2. Triple Whammy—HIV, Mental Disorders, African Americans
Incidence of Mental Disorders in the United States
Mental disorders occur commonly across all segments of the US population. Approximately 15% of adults with a mental disorder also experience a concurrent substance use disorder, thereby making treatment more challenging. [Satcher 2000] For purposes of this curriculum, the most relevant categories of mental disorders among HIV-infected African Americans are mood disorders (depression and bipolar disorder), anxiety disorders (generalized anxiety disorder, post-traumatic stress disorder, and panic disorder), and the psychotic disorder, schizophrenia.
The estimated incidences of these disorders among the general US adult population are as follows: [Kessler 2005]
- Any anxiety disorder—18.1%, of which 22.8% are classified as severe
- General anxiety disorder—3.1%, of which 32.3% are classified as severe
- Panic disorder—2.7%, of which 44.8% are classified as severe
- Post-traumatic stress disorder—3.5%, of which 36.6% are classified as severe
- Any mood disorder—9.5%, of which 45% are classified as severe
- Major depression—6.7%, of which 30.4% are classified as severe
- Dysthymia—1.5%, of which 49.7% are classified as severe
- Bipolar disorder—2.6%, of which 82.% are classified as severe
- Schizophrenia—1.1%
However, determining similarly specific estimates for the HIV-infected population is challenging. Nevertheless, investigators have endeavored to develop estimates of the percentages of people living with HIV disease who also experience mental health problems. [Hammond 2007]
- Depression—22% to 45%
- Anxiety disorders—38% [Elliott 1998]
- General anxiety disorder—15.8% [Bing 2001]
- Panic disorder—10.5%
- General anxiety and panic disorders—5%
- Schizophrenia—estimated incidence data are wide-ranging and not clear
Systematic analyses of the incidences of the above mental disorders among HIV-infected African Americans are not available. Nevertheless, in light of the disproportionate representation of African Americans among the HIV-infected population and the extent of under-diagnosis and misdiagnosis of mental disorders in African American communities, comorbidity of HIV disease and mental disorders is likely to be at least as significant as in the HIV-infected population as a whole.
