Rate four times the national average in this population
By Molly Walker,
May 08, 2017
SAN DIEGO — Women living with HIV had a lifetime prevalence of post-traumatic stress disorder four times the national average, according to a small study examining women from an urban HIV clinic.
Overall, 43.1% of participants met diagnostic criteria for lifetime PTSD, while the national prevalence for women is estimated at 10%, reported Keemi Ereme, MPH, of Howard University College of Medicine in Washington, D.C., and colleagues.
In addition, one in five women living with HIV met the diagnostic criteria for current PTSD, they said.
At a presentation at the American College of Obstetricians and Gynecologists meeting here, Ereme argued that the prevalence of trauma is five times higher among women living with HIV than in the general population of U.S. women. She added that anxiety and depression are 2-to-4 times more prevalent than in non-HIV infected women and intimate partner violence is more than twice the national prevalence.
“PTSD can lead to negative health outcomes among these women, such as missed appointments, poor medication adherence, and mental health comorbidities,” she explained.
Ereme and colleagues conducted a cross-sectional study that originally set out to examine drinking habits of women living with HIV. Participants were recruited from the Johns Hopkins HIV Clinic in Baltimore from 2006 to 2010 and were administered the structured clinical interview for the DSM-IV (SCIDS).
Ereme said most participants were from similar backgrounds: middle-aged black women who were unemployed with a high school education or less and living below the poverty level. There were no statistically significant differences between women in the study with no trauma, women with trauma but no PTSD, and women with diagnosed lifetime PTSD. However, Ereme noted that approximately a third of participants with PTSD had a detectable viral load, even when prescribed antiretroviral therapy.
One of the strongest predictors for PTSD, Ereme said, is childhood trauma and sexual assault. The large majority of women (82.3%) experienced at least one trauma. Rape was the most common form of trauma (39.3% of participants experiencing trauma) and around a quarter of women were raped or molested prior to the age of 17. This was much higher than the 1 in 6 women who have been raped in the general population, Ereme noted.
The next most common forms of trauma were physical assault and seeing violence occur.
Ereme said that PTSD is “rarely a solitary diagnosis” and is associated with comorbid conditions, such as major depressive disorder, anxiety disorder, and bipolar disorder. Of these, major depressive disorder was the most common comorbid psychiatric diagnosis. Nearly half of participants had major depressive disorder at some point in their lifetime, and 12.3% had a current diagnosis of the condition.
When asked if these results were surprising, Richard Beigi, MD, chief medical officer of Magee-Women’s Hospital at UPMC in Pittsburgh told MedPage Today via email that they were somewhat surprising, but noted that “comparative data were not provided.”
“Abuse rates are shockingly high in many patient populations, this being one of them,” he said. “Abuse clearly takes a major toll on women and efforts at prevention are clearly warranted.”
Ereme said that given the demographics of the patient population, even if a woman had no personal trauma, she was still living in a “highly stressful environment.”
She called for “more sensitive screening for community stress as part of an overall assessment strategy to treat this vulnerable group,” such as community-wide public health initiatives. She also called for “structural interventions” that could help locate and resolve social, economic, political, and environmental problems negatively effecting the individual and community.
Beigi said he did not believe that providers routinely screen for this condition “and these data suggest that it would be wise to do so, especially in this population.”
American College of Obstetricians and Gynecologists
Source Reference: Ereme K, et al “An examination of posttraumatic stress disorder (PTSD) among women living with HIV (WLHIV)” ACOG 2017; Abstract 15OP.