INTRODUCTION: Depressive symptoms are highly prevalent among people with HIV, which can negatively impact HIV-related outcomes. We explore the cascade of mental healthcare for people with HIV experiencing depressive symptoms. METHODS: People with HIV who were part of the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study (2013-2016) were included. A Patient Health Questionnaire-9 (PHQ-9) score ≥10 or Center for Epidemiologic Studies Depression Scale (CES-D) ≥16 was defined as moderate/severe depressive symptoms. Diagnosed depression and access to mental healthcare were self-reported. A cascade of mental healthcare was explored, defining individuals experiencing depressive symptoms
those among them reporting a diagnosis of depression
and of this latter group, the proportion reporting accessing mental healthcare. Demographic, social and clinical characteristics were assessed at each step using logistic regression. RESULTS: Of the 1009 participants (65.5% ≥50 years, 85.8% male, 85.1% white), 387 (38.4%) individuals were experiencing depressive symptoms, over half of whom (54.3%) reported a diagnosis of depression. Only 43.3% of individuals with diagnosed depression reported accessing mental healthcare. Men [odds ratio = 0.62, 95% confidence interval (CI): 0.42-0.92], people in a relationship (0.44, 0.33-0.59), those who were employed (0.28, 0.21-0.38) and those with university qualifications (0.54, 0.40-0.72) were less likely to experience depressive symptoms. Heterosexuals (0.30, 0.14-0.64) were less likely to report a diagnosed depression, whereas smokers were more likely to have a diagnosed depression (1.75, 1.10-2.77). Older individuals (2.36, 1.31-4.28) were less likely to have accessed mental healthcare. CONCLUSIONS: Our findings suggest the presence of unmet mental healthcare needs for people with HIV. We hope these findings will inform policies to streamline mental health services for people with HIV.