Depression and using party drugs boost emergency room use in people with HIV.
Current depression * and party drug use--separately or together--boosted chances that people with HIV would visit an emergency room in a 3482-person study. (1) Researchers determined that more than half of these emergency-room visits could have been avoided.Nearly half of people with HIV use party drugs or have depression (feeling sad or hopeless much of the time). Both can have a negative impact on care for HIV infection and can pose other health-related dangers, including a higher death risk.
Yet depression often goes undetected in people with HIV, (2) and they often avoid discussing party drug use with their HIV provider. As a result, depression and drug use often go untreated in HIV-positive people, even though there are effective strategies to control both conditions.
Research in the general population links depression and party drugs to higher use of hospital emergency departments. (3) Health workers in Ontario, Canada conducted this new study to see if depression and party drug use have the same impact on emergency-room use by people with HIV
How the study worked. people in an HIV study group who were in care in Ontario for at least 1 year from October 2007 through March 2013. Everyone completed regular interviews about health-related issues including party drug use. Researchers used standard tests to determine who currently had depression.
The research team divided study participants into four groups: (1) current depression only, (2) party drug use only, (3) both current depression and party drug use, or (4) neither current depression nor party drug use. The researchers observed study participants for a median (midpoint) of 2.8 years. Party drugs included amphetamines, methamphetamines, cocaine, crack/freebase, club drugs, heroin, opiates, tranquilizers, and anabolic steroids.
The investigators linked health records of these people to another database so they could see who visited a hospital emergency department during the study period. They rated emergency-room visits as urgent or semiurgent/nonurgent. They also determined who visited the emergency room a second time within 30 days and who got admitted to the hospital.
Finally, the researchers used an accepted statistical method to learn whether current depression, party drug use, or both affected chances of an emergency room visit or hospital admission during the 5.5-year study period. This kind of analysis simultaneously considers the impact of several factors that may affect chances of emergency-room use or hospital admission. By doing this the researchers could be more confident that depression, or party drug use, or both explained the hospital visit--regardless of other influencing factors.
What the study found. This study involved 3482 people with HIV whose age ranged from 17 to 85 years (median 46 years). Most study participants (83.5%) were men, and about two thirds were gay or bisexual men. About 85% of these people were taking antiretroviral therapy, and almost three quarters had an undetectable viral load. The group included 696 people (20%) who had depression only, 396 (11%) with party drug use only, and 253 (7%) with depression and party drug use.
During the 5.5-year study period, 2108 people (60.5% of 3482) went to the emergency room at least once. The researchers calculated that about 26 of every 100 people went to the emergency room every year, and about 7 of every 100 got admitted to the hospital every year. The researchers determined that more than half of emergency-room visits were possibly avoidable.
Compared with people who did not have depression and did not use party drugs, people with (1) depression only, (2) drug use only, and (3) both depression and drug use had a 20% to 40% higher risk of visiting the emergency room (Figure 1). Compared with people who did not have depression and did not use party drugs, those with depression only had a 30% higher risk of hospital admission and those with both depression and drug use had a 60% higher risk of hospital admission.
Compared with people who did not have depression and did not use party drugs, those with (1) depression only, (2) drug use only, and (3) both depression and drug use had a 20% to 30% higher risk of semiurgent/nonurgent emergency-room visits and a 30% to 50% higher risk of repeated emergency room visits (Figure 2).
What the findings mean for you. This large and long study in Ontario, Canada found that HIV-positive people with depression and people who used party drugs were more likely to make emergency room visits and more likely to get admitted to the hospital than HIV-positive people without depression who did not use party drugs. Depression and drug use also raised chances of less urgent emergency room visits and chances of repeated emergency room visits.
These findings add to the list of health problems already confirmed in HIV-positive people with depression or drug use. These already-established problems include poor healthcare visit attendance, irregular antiretroviral pill taking, uncontrolled HIV infection indicated by a detectable viral load, higher risk of passing HIV or other infections to sex partners, and higher risk of picking up sexually transmitted infections from sex partners.
The researchers suggest that poor antiretroviral pill-taking habits in people with depression raise chances of health problems that may send people to the emergency room. They also note much previous research showing that depression often goes undetected and untreated in people with HIV Uncontrolled depression could increase the risk of emergency-room visits or hospital admissions.
Depression is a common problem in people with HIV. It is a medical condition that can be detected with simple questions and treated effectively with drugs, counseling, or both. If you regularly feel sad, anxious, empty, or hopeless, you may have depression and you should talk to your provider about it. Don't wait for your provider to ask you if you're depressed. The US National Institute of Mental Health lists common depression indicators (Table 1).
Use of legal and illegal drugs not ordered by your provider may seem like a normal part of life to some people--but such drug use poses serious dangers. Many drugs are quickly addictive and can cause serious problems and even death if overdosed.
The US National Institute of Drug Abuse warns that drugs of abuse can (1) alter thinking and judgment, (2) lead to drugged driving, (3) lead to addiction, (4) lead to infectious diseases, and (5) harm unborn babies. (4) The Institute has practical online advice to help teens and adults understand whether they have a drug-abuse problem and how to find care for such a problem. (5) Click on the links at reference 5 below.
REFERENCES
(1.) Choi SKY, Boyle E, Cairney J, et al. Impact of depression and recreational drug use on emergency department encounters and hospital admissions among people living with HIV in Ontario: a secondary analysis using the OHTN cohort study. PLoS One. 2018;13(4):e0195185..
(2.) Cholera R, Pence BW, Bengtson AM, et al. Mind the gap: gaps in antidepressant treatment, treatment adjustments, and outcomes among patients in routine HIV care in a multisite U.S. clinical cohort. PLoS One. 2017;12:e0166435.
(3.) Langer S, Chew-Graham C, Hunter C, Guthrie EA, Salmon P. Why do patients with long-term conditions use unscheduled care? A qualitative literature review. Health Soc Care Community. 2013;21:339-351.
(4.) National Institute of Drug Abuse. Commonly abused drugs charts. https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts
(5.) National Institute of Drug Abuse. What to do if you have a problem with drugs: for teens and young adults. https://www.drugabuse.gov/related-topics/treatment/what-to-do-if-you-have-problem-drugs-teens-young-adults; What to do if you have a problem with drugs: for adults. https://www.drugabuse.gov/related-topics/treatment/what-to-do-if-you-have-problem-drugs-adults
* Words in boldface are explained in the Technical Word List at the end of this issue.
Table 1. Signs and symptoms of depression * Persistent sad, anxious, or empty mood * Feelings of hopelessness or pessimism * Irritability * Feelings of guilt, worthlessness, or helplessness * Loss of interest or pleasure in hobbies and activities * Decreased energy; fatigue * Difficulty sleeping, early-morning waking, or oversleeping * Appetite and/or weight changes * Thoughts of death or suicide Source: National Institute of Mental Health. https://www. nimh.nih.eov/health/topics/depression/index.shtml
Figure 1. In a study of 3482 people with HIV, those with
depression only, party drug use only, or both depression and
party drug use had higher risks of an emergency room visit.
People with depression only or both depression and party
drug use had higher risks of hospital admission.
Impact of depression and drug use
on hospital use
Depression Drug use Depression
Only only plus drug
use
Hospital admission 20% 30% 40%
Emergency room use 30% 60%
Note: Table made from bar graph.
Figure 2. Compared with HIV-positive people without
depression or party drug use, those with (1) depression
only, (2) drug use only, or (3) both depression and drug use
had higher risks of less urgent emergency room visits and
repeated emergency room visits.
Impact of depression and drug use on
type of emergency room visit
Depression Drug use Depression
only only plus drug
use
Repeat visit 20% 30% 30%
Less urgent visit 30% 50% 40%
Note: Table made from bar graph.
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| Title Annotation: | ARTICLE 9 |
|---|---|
| Publication: | HIV Treatment: ALERTS! |
| Date: | Dec 1, 2018 |
| Words: | 1472 |
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