Elsevier

Annals of Epidemiology

Volume 13, Issue 9, October 2003, Pages 606-612
Annals of Epidemiology

The association of psychiatric disorders and HIV infection in the correctional setting

https://doi.org/10.1016/S1047-2797(03)00061-9Get rights and content

Abstract

Purpose

Psychiatric disorders, such as bipolar disorder, schizophrenia, and depression, have been associated with both HIV-associated risk behaviors and HIV infection. While the US prison population is reported to exhibit elevated rates of HIV/AIDS and most psychiatric disorders, scarce information currently exists on the association of these conditions in the prison setting. The present study examined the association of six major psychiatric disorders with HIV infection in one of the nation's largest prison populations.

Methods

The study population consisted of 336,668 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January 1, 1999 and December 31, 2001. Information on medical conditions and sociodemographic factors was obtained from an institution-wide medical information system.

Results

Inmates diagnosed with HIV infection exhibited elevated rates of major depression, dysthymia, bipolar disorder, schizophrenia, schizoaffective disorder, and non-schizophrenic psychotic disorder. These rates persisted in stratified analyses and in a multivariate analysis that statistically adjusted for gender, race, and age category.

Conclusion

The present cross-sectional study's finding of a positive association between HIV infection and psychiatric diagnoses among inmates holds both clinical and public health relevance. It will be important for future investigations to prospectively assess the underlying mechanisms of these associations in the correctional setting.

Introduction

A number of studies have reported that individuals with psychiatric disorders, including schizophrenia, bipolar disorder, and depression, have an increased likelihood of engaging in HIV-associated risk behaviors 1., 2., 3., 4., 5.. These risk behaviors include: having multiple sex partners 2., 5., having sex in exchange for money or drugs (4), having sexual intercourse with partners with whom they are unfamiliar (4), having sex while under the influence of drugs or alcohol 4., 5., and using injection drugs 1., 4.. The elevated risk of these behaviors among patients with psychiatric disorders is attributable to a number of factors, including limited impulse control, difficulties in establishing stable social and sexual relationships, limited knowledge about HIV-related risk factors, increased susceptibility to coercion, and comorbid alcohol and drug use 6., 7.. Infection with HIV may also directly or indirectly cause the development of some psychiatric disorders via the retrovirus' effect on the central nervous system 8., 9. or as a result of medications (8), systemic disease, or psychosocial factors 8., 9., 10., 11.. Although prison inmates are reported to exhibit elevated rates of both HIV/AIDS and psychiatric disorders 12., 13., 14., to date, little research exists on the association of these conditions in the correctional setting. The purpose of the present study, therefore, was to compare the prevalence of six major psychiatric disorders among HIV-infected and non-infected inmates in one of the nation's largest prison systems.

Section snippets

Methods

The cohort under study consisted of 336,668 inmates incarcerated in the Texas Department of Criminal Justice (TDCJ) for any duration dating from January 1, 1999 through December 31, 2001. Texas houses one of the largest prison populations in the US and together with California houses almost one-fourth of all US prison inmates (15). The TDCJ system currently includes three main types of incarceration facilities: prisons, for the most serious felony offenders, state jails, for low-level drug and

Results

Table 1 presents the distribution of demographic factors among all TDCJ inmates and according to HIV infection status. The vast majority of the study population was male (88.7%) and aged 30 to 49 years (57.6%). Of the total 336,668 inmates under study, 32.9% were white, 42.2% were black, and 24.9% were Hispanic. Blacks and inmates aged 30 to 49 years were substantially overrepresented among inmates infected with HIV. Hispanics, as well as inmates in the youngest and oldest age groups, were

Discussion

Research indicates that individuals diagnosed with psychiatric disorders have an increased risk for HIV infection 5., 18.. This elevated risk is reported to be mediated in large part by increased HIV-associated risk behaviors among persons suffering from mental illness 1., 2., 3., 4., 19., 20.. In some cases, however, HIV/AIDS may directly cause mental health problems or exacerbate existing psychiatric disorders through a variety of physiological, pharmacologic, and social/behavioral mechanisms

Conclusion

If future investigations of inmate populations continue to demonstrate such a strong and consistent association between HIV-infection and psychiatric disorders, prison officials may wish to consider presence of a psychiatric disorder as a risk factor in the algorithm of HIV-screening. Considering the role of psychopathology in the development and maintenance of HIV-associated risk behaviors has far-reaching public health and clinical implications. It appears, based on these data, that

Acknowledgements

This project was supported by the National Institute of Justice, Office of Justice Programs, US Department of Justice. Points of view in this document are those of the authors and do not necessarily represent the official position or policies of the US Department of Justice.

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