Am J Psychiatry 1993; 150:705-712
Copyright © 1993 by American Psychiatric Association
Psychosocial impact of HIV-related caregiving on health providers: a review and recommendations for the role of psychiatry
DC Silverman
Department of Psychiatry, Beth Israel Hospital, Boston, MA 02215.
OBJECTIVE: The author considers current knowledge about the stresses of
HIV-related care and assesses available evidence for the presence of major
occupational, physical, and psychiatric morbidity in health care providers
involved in intensive HIV-related caregiving. METHOD: The review is based
on anecdotal reports of AIDS-care-related psychosocial distress and the
literature concerning caregivers' attitudes toward people with HIV illness
and HIV-related caregiving, the psychosocial impact of HIV work, and stress
related to the ethical and philosophical challenges facing HIV caregivers.
RESULTS: Few of the current publications concerning HIV caregiver stress
come from the psychiatric literature. Psychiatry appears to lack a strong
clinical, educational, research, or policy presence regarding psychosocial
stress in HIV care providers. The numerous studies in the nursing, medical,
public health, and health education literature do not include any
controlled investigations documenting the incidence and prevalence of
physical, psychological, occupational, or interpersonal symptoms or
disorders in health care professionals who devote a substantial amount of
their clinical activities to patients with HIV illness. CONCLUSIONS: Major
HIV-related stress in conjunction with other psychiatric morbidity, such as
mood disorders, anxiety disorders, substance abuse, and relationship and
occupational problems, seems likely in susceptible caregivers. Decisions
about the structure and form of delivery of HIV- related care and programs
for caregivers must be based on more carefully controlled psychiatric
observations of occupational, physical, psychological, and social
adaptation to HIV-related work. The author suggests several areas in which
psychiatric clinicians, educators, researchers, and policy experts can make
major contributions.
