Table 3.
Adjusted rate ratios for factors associated with treatment for mental disorders in patients aged 15–49 years followed-up in private care, public primary care and public tertiary care ART programmes during 2012–2017a
| Inpatient treatment ofb,c | Pharmacological treatment withb,d | |||||||
|---|---|---|---|---|---|---|---|---|
| Psychotic disorderse | Mood disorderse | Anxiety disorderse | Any mental disordere | Antipsychoticse | Antidepressantse | Anxiolyticse | Any psychiatric medicatione | |
| Type of care | ||||||||
| Private care | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Public primary | 1.80 (1.31–2.47) | 0.04 (0.03–0.05) | 0.07 (0.04–0.14) | 0.12 (0.10–0.14) | 0.38 (0.35–0.42) | 0.06 (0.06–0.07) | 0.02 (0.02–0.03) | 0.09 (0.08–0.09) |
| Public tertiary | 7.26 (3.66–14.41) | 0.20 (0.11–0.36) | 0.59 (0.22–1.60) | 0.44 (0.29–0.69) | 1.57 (1.27–1.93) | 0.48 (0.40–0.58) | 0.16 (0.12–0.21) | 0.44 (0.39–0.51) |
| Sex | ||||||||
| Male | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Female | 0.86 (0.59–1.24) | 1.56 (1.43–1.70) | 2.21 (1.75–2.79) | 1.49 (1.37–1.62) | 1.32 (1.24–1.4) | 1.49 (1.45–1.53) | 1.60 (1.55–1.64) | 1.43 (1.40–1.46) |
| Age, years | ||||||||
| 15–24 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 25–34 | 0.86 (0.40–1.85) | 0.92 (0.75–1.13) | 0.88 (0.52–1.51) | 0.90 (0.73–1.10) | 1.00 (0.85–1.18) | 1.52 (1.37–1.68) | 1.62 (1.45–1.80) | 1.40 (1.30–1.51) |
| 35–44 | 0.71 (0.33–1.53) | 0.84 (0.69–1.03) | 0.68 (0.40–1.15) | 0.80 (0.66–0.98) | 0.95 (0.81–1.12) | 1.75 (1.58–1.94) | 1.83 (1.64–2.04) | 1.55 (1.44–1.67) |
| 45–49 | 0.77 (0.34–1.74) | 0.76 (0.61–0.94) | 0.59 (0.34–1.04) | 0.74 (0.60–0.91) | 1.05 (0.88–1.24) | 2.06 (1.86–2.29) | 2.05 (1.84–2.29) | 1.76 (1.63–1.90) |
| Baseline CD4 cell count, cells/μla | ||||||||
| 0–99 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 100–199 | 0.79 (0.46–1.35) | 0.99 (0.84–1.17) | 1.56 (1.02–2.40) | 0.92 (0.79–1.07) | 0.95 (0.85–1.06) | 0.95 (0.9–1) | 1.01 (0.95–1.08) | 0.97 (0.93–1.01) |
| 200–349 | 0.63 (0.38–1.05) | 1.01 (0.87–1.17) | 1.37 (0.94–2.01) | 0.89 (0.78–1.02) | 0.87 (0.79–0.96) | 0.93 (0.88–0.97) | 0.99 (0.94–1.05) | 0.94 (0.91–0.98) |
| 350–499 | 0.38 (0.22–0.67) | 0.92 (0.79–1.07) | 1.16 (0.79–1.73) | 0.78 (0.68–0.90) | 0.89 (0.80–0.99) | 0.90 (0.85–0.94) | 0.99 (0.93–1.05) | 0.93 (0.89–0.96) |
| ≥500 | 0.49 (0.26–0.93) | 1.00 (0.86–1.15) | 1.38 (0.95–2.01) | 0.85 (0.75–0.97) | 0.88 (0.80–0.97) | 0.94 (0.90–0.99) | 1.00 (0.95–1.06) | 0.94 (0.91–0.98) |
| Missing | 0.44 (0.26–0.74) | 0.89 (0.76–1.03) | 0.93 (0.63–1.37) | 0.76 (0.67–0.87) | 0.99 (0.90–1.09) | 0.88 (0.84–0.92) | 0.98 (0.93–1.04) | 0.89 (0.86–0.93) |
Patients with at least one follow-up visit between 1 January 2012 and 31 December 2017 were included.
Data are aRRs with 95% CIs in parenthesis. Rate ratios were adjusted for ART programme, sex, age, baseline CD4 cell count and year.
Repeated hospital admissions were treated as separate events. The incidence of inpatient treatment for mental disorders was modelled as count data.
Pharmacy refills for psychiatric medication which occurred in the same year were counted as one event. The incidence of pharmacological treatment for a mental disorder was modelled as a binary outcome.
Psychotic disorder (ICD-10 codes F20–F29), mood disorder (F30–F39), anxiety disorder (F40–F48) and any mental disorder (F20–F99); antipsychotics (ATC code N05A), anxiolytics (N05B), antidepressants (N06A), any psychiatric medication (antipsychotics, anxiolytics, antidepressants, psychostimulants [N06B] or psychiatric combination drugs [N06C]).
fBaseline was defined as 1 January 2012 or date of ART initiation of the patient, whichever came second. The CD4 cell count measurement was the one closest to the baseline date, within a 6-month window (before or after).