PSYCHIATRIC DISORDERS ASSOCIATED WITH SEXUALLY TRANSMITTED INFECTIONS: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv17n58-038Keywords:
Sexually Transmitted Diseases, HIV Infections, Mental Disorders, DepressionAbstract
Introduction: Psychiatric disorders and sexually transmitted infections frequently coexist through overlapping biological, behavioral, and psychosocial pathways. Recent literature has shown that this interaction is especially relevant in human immunodeficiency virus care, but it also extends to broader sexual health populations in whom stigma, trauma, substance use, and barriers to care may intensify psychiatric vulnerability.
Objective: The main objective of this systematic review was to synthesize recent evidence on psychiatric disorders associated with sexually transmitted infections. Secondary objectives were to identify the most frequently reported psychiatric outcomes, compare findings across populations and care settings, examine associations with adherence and other clinical outcomes, evaluate methodological quality, and identify gaps for future research.
Methods: A systematic review was conducted in accordance with PRISMA principles using searches in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Original studies involving sexually transmitted infection-related populations and reporting psychiatric outcomes were considered eligible. The primary time window was the last five years, with predefined expansion criteria if needed. Study selection and data extraction were performed independently by reviewers, and methodological assessment was planned with RoB 2, ROBINS-I, QUADAS-2, and GRADE according to study design and outcome type.
Results and Discussion: Twenty studies were included in the final qualitative synthesis. The evidence was composed predominantly of observational human studies in people living with human immunodeficiency virus, with additional data from pre-exposure prophylaxis users and sexual and gender minority populations. Depression and anxiety were the most consistently reported outcomes, while suicidality, trauma-related symptoms, severe mental illness, substance-related problems, and cognitive impairment were also clinically relevant. Across studies, psychiatric morbidity was associated with greater stigma, poorer quality of life, weaker adherence, lower retention in care, and less favorable virological or preventive outcomes. Despite heterogeneity in populations, instruments, and study designs, the overall pattern supported the importance of integrated mental health assessment within sexually transmitted infection-related care.
Conclusion: The available evidence indicates that psychiatric disorders are a major component of the clinical burden associated with sexually transmitted infection-related populations, particularly in human immunodeficiency virus care. Routine screening for depression, anxiety, trauma, substance use, and suicidality should be considered in multidisciplinary sexual health services. Future studies should expand the evidence base beyond human immunodeficiency virus, standardize psychiatric outcome measures, and prioritize longitudinal and interventional designs.
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1 Nyongesa, M. K., Mwangi, P., Kinuthia, M., Hassan, A. S., Koot, H. M., Cuijpers, P., et al. (2021). Prevalence, risk and protective indicators of common mental disorders among young people living with HIV compared to their uninfected peers from the Kenyan coast: A cross-sectional study. BMC Psychiatry, 21(1), 90. https://doi.org/10.1186/s12888-021-03079-4
2 van der Kooij, Y. L., Kupková, A., den Daas, C., van den Berk, G. E. L., Kleene, M. J. T., Jansen, H. S. E., et al. (2021). Role of self-stigma in pathways from HIV-related stigma to quality of life among people living with HIV. AIDS Patient Care and STDs, 35(6), 231–238. https://doi.org/10.1089/apc.2020.0236
3 Wang, X., Luo, H., Yao, E., Tang, R., Dong, W., Liu, F., et al. (2021). The role of personality, socioeconomic and prevention strategy effects on health-related quality of life among people living with HIV/AIDS. Infectious Diseases of Poverty, 10(1), 104. https://doi.org/10.1186/s40249-021-00890-9
4 Yu, Y., Chang, Z., Li, H., Liu, X., & Lu, Y. (2021). Quality of life in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome in a HIV WeChat account and self-assessment of physical and mental health. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 46(9), 1024–1030. https://doi.org/10.11817/j.issn.1672-7347.2021.200343
5 Ahmed, A., Saqlain, M., Umair, M. M., Hashmi, F. K., Saeed, H., Amer, S., et al. (2021). Stigma, social support, illicit drug use, and other predictors of anxiety and depression among HIV/AIDS patients in Pakistan: A cross-sectional study. Frontiers in Public Health, 9, 693105. https://doi.org/10.3389/fpubh.2021.693105
6 Meeder, E., Matzaraki, V., Vadaq, N., van de Wijer, L., van der Ven, A., & Schellekens, A. (2021). Unbiased metabolomics links fatty acid pathways to psychiatric symptoms in people living with HIV. Metabolites, 11(12), 831. https://doi.org/10.3390/metabo11120831
7 Gooden, T. E., Gardner, M., Wang, J., Hsu, L., O’Halloran, C., Daskalopoulou, M., et al. (2022). The risk of mental illness in people living with HIV in the UK: A propensity score-matched cohort study. The Lancet HIV, 9(3), e172–e181. https://doi.org/10.1016/S2352-3018(21)00336-1
8 Wang, X., Yan, C., Tong, Y., Gao, J., Zhou, W., Lan, Z., et al. (2022). Comparison of psycho-social factors associated with suicidal ideation and suicide attempts among people living with HIV in Central West China. Frontiers in Public Health, 10, 832624. https://doi.org/10.3389/fpubh.2022.832624
9 Chipanta, D., Stöckl, H., Toska, E., Cheelo, C., Chubwa, C., Hobbins, M., et al. (2022). Facing the quality of life: Physical illness, anxiety, and depression symptoms among people living with HIV in rural Zambia – A cross-sectional study. AIDS Care, 34(8), 957–965. https://doi.org/10.1080/09540121.2021.1966693
10 Ong, J. Y., Yee, A., Nordin, A. S. A., Danaee, M., & Azwa, R. I. (2022). The prevalence of depression, anxiety and associated factors among adults with living human immunodeficiency virus in University Malaya Medical Centre. International Journal of STD & AIDS, 33(10), 880–889. https://doi.org/10.1177/09564624221106528
11 Wanjala, S. W., Abubakar, A., Nyongesa, M. K., Mwangome, M. K., Stewart, R. C., & Newton, C. R. J. C. (2022). Validation of the 12-item short version of the HIV stigma scale among adults living with HIV in coastal Kenya: A cross-sectional study. PLoS ONE, 17(3), e0264036. https://doi.org/10.1371/journal.pone.0264036
12 Filiatreau, L. M., Ebasone, P. V., Dzudie, A., Ajeh, R., Pence, B. W., Wainberg, M., et al. (2022). Prevalence of stressful life events and associations with symptoms of depression, anxiety, and post-traumatic stress disorder among people entering care for HIV in Cameroon. Journal of Affective Disorders, 308, 421–431. https://doi.org/10.1016/j.jad.2022.04.061
13 Lang, R., Hogan, B., Zhu, J., McArthur, K., Lee, J., Zandi, P., et al. (2023). The prevalence of mental health disorders in people with HIV and the effects on the HIV care continuum. AIDS, 37(2), 259–269. https://doi.org/10.1097/QAD.0000000000003420
14 Gutiérrez-Velilla, E., Barrientos-Casarrubias, V., Gómez-Palacio Schjetnan, M., Perrusquia-Ortiz, L. E., Cruz-Maycott, R., Alvarado-de la Barrera, C., et al. (2023). Mental health and adherence to antiretroviral therapy among Mexican people living with HIV during the COVID-19 pandemic. AIDS Research and Therapy, 20(1), 34. https://doi.org/10.1186/s12981-023-00532-0
15 Mburia-Mwalili, A., Wagner, K. D., Kwobah, E. K., Atwoli, L., Aluda, M., Simmons, B., et al. (2023). Social support and the effects of the COVID-19 pandemic among a cohort of people living with HIV (PLWH) in Western Kenya. PLOS Global Public Health, 3(2), e0000778. https://doi.org/10.1371/journal.pgph.0000778
16 Hernández-Salazar, P., Ortiz-Rodríguez, M. A., García Fuentes, N. B., & Martínez-Salazar, M. F. (2023). Physical activity, anxiety, depression, and adherence to antiretroviral therapy in people with HIV. AIDS Research and Human Retroviruses, 39(6), 310–316. https://doi.org/10.1089/AID.2022.0064
17 Carney, T., Choi, S. K., Stephenson, R., Bauermeister, J. A., & Carrico, A. W. (2023). Latent class analysis of substance use typologies associated with mental and sexual health outcomes among sexual and gender minority youth. PLoS ONE, 18(9), e0290781. https://doi.org/10.1371/journal.pone.0290781
18 Mukerji, R., Mannell, J., & Osrin, D. (2023). “I hope I die. That is what I hope for”: Qualitative study of lived experiences of mental health of Indian women living with HIV experiencing intersectional stigma. PLOS Global Public Health, 3(12), e0002075. https://doi.org/10.1371/journal.pgph.0002075
19 Ma, C., Yu, B., Fan, Y., Jia, P., & Yang, S. (2024). Exploring interrelationships between mental health symptoms and cognitive impairment in aging people living with HIV in China. Dementia and Geriatric Cognitive Disorders, 53(1), 19–28. https://doi.org/10.1159/000536056
20 Chen, S., Wang, H., Zeng, Y., Li, X., Qian, H. Z., Zhang, L., et al. (2024). Trajectories of anxiety and depression among Chinese men who have sex with men using pre-exposure prophylaxis and their associations with adherence. BMC Psychiatry, 24(1), 91. https://doi.org/10.1186/s12888-024-05533-8
21 Too, E. K., Abubakar, A., Nasambu, C., Koot, H. M., Cuijpers, P., Newton, C. R. J. C., et al. (2021). Prevalence and factors associated with common mental disorders in young people living with HIV in sub-Saharan Africa: A systematic review. Journal of the International AIDS Society, 24(Suppl 2), e25705. https://doi.org/10.1002/jia2.25705
22 Lee, K. W., Ang, C. S., Lim, S. H., Siau, C. S., Ong, L. T. D., Ching, S. M., et al. (2022). Prevalence of mental health conditions among people living with HIV during the COVID-19 pandemic: A rapid systematic review and meta-analysis. HIV Medicine, 23(9), 990–1001. https://doi.org/10.1111/hiv.13299
23 Conteh, N. K., Latona, A., & Mahomed, O. (2023). Mapping the effectiveness of integrating mental health in HIV programs: A scoping review. BMC Health Services Research, 23(1), 396. https://doi.org/10.1186/s12913-023-09359-x
24 Haas, A. D., Lienhard, R., Didden, C., Cornell, M., Folb, N., Boshomane, T. M. G., et al. (2023). Mental health, ART adherence, and viral suppression among adolescents and adults living with HIV in South Africa: A cohort study. AIDS and Behavior, 27(6), 1849–1861. https://doi.org/10.1007/s10461-022-03916-x
25 Lopez, C. M., Moreland, A., Goodrum, N. M., Davies, F., Meissner, E. G., & Danielson, C. K. (2023). Association of mental health symptoms on HIV care outcomes and retention in treatment. General Hospital Psychiatry, 82, 41–46. https://doi.org/10.1016/j.genhosppsych.2023.03.003
26 Mandlate, F. M., Greene, M. C., Pereira, L. F., Gouveia, M. L., Mari, J. J., Cournos, F., et al. (2023). Association between mental disorders and adherence to antiretroviral treatment in health facilities in two Mozambican provinces in 2018: A cross-sectional study. BMC Psychiatry, 23(1), 274. https://doi.org/10.1186/s12888-023-04782-0
27 Joska, J. A., Lee, J. S., Andersen, L. S., Stanton, A. M., O’Clereigh, C., & Safren, S. (2023). Trajectories of treatment response in a cognitive-behavioral therapy intervention for depression and adherence in persons with HIV in South Africa. Journal of Affective Disorders, 343, 136–143. https://doi.org/10.1016/j.jad.2023.10.001
28 Dreyer, A. J., Nightingale, S., Andersen, L. S., Lee, J. S., Gouse, H., Safren, S. A., et al. (2023). Cognitive performance, as well as depression, alcohol use, and gender, predict antiretroviral therapy adherence in a South African cohort of people with HIV and comorbid major depressive disorder. AIDS and Behavior, 27(8), 2681–2694. https://doi.org/10.1007/s10461-022-03982-1
29 Meng, J., Huang, H., Xu, Y., Chen, J., Zheng, X., Chen, H., et al. (2023). Sleep quality, social rhythms, and depression among people living with HIV: A path analysis based on social zeitgeber theory. Frontiers in Psychiatry, 14, 1102946. https://doi.org/10.3389/fpsyt.2023.1102946
30 Engler, K., Avallone, F., Cadri, A., & Lebouché, B. (2024). Patient-reported outcome measures in adult HIV care: A rapid scoping review of targeted outcomes and instruments used. HIV Medicine, 25(6), 633–674. https://doi.org/10.1111/hiv.13599
31 van der Kooij, Y. L., den Daas, C., Bos, A. E. R., Willems, R. A., & Stutterheim, S. E. (2023). Correlates of internalized HIV stigma: A comprehensive systematic review. AIDS Education and Prevention, 35(2), 158–172. https://doi.org/10.1521/aeap.2023.35.2.158
32 Aymerich, C., Fares, V., Cuadras, D., Malla, A., & Haro, J. M. (2024). Sexually transmitted infections, sexual life and risk behaviours in schizophrenia patients: A systematic review. Schizophrenia Research, 267, 160–169. https://doi.org/10.1016/j.schres.2024.04.006
33 Arora, A. K., Vicente, S., Engler, K., Lessard, D., Huerta, E., Ishak, J., et al. (2024). Patient-reported outcomes and experiences of migrants enrolled in a multidisciplinary HIV clinic with rapid, free, and onsite treatment dispensation: The ASAP study. AIDS Research and Therapy, 21(1), 40. https://doi.org/10.1186/s12981-024-00632-5
