When Mental Health Impacts on Sexually Transmitted Disease Risk

Marc Safran, MD, MPACAPT, US Public Health Service

Senior Medical Officer / Senior PsychiatristCenters for Disease Control and Prevention

USPHS Scientific and Training Symposium, June 20, 2012

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionDivision of STD Prevention

Ground Rules This brief workshop is meant to foster open

interactive dialogue regarding mental health and STD challenges facing our communities and our nation

Comments expressed during this workshop do not necessarily represent opinions of CDC or PHS

Please avoid sharing information that could jeopardize a person’s privacy or otherwise cause someone harm

Part I – Overview

Part II – Audience Discussion

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionDivision of STD Prevention

When Mental Health Impacts on STD Risk

Mental Health

• Is “successful performance of mental functions in terms of thought, mood and behavior.”

• Results in “productive activities, fulfilling relationships,… and... ability to adapt… and to cope…”

Source: Mental Health: A Report of the Surgeon General, 1999.

Mental Disorders

“…health conditions characterized by alterations in thinking, mood, or behavior

… associated with distress and/or impaired functioning.”

Reference: Mental Health: A Report of the Surgeon General, 1999.

Prevalence of Mental Disorders a decade ago

Data source: Mental Health: A Report of the Surgeon General, 1999.

1 in 5 Americans

Mental health disparities remain prevalent:

• In the general population

• In specific populations served by the U.S. Public Health Service

• In the way mental health is treated within the health system

References:Safran MA, Mays RA; Huang LN, McCuan R, Pham PK, Fisher SK, McDuffie KY, Trachtenberg A. Mental Health Disparities. American Journal of Public Health. 2009, 99(11): 1962-1966. Safran MA. Achieving recognition that mental health is part of the mission of CDC. Psychiatric Services. 2009, 60(11): 1532-1534.

DSM IV Multiaxial Assessment

• Axis I - clinical disorders and other conditions

• Axis II - personality disorders and mental retardation

• Axis III - general medical conditions• Axis IV - psychosocial and environmental

problems• Axis V - global assessment of functioning

Source: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994.

Some potential symptoms ofBipolar Disorder

• Elevated, expanded or irritable mood • Grandiosity• Less need for sleep• More talkative• Racing thoughts• Distractible• increased goal-directed activity (either socially, at work, or

school, or sexually) or psychomotor agitation”• “excessive involvement in pleasurable activities that have a

high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)”

Some potential symptoms ofMajor Depression

• Sadness • Anhedonia• Too much or too little sleep • Excessive guilt• Decreased energy • Impaired concentration • Appetite and weight

changes • Psychomotor changes• Suicidal thoughts

Some potential symptoms ofSchizophrenia

• Hallucinations • Delusions• Behavioral

Disorganization• Speech

Disorganization • Negative Symptoms

Accessing different systems of care

HIV/AIDS

• In 1994, the CDC National AIDS Hotline was the largest public health hotline in the world, fielding over a million calls a year

• Evaluation showed the Hotline was receiving mental health-related calls as part of its overall call mix

• Staff training needs were identified and addressed within the context of the Hotline’s role as an HIV information hotline

Safran MA, Waller RR. "Mental health-related calls to the CDC National AIDS Hotline." AIDS Education and Prevention, 1996, 8, 1, 37-43.

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionDivision of STD Prevention

When Mental Health Impacts on STD Risk

Part II - Audience Discussion• The floor is open for audience members to share

examples of situations where mental health impacted STD risk*

• The audience is also asked to think about potential strategies for mental health aspects of STD prevention

* As a reminder, please avoid sharing information that could jeopardize a person’s privacy or otherwise cause someone harm

Closing Questions What are three ways in which mental health

and STD prevention are inter-related? What are two strategies for promoting STD

prevention via attention to mental health? How might mental health and STD

prevention be better addressed?

Thank you!

Marc Safran, MD, MPACaptain, US Public Health ServiceSenior Medical Officer/ Senior Psychiatrist

Centers for Disease Control and Prevention1600 Clifton Road, NE, Mail Stop E-44Atlanta, GA 30333MSafran@cdc.gov