Routine Screening for Depression: Identifying a Challenge for Successful HIV Care

Abstract

Individuals with HIV experience fluctuating levels of distress throughout the course of HIV infection. This study was conducted to examine the associations of depressive symptomatology with HIV disease in a cohort of individuals who are engaged in routine medical care. This cross-sectional study examined the prevalence of depressive symptoms that were measured as part of a standard of care behavioral assessment among individuals at an urban HIV clinic in the Midwest. Demographic characteristics, depressive symptoms, and behavioral risk factors were collected. A total of 514 individuals participated in the study, the majority of whom was male and African American. One quarter of the sample endorsed symptoms of other depressive disorder, while 18% (n ¼ 91) endorsed symptoms of major depressive disorder as measured by the Patient Health Questionnaire-9 (PHQ-9). Among those on highly active antiretroviral therapy (HAART), individuals who were unemployed (adjusted odds ratio [AOR] ¼ 2.47, 95% confidence interval [CI] ¼ 1.54, 3.97), had a minor dependent (AOR ¼ 2.17, 95% CI ¼ 1.25, 3.77), or between the ages of 18 and 34 years (AOR ¼ 1.37, CI ¼ 1.03, 1.94) and detectable HIV viral load (AOR ¼ 2.52, 95% CI ¼ 1.22, 5.23) were more likely to report depressive disorder symptoms when controlling for age, gender, race, and education. Nearly 15% of the sample endorsed having suicidal thoughts at least once in the past two weeks. Regardless of HAART prescription, individuals who were unemployed had a higher likelihood of expressing suicidal ideation (AOR ¼ 3.43, 95% CI ¼ 1.66, 7.06). Given the association between depressive symptomatology and poor rates of HIV viral suppression, screening and appropriate interventions for depressive symptoms are warranted in the HIV outpatient setting to improve outcomes.

The Interplay of Sociodemographic Factors on Virologic Suppression Among a U.S. Outpatient HIV Clinic Population

“…44 In our clinic, much of the patient population has a low annual income and struggles with other survival challenges that are not specifically related to HIV. Key features that have been highlighted in other research include missed clinic visits, 45 having children to care for in the home (although not significant in this study), 29,47 and substance use disorders. 10 The treatment and care of individuals with HIV continue to be complicated by sociodemographic factors that are not easily modified, and findings suggest a need for further research regarding care provision is warranted.…”

“…Depression severity was dichotomized to those who expressed symptoms of major or other depressive disorders (MDD=ODD) within the past 2 weeks and those who did not. Age was categorized for regression analyses (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), older than 50 years). The 4-day recall of medication adherence was dichotomized as less than 95% and more than 95% adherent.…”

Depression in HIV Infected Patients: a Review

“…However, studies report low screening rates in clinical practice for depression in HIV patients, depending on the absence of systematic screening processes and efficient validated screening tools [98,99].…”

Sadness in the SUN: Using Computerized Screening to Analyze Correlates of Depression and Adherence in HIV-Infected Adults in the United States

“…29 Fortunately, treatment of depression pharmacologically or through other behavioral interventions can be beneficial with demonstrated improved clinical outcomes and HAART adherence; 12,[31][32][33][34][35][36] however, differential use of antidepressants has been documented. [37][38][39] The relationship of depression and its treatment and HAART adherence is a dynamic one and longitudinal evaluations of HIV-infected persons in the evolving chronic disease model of care are needed. Assessing depression in HIV-infected persons can be done through structured interviews or standardized screening instruments that may be selfadministered or done electronically.…”