Psychiatric comorbidity in depressed HIV-infected individuals: common and clinically consequential

Abstract

Objective To report on the prevalence of psychiatric comorbidity and its association with illness severity in depressed HIV patients. Methods As part of a multi-site randomized controlled trial of depression treatment for HIV patients, 304 participants meeting criteria for current Major Depressive Disorder (MDD) were assessed for other mood, anxiety and substance use disorders with the Mini-International Neuropsychiatric Interview, a structured psychiatric diagnostic interview. We also assessed baseline adherence, risk, and health measures. Results Complicated depressive illness was common. Only 18% of participants experienced MDD with no comorbid psychiatric diagnoses; 49% had comorbid dysthymia, 62% had ≥1 comorbid anxiety disorder, and 28% had a comorbid substance use disorder. Self-reported antiretroviral adherence did not differ by the presence of psychiatric comorbidity. However, psychiatric comorbidity was associated with worse physical health and functioning: compared to those with MDD alone, individuals with ≥1 comorbidity reported more HIV symptoms (5.1 vs. 4.1, p-value=0.01), and worse mental health-related quality of life on the SF-12 (29 vs. 35, p<0.01). Conclusion For HIV patients with MDD, chronic depression and psychiatric comorbidity are strikingly common, and this complexity is associated with greater HIV disease severity and worse quality of life. Appreciating this comorbidity can help clinicians better target those at risk of harder-to-treat HIV disease, and underscores the challenge of treating depression in this population.

Trajectories of Depressive Symptoms Among a Population of HIV-Infected Men and Women in Routine HIV Care in the United States

“…However, no clear pattern of factors emerged to distinguish participants in the improving, rebounding (men only), and severe trajectory groups from one another. Depression has been reported as comorbid with other mental health condition in both HIV-infected and uninfected adults [49, 50]. Our study further suggests that participants with comorbid mental health conditions may be likely to experience more severe and persistent depressive symptoms.…”

Predictors of depression recovery in HIV-infected individuals managed through measurement-based care in infectious disease clinics

“…As described previously, our population showed high levels of comorbid anxiety and/or substance abuse at baseline (Gaynes et al, 2015). Having comorbid anxiety and depression at baseline predicted a slower time to remission in all subjects and those in active depression treatment with a 95% CI that excluded the null (Fig.…”

“…1). In HIV-infected individuals, having comorbid anxiety with depression is significantly associated with a greater number of reported HIV symptoms, as well as worse mental health functioning (Gaynes et al, 2015). Further, having “anxious depression” was associated with lower remission and response rates in the STAR*D trial (Fava et al, 2008).…”

Examining transdiagnostic vulnerabilities among HIV positive smokers seen at three inner city community based organizations

“…Compared to the adult general population, PLWHA are more likely to smoke and less likely to quit smoking (Mdodo et al, 2015). Rates of depression among PLWHA also exceed the general population (O’Cleirigh, et al, 2015), and multiple psychiatric conditions are common among PLWHA (Gaynes et al, 2015). …”