Use of Depression Services Differed by Demographics in People Living With HIV

People living with HIV (PWH) are twice as likely to be living with depression compared with those who do not have HIV,1 making depressive services important for this demographic. However, significant demographic differences were found in PWH who used depression treatment services, according to a new study published in the Journal of Affective Disorders,2 indicating a potential difference in outcomes for PWH of various backgrounds.

The use of depression services varied by demographic data in people living with HIV | Image credit: H_Ko - stock.adobe.com

The disproportionate rates of depression in PWH are likely related to their condition as well as any other biological reasons that could lead to depression, making treatment vital for increasing an individual’s quality of life. However, access to this treatment, as well as inclination toward receiving it, is less consistent. This study aimed to assess the clinical characteristics and sociodemographics that are associated with the use of depression treatment in PWH who have been diagnosed with depression.

The electronic health records of Kaiser Permanente Northern California were used for this study, as the number of PWH enrolled has increased, and depression services are usually a covered benefit offered both in person and virtually. Smoking status and alcohol use are screened annually in all patients and included in their electronic health record. All participants were a part of the HIV registry that includes a list of all PWH, their date of infection, transmission risk factors, diagnoses of AIDS, and data related to HIV from both the lab and pharmacy. All participants were aged 18 years or older and had a primary care encounter between January 1, 2014, and December 31, 2020. All participants also needed to have a depression diagnosis based on the International Classification of Diseases and to be active members of Kaiser Permanente for 1 year after the index date. The index date was the date of the patient’s screening for alcohol.

Any prescription fills or any outpatient or telehealth encounters in the Department of Psychiatry were noted for each participant. Sociodemographic data were also collected, including age, race/ethnicity, and sex. The Charlson comorbidity index was used to assess medical comorbidities.

There were 3078 patients with HIV who were included in this study, of which 24.7% had depression within 6 months of a primary care encounter. A total of 52.6% of the population was aged at least 50 years, and 10.5% were women; 56.1% were White. Hazardous alcohol use was reported in 8.8% of the participants, and moderate use in 27.6%; 19% reported smoking.

A total of 35.0% of the 761 participants with depression had at least one mental health encounter within a year of their index date, and 67.7% had an antidepressant filled. Those who were older than 40 years had lower odds of a mental health encounter compared with those aged 40 years or younger. Antidepressant fills and depression treatment were less likely to occur for Black, Hispanic, or Asian patients when compared with White patients. Drinking and smoking were not associated with use of depression treatment.

There were some limitations to this study. The study was conducted in an integrated health care system, which could allow for easier access to depression treatment and longer windows of evaluation. Data on employment status were not available for the study. Alcohol and smoking use were based on self-report and could be biased. Any care that was not covered by insurance may not have been captured in this study. Anti-depression medications have other uses and may have overestimated the number of patients using prescribed medication to address their depression.

The authors concluded that racial and ethnic minority status was linked to the likelihood of receiving depression treatment in PWH, as well as the age of the patient. “Additional efforts need to be made to facilitate access to and use of depression treatment services for older PWH and racial and ethnic minority individuals in a holistic way when receiving medical care,” the authors concluded.

References

1. HIV and mental health. HIVinfo. Updated November 13, 2024. Accessed July 8, 2025. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-mental-health

2. Metz VE, Kline-Simon AH, Levine T, et al. Sociodemographic and clinical factors associated with use of depression treatment among people with HIV in the United States: an electronic health records-based cohort study. J Affect Disord. Published online July 5, 2025. doi:10.1016/j.jad.2025.119815