Prevalence of DSM-IV Disorders in an Multi-Center HIV+ Women's Cohort

描述（由申请人提供）：由NIAID、NIDA、NCI和NICHD资助，妇女机构间HIV研究（WIHS）是一项在美国6个研究中心（包括布鲁克林、布朗克斯、芝加哥、洛杉矶、旧金山弗朗西斯科/湾区和华盛顿）的1，508名HIV阳性妇女中进行的HIV疾病进展的多中心队列研究。自1994年以来，妇女参加了一年两次的研究访问，其中包括身体和妇科检查、血清和唾液样本，以及关于健康、心理社会状况、服务利用和人口特征的一系列广泛措施的管理。该群体主要是非洲裔美国人（72%）和拉丁裔（27%）;一半生活在贫困中（52%）;三分之二没有就业（66%）;很大一部分人没有完成高中学业（40%）;女性平均年龄为45岁。迄今为止，WIHS对精神健康和物质使用的评估仅限于自我报告的抑郁和焦虑症状，以及自我报告的酒精和街头毒品使用情况。本研究的目的是管理WIHS队列的黄金标准，在结构化诊断访谈行为健康流行病学，世界精神卫生复合国际诊断访谈（WMH-CIDI）。第一个研究目的是确定队列中精神健康和物质使用障碍（MH/SUD）的患病率，类型和严重程度。第二个目标是进行分析，解决2个特定的MH/SUD-抑郁症和可卡因滥用/依赖-与疾病进展和免疫重建，艾滋病定义疾病，死亡率和HAART使用和依从性的免疫学和病毒学组成部分之间的关联。这将涉及在2010年和2011年在其6个站点中的每个站点向WIHS队列成员管理WMH-CIDI，并将其诊断数据与WIHS核心数据相关联。这些核心数据将提供评估疾病进展的6个月和12个月结局（例如，艾滋病毒1-RNA、CD 4、艾滋病定义疾病）和艾滋病相关死亡率。WMH-CIDI将在单独的研究访视时由WIHS访谈者进行，这些访谈者已接受过世界卫生组织赞助的培训师的笔记本电脑CIDI管理培训和认证。研究受试者将经历单独的知情同意过程，并将获得研究酬金沿着旅行津贴。鉴于我们对HIV+个体的大队列中HIV和MH/SU疾病的共病性缺乏了解，本研究有可能增强我们对行为健康因素如何影响恢复和长期生存的了解。WMH-CIDI数据也将提供给更大的WIHS的研究人员，使他们能够检查MH/SUD在他们正在进行的神经认知，基因组，病毒学和免疫学研究中的影响。 公共卫生相关性：在艾滋病毒抗体阳性的成年人中，艾滋病毒疾病与精神病和药物使用障碍并存的比率很高，有证据表明，这些障碍干扰了有效抗逆转录病毒疗法的开始和持续使用。先前的研究还表明，艾滋病毒阳性妇女中抑郁症等某些心理健康疾病的发生率高于男子，而快克可卡因滥用/依赖等成瘾性疾病对妇女的艾滋病毒疾病进展和死亡率具有特别有害的影响。这项研究的重点是精神疾病和成瘾如何影响艾滋病毒治疗，疾病进展和死亡率，有可能产生知识，这将大大提高我们国家的公共卫生。

DESCRIPTION (provided by applicant): Funded by NIAID, NIDA, NCI, and NICHD, the Women's Interagency HIV Study (WIHS) is a multi-site cohort study of HIV disease progression in 1,508 HIV-positive women at 6 sites in the U.S. including Brooklyn, Bronx, Chicago, Los Angeles, San Francisco/Bay Area, and Washington, DC. Since 1994, women have participated in bi-annual study visits that include physical and gynecological exams, serologic and salivary samples, and administration of an extensive battery of measures regarding health, psychosocial status, service utilization, and demographic features. The cohort is primarily African American (72%) and Latina (27%); half live in poverty (52%); two-thirds are not employed (66%); a substantial proportion did not complete high school (40%); and women average 45 years of age. To date, assessment of mental health and substance use in the WIHS has been limited to self- reported symptoms of depression and anxiety, and self-reported use of alcohol and street drugs. The purpose of this study is to administer to the WIHS cohort the gold standard in structured diagnostic interviews for behavioral health epidemiology, the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI). The first study aim is to determine the prevalence, type, and severity of mental health and substance use disorders (MH/SUD) in the cohort. The second aim is to conduct analyses addressing associations between 2 specific MH/SUDs -- depression and crack cocaine abuse/dependence - and immunological and virological components of disease progression and immune reconstitution, AIDS-defining illnesses, mortality, and HAART use and adherence. This will involve administering the WMH-CIDI to members of the WIHS cohort at each of its 6 sites in 2010 and 2011, and linking their diagnostic data to WIHS core data. These core data will provide 6-month and 12-month outcomes assessing disease progression (e.g., HIV1-RNA, CD4, AIDS-defining illnesses) and AIDS-related mortality. The WMH-CIDI will be administered at a separate study visit by WIHS interviewers who have been trained and certified in laptop CIDI administration by World Health Organization-sponsored trainers. Study subjects will undergo a separate consent process, and will receive a research honorarium along with travel stipends. Given the paucity of our knowledge about co-morbidity of HIV and MH/SU disorders in large cohorts of HIV+ individuals, this study has the potential to enhance our knowledge about how behavioral health factors impact recovery and long- term survival. WMH-CIDI data will also be made available to investigators in the larger WIHS, enabling them to examine the impact of MH/SUD in their ongoing neurocognitive, genomic, virologic, and immunologic studies. PUBLIC HEALTH RELEVANCE: Rates of co-occurrence of HIV disease with psychiatric and substance use disorders are high among HIV-positive adults, and evidence suggests that these disorders interfere with the initiation and continued use of effective antiretroviral therapies. Prior research also shows that certain mental health disorders, such as depression, occur at higher rates in HIV+ women than men, and that addictive disorders, such as crack cocaine abuse/dependence, have a particularly deleterious effect on women's HIV disease progression and mortality. This study's focus on how mental illness and addiction impact treatment for HIV, disease progression, and mortality has the potential to produce knowledge that will greatly enhance our nation's public health.