Depression and Survival in a 17-Year Longitudinal Study of People With HIV: Moderating Effects of Race and Education

Ironson, Gail; Fitch, Calvin; Stuetzle, Rick

doi:10.1097/psy.0000000000000488

Cited by 27 publications

(14 citation statements)

References 55 publications

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“…These factors fall into the domains of sociodemographics, neighborhood and local environmental factors, social structures, individual biology, and intersecting societal stigmas. Structural factors, including poverty, low education, unstable housing, and food insecurity, contribute to increased vulnerability to HIV infection and poor HIV health outcomes [56,57]. Neighborhood and environmental factors, including violence and lack of safety, lack of adequate safe and steady water supply, wars, and natural disasters, cause psychological trauma, disrupt the delivery of medical supplies, and present barriers to healthcare access [58–60].…”

Section: Intersecting Vulnerabilitiesmentioning

confidence: 99%

Mental health and HIV/AIDS

Remien

Stirratt

Nguyen

et al. 2019

Aids

431

211

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Tremendous biomedical advancements in HIV prevention and treatment have led to aspirational efforts to end the HIV epidemic. However, this goal will not be achieved without addressing the significant mental health and substance use problems among people living with HIV (PLWH) and people vulnerable to acquiring HIV. These problems exacerbate the many social and economic barriers to accessing adequate and sustained healthcare, and are among the most challenging barriers to achieving the end of the HIV epidemic. Rates of mental health problems are higher among both people vulnerable to acquiring HIV and PLWH, compared with the general population. Mental health impairments increase risk for HIV acquisition and for negative health outcomes among PLWH at each step in the HIV care continuum. We have the necessary screening tools and efficacious treatments to treat mental health problems among people living with and at risk for HIV. However, we need to prioritize mental health treatment with appropriate resources to address the current mental health screening and treatment gaps. Integration of mental health screening and care into all HIV testing and treatment settings would not only strengthen HIV prevention and care outcomes, but it would additionally improve global access to mental healthcare.

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Section: Intersecting Vulnerabilitiesmentioning

confidence: 99%

Mental health and HIV/AIDS

Remien

Stirratt

Nguyen

et al. 2019

Aids

431

211

View full text Add to dashboard Cite

show abstract

“…Taken together, research to date has consistently identified pathways of both HIV-related stigma and life stress to important disease-related variables such as substance use, depression, and health outcomes in PLWHA. The associations to depression and substance abuse are also important in and of themselves because both depression [24,33,34] and substance use [35][36][37] have been associated with worse HIV outcomes over and above the effects of antiretroviral use or adherence. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which may reveal a more nuanced understanding of how HIV-related stigma and life stress affect functional health in PLWHA.…”

Section: Introductionmentioning

confidence: 99%

Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use

et al. 2019

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Background-Despite antiretroviral treatment (ART) being an efficacious treatment for HIV, essentially making it a chronic nonterminal illness, two related and frequent concerns for many people living with HIV/AIDS (PLWHA) continue to be HIV-related stigma and life stress. These two variables are frequently associated with depression, substance use, and poorer functional health. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which could reveal a more nuanced understanding of how HIVrelated stigma and life stress affect functional health in PLWHA. Methods-The current study employed hybrid structural equation modeling to examine the interconnectedness and potential indirect relationships of HIV-related stigma and life stress to worse health through substance use and depression, controlling for ART adherence and age. Participants were 240 HIV-infected individuals who completed a biopsychosocial assessment battery upon screening for an RCT on treating depression in those infected with HIV. Results-Both HIV-related stigma and stressful life events were directly related to depression, and depression was directly related to health. There were significant indirect effects from stigma and stress to health via depression. There were no significant effects involving substance use. Conclusion-It is important to continue to develop ways to address stigma, stressful life events, and their effects on distress in those living with HIV. Expanding our knowledge of disease Steven A. Safren ssafren@miami.edu. Conflict of Interest The authors declare that they have no conflict of interest. Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent Informed consent was obtained from all individual participants included in the study.

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“…Additionally, this group might be targeted for the treatment of sleep disturbance for the prevention of depression. Efforts to decrease the prevalence of depression in HIV+, in turn, might improve adherence to HAART [ [29] , [30] , [31] ] and mitigate adverse medical outcomes [ 25 ] and mortality risk [ [32] , [33] , [34] , [35] , [36] ].Moreover, treatments that target insomnia complaints are thought to optimize the efficacy of depression prevention efforts, by reducing the number needed to treat to achieve benefit. Indeed, cognitive behavioral therapy for insomnia (CBT—I), as well as mindfulness based interventions (MBI), achieve >50% clinical response rate [ [37] , [38] , [39] ], suggesting that such prevention strategies are feasible in collaborative care (i.e., CBT—I) or community settings (i.e., MBI), with the potential to prevent incident depression in HIV+ MSM.…”

Section: Discussionmentioning

confidence: 99%

Increased risk of depression in non-depressed HIV infected men with sleep disturbance: Prospective findings from the Multicenter AIDS Cohort Study

et al. 2018

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ObjectiveSleep disturbance is a known risk factor for depression, but it is not known whether sleep disturbance contributes to greater risk of depression in those infected with human immunodeficiency virus (HIV+) as compared to those uninfected with HIV (HIV-).MethodsUsing data from the Multicenter AIDS Cohort Study, a population-based prospective study of men who have sex with men (MSM), self-reported sleep disturbance (>2 weeks) and depressive symptoms (Clinical Epidemiologic Scale for Depression, CES-D) were assessed every 6 months over 12 years of follow-up. Adjusted mixed effects logistic regression analyses tested whether sleep disturbance predicted depression (CES-D ≥ 16) at the immediate subsequent visit, and so on over 12 years, in non-depressed HIV+(N = 1054; 9556 person-visits) and non-depressed HIV- (N = 1217; 12,680 person-visits). In HIV+ vs. HIV- MSM, linearly estimated average incidence of depression and normalized cumulative rate of depression over 12 years were compared.ResultsIn the HIV+ MSM, sleep disturbance was associated with a significant increase in depression 6 months later (OR = 1.6; 95% CI, 1.30, 1.96), which was significantly greater (P < .05) than in HIV- MSM (OR = 1.16; 95% CI, 0.94, 1.44). HIV status and sleep disturbance interacted (P < .001), such that incidence of depression and normalized cumulative rate of depression were greater in HIV+ with sleep disturbance than in HIV+ without sleep disturbance and HIV- groups (all P's < 0.001).ConclusionsHIV+ persons who report sleep disturbance represent a high risk group to be monitored for depression, and possibly targeted for insomnia treatment to prevent depression.FundNational Institute of Allergy and Infectious Diseases.

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Depression and Survival in a 17-Year Longitudinal Study of People With HIV: Moderating Effects of Race and Education

Cited by 27 publications

References 55 publications

Mental health and HIV/AIDS

Mental health and HIV/AIDS

Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use

Increased risk of depression in non-depressed HIV infected men with sleep disturbance: Prospective findings from the Multicenter AIDS Cohort Study

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