalhealth,itmayalsobehelpfultoseeksupportofotherWLHIV– Supportgroups– Peercounseling– TheWellProject’sonlineblogforwomenlivingwithHIV,AGirlLikeMe

• SocialsupportfromfriendsandfamilyhasbeenfoundtohelppeoplewithHIVavoiddepression,copebetter– Friendsandfamilycanalsoprovideemotionalsupport


OtherTreatment

• Meditation,massage,yoga,breathing,relaxationexercisescanhelpwithmentalhealth,depression,stress

• Acupunctureandacupressuretherapiesmayhelpreducestress,improvemood

• Mindfulnesstechniquesmayhelpyougetbackintouchwithwhatmakeslifeworthliving– Somehavebeencombinedwithtraditionalpsychotherapy,shownveryeffective(e.g.,mindfulness-basedcognitivetherapy)

• Goodnutritionandphysicalactivityarebeneficial,nomatterwhichtreatmentsarechosen


• Tolearnmore,andforlinkstoarticlesfeaturingmoredetails,pleasereadthefullfactsheet:– Depression,Women,andHIV– StressManagement

• FormorefactsheetsandtoconnecttoourcommunityofwomenlivingwithHIV,visit:– www.thewellproject.org– www.facebook.com/thewellproject– www.twitter.com/thewellproject


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women, mental health, and hiv · 2018. 3. 18. · what is mental health? • refers to emotional,...

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