Depression and HIV Infection
Jane McCall MSN, RN; Joel Singer PhD; Terry Lee PhD
St. Paul’s Hospital, Vancouver, BC, Canada
Background There is a wealth of literature and evidence that discusses the link between depression and HIV infection. Depression is very common in people living with HIV (PLWH) (Gaynes, Pence, Evan & Miller, 2008) and PLWH are more likely to be diagnosed with a depressive disorder. (Sherr et al, 2011). The majority of PLWH do not receive psychological evaluation and counselling as part of their routine HIV care (Mugavero et al, 2006). This is a concern because untreated depression in PLWH is associated with high rates of mortality, non-adherence to antiretroviral therapy (ART), faster progression to AIDS related illnesses and sexual risk behaviour (Ryan, Forehand, Solomon & Miller, 2008; AIDS Alert, 2008; Kalichman, 2008; Bradley, Reiman, & Dolezal, 2008; Leserman, 2008).
Purpose of the Study
Sample
Discussion
The sample consisted of 100 participants, 19% female and 81% male. This reflected the usual population on the unit. 45% of the sample were MSM, 71% used illicit drugs, 47% were immune compromised and 18% were currently taking an antidepressant. Mean age of the sample was 48.5 years.
Rates of depression in the population were significant. It is clear that more needs to be done to routinely screen PLWH for signs and symptoms of depression. 78% of the patients with a BDI score above 13 were not on an anti-depressant. This indicates a need for routine screening and skilled psychiatric followup. The inverse association between immune-compromise and BDI score indicates an issue with non-adherence. There is a significant literature that indicates an association between non-adherence and depression and that finding is replicated here. Also of interest was the finding that 14 of the 18 patients who were on antidepressants still exhibited depressive symptoms. This indicates a need for ongoing followup and the integration of pharmacotherapy with psychotherapy. There is evidence of a synergistic effect when different treatment modalitites are combined (Keller et al, 2000).
Results 50% of the respondents scored as depressive on the BDI. 22% scored as severely depressive, 17% had moderate depressive symptoms and 11% scored as minimally depressive. There were statistically significant associations between bisexuality, being female, being immune-compromised or being on an antidepressant and scoring as depressive on the BDI scale.
This descriptive cross-sectional study utilized a depression scale to determine the percentage of patients who presented to an HIV unit with depressive symptoms. Three research questions were asked:
BDI Score as continuous Odds ratio (95% CI)
1.
What percentage of patients were admitted with depressive symptoms?
2.
What demographic characteristics were associated with depressive symptoms?
Female (compared to male)
7.51(0.81,14.21)
0.028
3.
What percentage of patients who screened positive for depressive symptoms were taking an anti-depressant?
Gay (compared to straight)
-0.84(-6.36,4.68)
0.763
Bisexual (compared to straight)
11.46(1.87,21.05)
0.020
Bisexual (compared to gay)
12.30(2.75,21.85)
0.012
Immune-compromised (CD4 < 200)
6.15(1.24,11.06)
0.015
Used antidepressant
7.83(1.34,14.32)
0.019
Study Design The study utilized the Beck Depression Inventory (BDI), an established and well-tested tool for assessment of depressive symptoms. The BDI clearly differentiates depression from anxiety (Beck, Stear & Carbin, 1988) and is considered to have high internal . consistency, high content validity, validity in differentiating between depressed and non-depressed subjects, sensitivity to change, and it has been widely adopted and is in universal use (Richter et al, 1988). A score of 14 to 19 indicates minor depressive symptoms, a score of 20 to 28 indicates moderate symptoms and a score of greater than 28 is indicative of severe symptoms. A demographic tool was also used. It provided background variables including gender, age, sexual orientation, history of illicit drug use, immune status and present antidepressant use. The survey was administered to all newly admitted patients who spoke English, were medically stable and were cognitively capable of completing the forms. Informed consent and ethical approval were obtained.
p-value
An odds ratio of >1 suggests an increase in the odds of depressive symptoms Limitations: The sample comprised a particular population of predominantly street-involved, marginalized, drug addicted individuals. The results are not generalizable to the general HIV infected population.
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