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Forensic psychiatry
Psychological distress in women and men living with HIV in Spain: a cross-sectional telephone survey
  1. Cesar Garriga1,2,3,
  2. Lourdes Gutiérrez Trujillo2,
  3. Jorge Del Romero4,
  4. Marta Montero5,
  5. María Jesús Pérez-Elías6,
  6. Dante Culqui Lévano3,7,
  7. Félix Gutierrez8,
  8. Juan Luis Gómez-Sirvent9,
  9. Alejandro Peña-Monje10,
  10. José Ramón Blanco11,
  11. María Angeles Rodríguez-Arenas2
  1. 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
  3. 3Spanish Field Epidemiology Training Programme (FETP/PEAC), National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
  4. 4Centro Sanitario Sandoval, Madrid, Spain
  5. 5Infectious Diseases Unit, Hospital Universitario La Fe, Valencia, Spain
  6. 6Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
  7. 7Centro Sociosanitario Isabel Roig (Geriatric Hospital), Barcelona, Spain
  8. 8Infectious Diseases Unit, Hospital General de Elche & Universidad Miguel Hernández, Alicante, Spain
  9. 9Internal and Infectious Medicine Service, Hospital Universitario de Canarias, La Laguna, Canarias, Spain
  10. 10Infectious Diseases Unit, Hospital Universitario San Cecilio, Granada, Spain
  11. 11Department of Infectious Diseases, Hospital Universitario San Pedro, Logroño, Spain
  1. Correspondence to Dr Cesar Garriga, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom; cesar.garriga{at}


Background Psychological distress includes a broader range of experiences, varying from less severe symptoms of depression and anxiety to severe psychiatric disease. Global estimates for depression and anxiety in 2017 were 3.4% and 3.8%, respectively. While for people living with HIV, global estimates were 16% and 33%, respectively.

Objective We aimed to determine the prevalence of psychological distress by gender and associated characteristics in patients living with HIV.

Methods A cross-sectional study was conducted within the Spanish HIV Research Network CoRIS. Participants were interviewed by telephone between 2010 and 2014 about their psychological distress, sociodemographics, drug consumption, self-perceived health and combined antiretroviral therapy (cART) adherence. Laboratory tests and medical history details were collected from CoRIS. Logistic regression was used to identify characteristics associated with psychological distress.

Findings We interviewed 99 women and 464 men, both living with HIV. A greater proportion of women (51, 51.5%) reported psychological distress than men (179, 38.6%; p<0.01). Non-adherence to cART (OR 4.6 and 2.3, 95% CI 1.4‒15.1 and 1.3‒4.2) and non-use of cART (8.4 and 1.8, 2.2‒32.4 and 1.1‒2.8) were related to psychological distress in women and men, respectively. Spending little time in leisure-based physical activity was related to psychological distress in women (3.1, 1.1‒9.0). Living alone (2.0, 1.3‒3.0) and being unemployed (2.3, 1.4‒3.6) were related to psychological distress in men.

Conclusions and clinical implications As people living with HIV have a high prevalence of psychological distress, their regular screening appointments should include psychological assessment. A gendered approach is needed to detect and manage psychological distress.

  • depression & mood disorders
  • anxiety disorders

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  • CG and MAR-A are joint senior authors.

  • Contributors All authors worked in the design and analysis and elaboration of the final manuscript.

  • Funding The study was supported by Fondo de Investigación Sanitaria: FIS:PI09/1889. CoRIS is supported by the Instituto de Salud Carlos III through the Red Temática de Investigación Cooperativa en Sida (RD06/006, RD12/0017/0018 and RD16/0002/0006) as part of the Plan Nacional R+D+I and cofinanced by ISCIII-Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER). CG was supported by the 12/PEAC-06 grant from the Spanish Field Epidemiology Training Programme (“Programa de Epidemiología Aplicada de Campo”), Institute of Health Carlos III (“Instituto de Salud Carlos III”). The funders had no role in study design, data collection and analysis, decision to publish or manuscript preparation.

  • Disclaimer This paper presents independent results and/or research. The views expressed are those of the author(s) and not necessarily those of the Instituto de Salud Carlos III.

  • Competing interests Dr Garriga, Ms Gutiérrez-Trujillo, Dr Culqui Levano, Dr del Romero, Dr Gómez-Sirvent, Dr Peña-Monje and Dr Rodríguez-Arenas declare that they have no conflicts of interest. Mrs Montero reports personal fees outside the submitted work from Bristol-Myers Squibb, ViiV Healthcare, Merck, Abbvie, Gilead Sciences, Janssen, Abbott Laboratories and Pfizer. Dr Pérez-Elías reports personal fees from Bristol-Myers Squibb and grants and personal fees from ViiV Healthcare, Janssen and Gilead Sciences, outside the submitted work. Dr Gutiérrez reports personal fees from Gilead Sciences, Janssen Cilag and ViiV Healthcare, outside the submitted work. Dr Blanco has carried out consulting work for Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck and ViiV Healthcare; received compensation for lectures from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck and ViiV Healthcare; and received grants and payments for the development of educational presentations from Gilead Sciences, Bristol-Myers Squibb and ViiV Healthcare, outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institute of Health Carlos III Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data is available on reasonable request. email to: Cesar Garriga, (alternative email: or M. Ángeles Rodríguez-Arenas,