Do Postpartum Mothers With HIV Access Mental Healthcare More Often?

Pregnant woman on counseling appointment, talking about pregnancy.
Women with human immunodeficiency virus (HIV) were more likely to access mental health services within 1 year postpartum compared with women who are HIV-negative.

Women with human immunodeficiency virus (HIV) were more likely to use outpatient and acute mental health services within 1 year postpartum than women who are HIV-negative, according to study results published in AIDS Care.

This population-based, retrospective cohort study included data from 861,365 women who delivered live singletons between April 1, 2002 and March 31, 2012 in Ontario, Canada. Of these women, 530 were HIV-positive. Investigators assessed the women’s use of outpatient mental health services — including any outpatient visit to a psychiatrist, family physician, or non-psychiatric medical specialist for a mental health reason — within 1 year postpartum. They also measured engagement in outpatient mental health services, defined as ≥3 visits, and the use of acute care psychiatric services, defined as any psychiatric emergency department visit or psychiatric hospitalization.

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Analyses revealed that 21.0% of all the women used outpatient mental health services within 1 year postpartum. Most of these visits were to family practices (19.8%), followed by visits to psychiatrists (11.9%), and other medical specialists (3.2%).

Compared with HIV-negative women, women who were HIV-positive were significantly more likely to access outpatient mental health services in the year following delivery (31.5% vs 21.0%, respectively; adjusted odds ratio [aOR], 1.26; 95% CI, 1.03-1.55) and were more likely to visit psychiatrists (9.2% vs 2.5%; aOR, 1.95; 95% CI, 1.34-2.75) than family physicians or other medical specialists. Compared with HIV-negative women who accessed outpatient services, women who were HIV-positive engaged more in care overall (43.1% vs 31.8%; crude OR, 1.63; 95% CI, 1.19-2.21) and were more likely to use acute care psychiatric services (3.3% vs. 1.1%; crude OR, 3.11; 95% CI, 1.99-4.59).

Study results are limited by the small size of the HIV-positive cohort compared with the HIV-negative cohort.

The researchers wrote, “[These findings are] of importance in the current context where women with HIV are increasingly becoming pregnant.”

“Research aimed at quantifying postpartum psychiatric morbidity in this population and identifying HIV-positive women at risk for adverse mental health outcomes postpartum would help to optimize the mental health services offered to all HIV-positive mothers during this important time,” they concluded.


Sparrow-Downes VM, Loutfy M, Antoniou T, Vigod SN. Postpartum mental health service utilization in women with Human Immunodeficiency Virus (HIV): a population-based study [published online April 29, 2019]. AIDS Care. doi:10.1080/09540121.2019.1612007