Impact of depression and recreational drug use on emergency department encounters and hospital admissions among people living with HIV in Ontario: A secondary analysis using the OHTN cohort study

PLoS One. 2018 Apr 9;13(4):e0195185. doi: 10.1371/journal.pone.0195185. eCollection 2018.


Introduction: Nearly half of HIV-positive patients experience mental health and substance use problems, but many do not receive adequate or ongoing mental health or addiction care. This lack of ongoing care can result in the use of costly acute care services. Prospective evaluations of the relationship between psychiatric and substance use disorders and acute care services use are lacking, and this information is needed to understand unmet needs and improve access to appropriate services.

Methods: We conducted a secondary data analysis from a multicenter, longitudinal, prospective cohort study (n = 3,482 adults) between October 1, 2007 and March 31, 2013. We used explanatory extended Cox proportional hazard regression models to examine the impact of current depression and recreational drug use on acute care services use, and to explore whether current depression and recreational drug use were associated with potentially avoidable acute care services use.

Results: Over our 5.5 year study period, HIV-positive participants with current depression-only (aHR [95% CI]:1.2[1.1-1.4]), recreational drug use-only (1.3[1.1-1.6]), or co-occurring depression and recreational drug use (1.4[1.2-1.7]) were associated with elevated hazard of emergency department (ED) encounters compared to participants without these conditions. Over half of ED encounters were potentially avoidable. Participants with current depression-only (1.3[1.1-1.5];1.3[1.03-1.6]), recreational drug use-only (1.3[1.04-1.6];1.5[1.1-1.9]), or co-occurring depression and recreational drug use (1.3[1.04-1.7];1.4[1.06-1.9]) were associated with elevated hazard of low-acuity or repeated ED encounters respectively.

Conclusions: We found a significant increase in ED services use and potentially avoidable ED encounters (including low-acuity or repeated ED encounters), particularly among those with either current depression or recreational drug use. These findings emphasize the challenges in managing HIV and mental health/addiction co-morbidities in the current HIV care model. Future research should evaluate integrated and collaborative care programs for improving the coordination of care and effectively treat mental health and addiction problems among HIV-positive patients in Ontario.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Comorbidity
  • Depressive Disorder / epidemiology*
  • Depressive Disorder / etiology
  • Emergency Medical Services / statistics & numerical data*
  • Female
  • HIV Infections / complications*
  • HIV Infections / psychology
  • HIV-1 / drug effects*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Illicit Drugs / adverse effects*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Ontario / epidemiology
  • Prospective Studies
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / etiology
  • Young Adult


  • Illicit Drugs

Grant support

The study was supported by the Ontario HIV Treatment Network (OHTN) and the Institute for Clinical Evaluative Sciences, which are funded by annual grants from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.