Frequency of and Risk Factors for Depression among Participants in the Swiss HIV Cohort Study (SHCS)

Abstract

ObjectivesWe studied the incidence and prevalence of, and co-factors for depression in the Swiss HIV Cohort Study.MethodsDepression-specific items were introduced in 2010 and prospectively collected at semiannual cohort visits. Clinical, laboratory and behavioral co-factors of incident depression among participants free of depression at the first two visits in 2010 or thereafter were analyzed with Poisson regression. Cumulative prevalence of depression at the last visit was analyzed with logistic regression.ResultsAmong 4,422 participants without a history of psychiatric disorders or depression at baseline, 360 developed depression during 9,348 person-years (PY) of follow-up, resulting in an incidence rate of 3.9 per 100 PY (95% confidence interval (CI) 3.5–4.3). Cumulative prevalence of depression during follow-up was recorded for 1,937/6,756 (28.7%) participants. Incidence and cumulative prevalence were higher in injection drug users (IDU) and women. Older age, preserved work ability and higher physical activity were associated with less depression episodes. Mortality (0.96 per 100 PY, 95% CI 0.83–1.11) based upon 193 deaths over 20,102 PY was higher among male IDU (2.34, 1.78–3.09), female IDU (2.33, 1.59–3.39) and white heterosexual men (1.32, 0.94–1.84) compared to white heterosexual women and homosexual men (0.53, 0.29–0.95; and 0.71, 0.55–0.92). Compared to participants free of depression, mortality was slightly elevated among participants with a history of depression (1.17, 0.94–1.45 vs. 0.86, 0.71–1.03, P = 0.033). Suicides (n = 18) did not differ between HIV transmission groups (P = 0.50), but were more frequent among participants with a prior diagnosis of depression (0.18 per 100 PY, 95%CI 0.10–0.31; vs. 0.04, 0.02–0.10; P = 0.003).ConclusionsDepression is a frequent co-morbidity among HIV-infected persons, and thus an important focus of care.

Prevalence, Recurrence, and Incidence of Current Depressive Symptoms among People Living with HIV in Ontario, Canada: Results from the Ontario HIV Treatment Network Cohort Study

“…Consistent with prior studies [38,58–61], we found an elevated point prevalence of depressive symptoms among HIV-positive participants who had a history of depression and among those who were: female, younger, recreational drug users, or unemployed/disabled. Unlike the U.S. evidence [58,61], we did not note differences among ethnocultural minorities.…”

“…Our incidence rate of 4.5 per 100 person-years was similar to the rate of 3.9 per 100 person-years reported by Anagnostopoulos et al in a depressive symptoms -free sample of the Swiss HIV Cohort [38]. However, our incidence rate was higher than prior findings of 1.04–2.2 per 100 person-years reported in French and French Guiana studies [35–37] where their denominator included all participants and that would underestimate the incidence rate.…”

“…With regard to factors associated with incidence rate of depressive symptoms, consistent with prior evidence, we found HIV-positive participants who were younger or recreational drug users were more likely to develop incident depressive symptoms [35–38]. Unlike prior evidence [35,37], we did not find that those with more severe HIV conditions were more likely to develop incident depressive symptoms but we did observe the incident cases were associated with poor physical health.…”

“…Explanatory variables entered into and kept in the explanatory multivariate models were based on evidence from prior studies [38,58–61]. When an explanatory variable did not have a priori evidence, we used a backward selection method [62–64].…”

“…Six studies have documented the incidence [35–38] and persistence (or recurrence) [39,40] of depression over time among people living with HIV. In Canada, information describing the epidemiology of depression among people living with HIV is scarce.…”