Stability of mood despite HIV illness progression in a group of homosexual men

Abstract

B oth doctors and patients often assume that people with terminal illnesses are apt to become clinically depressed, especially as death approaches. Rarely, however, has this assumption been studied systematically or prospectively. Our data allow us to shed some light on whether clinical depression is an inevitable or even likely concomitant of fatal illness.While several large studies have generated prevalence rates of mood disorders among HIV-positive and HIVnegative men and women on a cross-sectional basis, there is a paucity of information about longitudinal changes in rates of either syndromal disorders or psychiatric symptoms as HIV illness progresses. Joseph et al. (1) found stable scores over six semiannual occasions on self-rating scales of depression in the Chicago Multicenter AIDS Cohort Study group, despite HIV illness progression. Perry et al. (2) followed 328 homosexual and heterosexual men and women, both HIV negative and HIV positive, who sought HIV antibody testing. Over a 1-year period, they found a decline in severity of depressive symptoms on both clinician-and self-rated scales, but no difference between HIV-positive and HIV-negative subjects on any occasion.A pair of studies (3, 4), published in the Journal of the American Medical Association, followed community cohorts of homosexual men semiannually since 1985. Both used the same self-report screening scale for mood problems (Center for Epidemiologic Studies Depression [CES-D] Scale). Neither study found a significant relation between CES-D Scale scores and the time to either diagnosis of AIDS or death, although they differed regarding the effect of depressive symptoms on the rate of decline of CD4 cells.

Psychiatric morbidity in asymptomatic human immunodeficiency virus patients

“…These guidelines were not followed by many of the studies, which resulted in erroneous observations. [232425] Some studies have kept sexually transmitted diseases patients as controls in view of similar social stigmatization,[2627] others high risk HIV seronegative persons (homosexuals and IV drug users)[2829] and still others rheumatoid arthritis. [11] Control subjects in this study were the normal healthy persons who had the same atmosphere and background as of the cases.…”

“…[11243031] On the other hand, the western studies had higher number of homosexual transmission and intravenous drug abuse. [2528]…”

Illness Behavior, Emotional Stress and Psychosocial Factors among Asymptomatic HIV-Infected Patients

“…In fact, even if the patients had no knowledge of their blood results at the time of the psychosocial assessment, they were informed of their immunological status, as represented by CD4+ and CD8+ cell counts at the previous visit and by their change over time. However, further research is needed to examine this aspect, since some studies found a significant association between reduction in CD4+ cell count and depression [39], while others showed that psychological stress symptoms were independent of immunological parameters [21, 22]among HIV-seropositive patients. However, when illness behavior was examined using the cumulative measures of illness behavior of Disease Affirmation and Affective State, it was shown that only the latter was predicted by psychosocial and clinical variables.…”

“…This does not permit to draw conclusions about the nature and diagnostic characteristics of the patients’ emotional problems (‘cases’). Fourth, although several reports indicate that life-time history of psychological and personality disorders are important predictors of maladjustment to HIV infection [6, 22], data concerning these variables were not collected in this study. Also, data concerning the subjective perception of symptoms, use of health services, compliance with therapy, maintenance of at-risk behavior and impact on the patients’ life areas, such as family and work, were not explored.…”

“…However, since clinical variables (e.g. CD4+ cell count, time since diagnosis) have been shown either to be related to [6, 20]or independent of the patients’ psychological status and adjustment to HIV infection [21, 22], their role in determining illness behavior during the asymptomatic phase of illness merits to be explored.…”