ASSESSING HIV RISK IN SEVERELY MENTALLY ILL PEOPLE

来自严重精神疾病(SMI)患者的信息对于准确诊断、有效监测和研究改善服务至关重要。尽管有报告称这一人群中艾滋病毒和其他性传播疾病(STDS)的风险增加，但风险和疾病状况没有得到充分评估。自我报告数据对这项评估至关重要。我们小组和其他人的研究表明，物质使用障碍和创伤后应激障碍(PTSD)是导致艾滋病毒风险的因素，在SMI患者中很常见，但在入院时很少被注意到。同样，在精神卫生服务环境中，艾滋病毒和其他性传播疾病往往没有被发现。我们联盟目前的研究强调了艾滋病毒/艾滋病和其他性传播疾病风险行为评估的问题，包括采访者不情愿和患者报告不足。需要对风险状况和并存状况进行系统评估，以进行有效干预。该领域正在进行计算机化，但仍在以昂贵、耗时的方式收集患者的信息。服务提供商和研究人员经常使用训练有素的面试者来收集患者的数据。他们认为，面试官对于克服潜在的识字问题、翻译模棱两可的语言以及使用非语言信息来促进数据收集至关重要。这些原因很少受到调查。使用训练有素的面试官存在缺陷：面试官不情愿，成本高，缺乏一致性，在回答敏感问题时受到抑制，以及可能的主观性。我们提出了一项研究，比较了训练有素的面试者和计算机辅助面谈(计算机辅助面谈)，以从SMI患者那里获得艾滋病毒风险和共病情况的自我报告。计算机辅助教学包括语音，并使用互联网。我们将收集关于性别、年龄和最近住院次数的数据，并在几个方面进行衡量：艾滋病风险清单(ARI)、达特茅斯生活方式评估工具(DALI，药物滥用筛查)、创伤后应激障碍检查表(PCL)和关于患者偏好的问卷。之所以选择这些量表，是因为它们强调自我报告的不同方面，而且它们与艾滋病毒和其他性传播疾病在该人群中的流行率有关。我们计划衡量患者的态度、可靠性、相互关系、完成率和泄露的信息量。我们有DALI和医院利用的药物滥用标准衡量标准，允许我们计算这些衡量标准的有效性。这些数据将补充两个正在进行的研究项目，调查艾滋病毒/艾滋病和SMI患者的危险行为。

Information from patients with severe mental illness (SMI) is essential for accurate diagnosis, effective monitoring, and research to improve services. Despite reports of elevated risk for HIV and other sexually transmitted diseases (STDs) in this population, risk and disease status are inadequately assessed. Self-report data are crucial for this assessment. Studies by our group and others have shown that substance use disorders and posttraumatic stress disorder (PTSD), contribute to HIV risk, are prevalent in people with SMI, but are rarely noted on admission. Similarly, HIV and other STDs often go undetected in mental health services settings. Current research by our consortium has underlined the problems of assessment of risk behavior for HIV/AIDS and other STDs including interviewer reluctance and patient underreporting. Systematic assessment of risk status and co-morbid conditions is needed for effective intervention. Computerization is proceeding in the field, but patient input continues to be collected in an expensive, time-consuming manner. Service providers and researchers often use trained interviewers to collect data from patients. They believe that interviewers are essential for overcoming potential literacy problems, translating ambiguous language, and using nonverbal information to facilitate data collection. These reasons have rarely been subjected to investigation. There are liabilities to the use of trained interviewers: interviewer reluctance, high cost, lack of uniformity, inhibition in answering sensitive questions, and possible subjectivity. We propose a study comparing trained interviewers and computer- assisted interviews (CAI) for obtaining self-report on HIV risk and co-morbid conditions from patients with SMI. The CAI includes speech and uses the internet. We will collect data on gender, age, and number of recent hospitalizations and on several scales: the AIDS Risk Inventory (ARI), the Dartmouth Assessment of Lifestyle Instrument (DALI, a substance abuse screen), the PTSD Checklist (PCL), and a questionnaire on patient preferences. These scales were chosen because they stress different aspects of self report and because they are related to the prevalence of HIV and other STDs in this population. We plan to measure patient attitudes, reliability, intercorrelations, completion rates, and amount of information divulged. We have criterion measures of substance abuse for the DALI and hospital utilization, allowing us to compute criterion validity for those measures. The data will supplement two ongoing research projects investigating HIV/AIDS and risky behaviors in people with SMI.