Do Postpartum Mothers With HIV Access Mental Healthcare More Often?

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.

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.

Reference

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