Share this article on:

Prevalence, Incidence, and Persistence of Psychiatric and Substance Use Disorders Among Mothers Living With HIV

Malee, Kathleen M. PhD*; Mellins, Claude A. PhD; Huo, Yanling MS; Tassiopoulos, Katherine DSc§; Smith, Renee PhD; Sirois, Patricia A. PhD; Allison, Susannah M. PhD#; Kacanek, Deborah ScD; Kapetanovic, Suad MD#; Williams, Paige L. PhD; Grant, Mitzie L. PhD**; Marullo, Daniel PhD††; Aidala, Angela A. PhD‡‡for the Pediatric HIVAIDS Cohort Study (PHACS)

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 15th, 2014 - Volume 65 - Issue 5 - p 526–534
doi: 10.1097/QAI.0000000000000070
Clinical Science

Objective: To evaluate prevalence, incidence, remission, and persistence of psychiatric and substance use disorders among HIV-infected mothers and identify biopsychosocial correlates.

Methods: HIV-infected mothers (n = 1223) of HIV-exposed uninfected children enrolled in a prospective cohort study; HIV-uninfected mothers (n = 128) served as a comparison group. Mothers provided sociodemographic and health information and completed the Client Diagnostic Questionnaire (CDQ). Prevalence of any psychiatric or substance use disorder at initial evaluation was compared between the 2 groups. Incident, remitting, and persisting disorders were identified for 689 mothers with HIV who completed follow-up CDQs. We used logistic regression to evaluate adjusted associations of biopsychosocial characteristics with presence, incidence, remission, and persistence of disorders.

Results: Thirty-five percent of mothers screened positive for any psychiatric or substance use disorder at initial evaluation, with no difference by maternal HIV status (P = 1.00). Among HIV-infected mothers, presence of any disorder was associated with younger age [adjusted odds ratio (aOR): 1.39; 95% CI: 1.09 to 1.75], single parenthood (aOR: 1.35; 95% CI: 1.08 to 1.68), and functional limitations (aOR: 2.29; 95% CI: 1.81 to 2.90). Incident disorders were associated with functional limitations (aOR: 1.92; 95% CI: 1.10 to 3.30). Among HIV-infected mothers with a disorder at initial evaluation (n = 238), 61% had persistent disorders. Persistent disorders were associated with lower income (aOR: 2.44; 95% CI: 1.33 to 4.76) and functional limitations (aOR: 3.19; 95% CI: 1.87 to 5.48). Receipt of treatment for any disorder was limited: 4.5% at study entry, 7% at follow-up, 5.5% at both entry and follow-up.

Conclusions: Psychiatric and substance use disorders remain significant comorbid conditions among HIV-infected mothers and require accessible evidence-informed treatment.

Supplemental Digital Content is Available in the Text.

*Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL;

HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, New York, NY;

Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard School of Public Health, Boston, MA;

§Department of Epidemiology, Harvard School of Public Health, Boston, MA;

Department of Pediatrics, University of Illinois, Chicago, IL;

Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA;

#National Institutes of Health/National Institute of Mental Health, Bethesda, MD;

**Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA;

††Department of Children's Behavioral Health, Children's of Alabama, Birmingham, AL; and

‡‡Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY.

Correspondence to: Kathleen M. Malee, PhD, Ann and Robert H. Lurie Children’s Hospital, 215 East Chicago Avenue, Box 155, Chicago, IL 60614 (e-mail:

The Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with cofunding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, the Office of AIDS Research, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard University School of Public Health (HD052102, 3 U01 HD052102-05S1, 3 U01 HD052102-06S3) and the Tulane University School of Medicine (HD052104, 3U01HD052104-06S1). This project was also supported in part by the Intramural Research Program of the National Institute of Mental Health.

Presented in part at the 3rd International Conference on HIV and Women, January 14, 2013, Toronto, Canada, Session 2. Abstract O_06.

The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's web site (

Received August 20, 2013

Accepted November 22, 2013

© 2014 by Lippincott Williams & Wilkins