Study Uses Data to Examine Mental Health Trends in Patients With HIV Before, After COVID-19 Outbreak

Key Takeaways:

1. Mental Health Trends in People Living with HIV: Using research from the National Institute of Health’s All of Us program, the study aims to analyze trends in mental health outcomes among people living with HIV (PLWH) before and after the COVID-19 outbreak while identifying key factors.

2. Factors Influencing Mental Health: The study considers various factors including psychiatric disorders, psychological assessments, sociodemographic information, and protective measures at individual, interpersonal, and institutional levels. This approach provides a detailed understanding of the different experiences of PLWH during the pandemic and can lead to targeted interventions.

3. Looking to the Future: The study’s findings may have significant implications for health care beyond the COVID-19 pandemic, as it can help clarify the diverse experiences of PLWH and interventions can be tailored to improve mental health outcomes while reducing disparities within care.

The COVID-19 pandemic has been shown to have a widespread influence on the mental health of many populations, but has especially affected the mental health of marginalized populations. Such effects may be compounded among some vulnerable populations including people living with HIV (PLWH). The pandemic has further separated the gap between populations, and in response, the mental health and related disparities among PLWH during the COVID-19 pandemic has been prioritized.

A study published in BMJ Open aimed to examine the trends and patterns of mental health outcomes among PLWH before and after the COVID-19 outbreak. In addition, the study authors sought to identify the potential protective factors for mental health outcomes among this population. According to the authors, the study’s findings will be presented at academic conferences and publications in peer-reviewed journals.

The study was guided by a multicomponent, multilevel conceptual framework that depicts the challenges for PLWH during the COVID-19 pandemic, as well as the role of resilience development in mitigating negative effects on mental health outcomes and the key protective factors for mental health outcomes. The authors note that this framework also highlights the role of resilience development in mitigating negative effects on mental health outcomes while identifying key protective factors for mental health outcomes.

Further, this framework is used to evaluate trends or patterns of mental health outcomes among PLWH prior to and after the COVID-19 outbreak. The study uses information from the National Institute of Health’s All of Us program, which includes various types of data (eg, electronic health records [EHR], survey responses, physical measurements, and wearables and genomic data) and participants who are from underrepresented populations.

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The aim 1 cohort (HIV cohort) has an estimated 4000 to 6000 participants who are PLWH identified through phenotyping based on EHR and Personal and Family Health History data. For EHR data, the sets of the phenotyping are primarily ones that were established in prior research, and sets were modified for the current study.

The authors note that in order to phenotyping the cohort requires the development of an operational definition of a cohort by determining diagnostic codes of HIV that includes clinical procedures relevant to HIV treatment; medication prescriptions for HIV; annotated clinical notes suggestive of HIV and COVID-19 Patient Experience (COPE) Survey items indicating self-reported HIV; identifying a set of Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) concepts suggestive of the operational definition of measure; and the developed concept sets must be validated.

Further, mental health outcomes include psychiatric disorders and psychological assessment that are derived from the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes across 6 areas (eg, mood disorders, anxiety disorders, substance abuse disorders, stress-related disorders, schizophrenia, and personality disorders). The psychological assessment is based on existing standardized scales used by COPE Surveys regarding anxiety and mood, stress, loneliness, substance abuse, and general psychosocial well-being.

Further, the authors recorded sociodemographic measures such as race, sex assigned at birth, gender, age, sexual orientation, education, and household income; and protective factors at an individual level (eg, resilience, physical activity, and adaptive coping), interpersonal level (eg, social support and social capital), and institutional level (eg, health access and utilization). In addition, contextual factors such as COVID-19 pandemic indication (eg, no, before March 10, 2020; yes, after March 11, 2020), COVID-19 related factors (eg, self-reported COVID-19-related symptoms, COVID-19 infection status, COVID-19 vaccine uptake, and COVID-19 impacts on life), pre-existing health conditions (eg, chronic disease burden), discrimination during the COVID-19 pandemic, and social determinants of health (SDOH) factors were taken into consideration.

The study authors note that the results have the potential to be applied in public health resource allocation in the COVID-19 pandemic and beyond. They added that the findings can also help to better prepare the health care system for additional patients who may seek out mental health treatment due to COVID-19-induced stress. Further, the study’s results on heterogeneous experiences of PLWH during the COVID-19 pandemic can promote precision medicine in HIV care and treatment.

The authors note that populations who have been historically underserved, such as racial minorities, disproportionately tolerate the burden induced by the HIV epidemic, and it isn’t unprecedented that additional subgroups among PLWH suffered multiple health disparities (eg, gender, race, sexual orientation) during the pandemic due to existing barriers. The identification of socially disadvantaged or stigmatized subgroups can help inform interventions to improve mental health outcomes and reduce disparities across PLWH.

Limitations of the study include the launch of the COPE Survey after the COVID-19 outbreak, therefore, it lacks data prior to the initial outbreak; the definition of psychiatric disorders through existing ICD-10 codes, which may undervalue the prevalence rate of psychiatric disorders; and the inability to integrate certain key SDOH factors into the dataset due to missing information. Further, participants were required to complete 3 surveys (eg, Basics, Overall Health, and Lifestyle) at the time of enrollment that were used as a baseline, however, other survey questionnaires may have been incomplete.

In addition, there were shifting dates in EHR data, which could result in inaccuracies. The study authors note that data obtained from this study can supplement health care and position professionals for future efforts in improving both mental and general health outcomes in PLWH.


Qiao S, Zhang J, Liang C, et al. Using All of Us data to examine the mental health change during COVID-19 pandemic among people living with HIV: A longitudinal study protocol. BMJ Open 2023;13:e071285. doi:10.1136/bmjopen-2022-071285

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