Symptoms of Psychological Distress among African Americans Seeking HIV-Related Mental Health Care

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.

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

Shacham

Nurutdinova

Satyanarayana

et al. 2009

“…The total score could range from 0 to 27. Depression severity was defined as none/minimal (total score 0-4), mild (total score 5-9), moderate (total score [10][11][12][13][14], moderately severe (total score [15][16][17][18][19], and severe (total score [20][21][22][23][24][25][26][27], as previously reported. 43,45,46 We defined major depression as (1) a score of 2 or 3 on four of the nine items, including on each of the screener's first two items; or (2) a score of 2 or 3 on five of the nine items, including on at least one of the screener's first two items.…”

Section: Definitions Of the Outcome Variablesmentioning

confidence: 99%

“…19 As the current U.S. HIV epidemic disproportionately impacts communities of color, the relationship of gender and ethnicity to depression is important to document and understand. [20][21][22][23][24][25][26] Depression and depressive symptoms do seem to occur more frequently in HIV-infected women compared to men. 3,15,16 Women living with HIV infection often have many sociodemographic and lifestyle characteristics associated with depression, such as poverty, isolation, higher rates of smoking, traumatic life events, and substance abuse.…”

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confidence: 99%

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

Tedaldi

Berg-Wolf

Richardson

et al. 2012

We used a standardized screening tool to examine frequency of depression and its relation to antiretroviral medication adherence among HIV-infected persons on highly active antiretroviral therapy (HAART) in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN Study). This is a prospective observational cohort of 700 HIV-infected patients enrolled between March 2004 and June 2006 in four U.S. cities, who completed a confidential audio computer-assisted self-interview [ACASI] with behavioral risk and health-related questions at baseline and 6-month follow-up visits, including the nine-question PRIME-MD depression screener and a validated 3-day antiretroviral adherence question. Among 539 eligible participants receiving HAART, 14% had depression at baseline (22% women, 12% men). In multivariable analysis using generalized estimating equations (GEE) to account for repeated measurements through 24 months of follow-up, persons who reported depression on a given ACASI were twice as likely to report nonadherence to antiretrovirals on the same ACASI (Odds ratio [OR] 2.02, 95% CI: 1.15, 3.57] for mild/moderate depression versus none); such persons were also less likely to have HIV viral load < 400 copies/mL. Self-administered computerized standardized screening tools can identify at-risk individuals with depression who may benefit from interventions to improve antiretroviral adherence.

“…42 Similarly, there is evidence that patient report of psychological distress may be less valid than clinician ratings of such distress. 43,44 Taken together, the literature referenced above 21,40,41 indicates that neuropsychological impairment negatively impacts both electronically monitored and self-reported adherence. This literature also suggests that neuropsychological impairment may affect the discrepancy between the two, in that those with such impairment may be less accurate in recalling and reporting their level of adherence.…”

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confidence: 96%

The Impact of Neuropsychological Functioning on Adherence to HAART in HIV-Infected Substance Abuse Patients

Applebaum

Reilly

Gonzalez

et al. 2009

This study assessed the frequency of neuropsychological impairment and its relationship to adherence in a sample of HIV-infected injection drug users (IDUs) in treatment. One hundred eight participants recruited between September 2006 and October 2008 completed psychodiagnostic and neuropsychological assessments and monitored HAART adherence over a 2-week period via the use of Medication Event Monitoring System (MEMS) electronic pill caps and self-report. Assessment of concurrent functioning included clinician-rated scales of depression and substance use severity, and a battery of neuropsychological tests. Findings from individual neuropsychological tests were converted to Z scores relative to standard norms and averaged to form a composite score (NPZ). NPZ was generally poor (mean ¼ À1.505, standard deviation ¼ 1.120), with 76.9% of the sample being classified as highly impaired. Self-reported adherence was significantly higher than MEMS cap adherence. In contrast with previous studies, overall neuropsychological functioning was not a significant predictor of electronically monitored or self-reported adherence. However, examiner-rated current global severity of substance use and delayed word list recall emerged as significant predictors of self-reported adherence. Additionally, estimated premorbid verbal intelligence emerged as a significant predictor of the discrepancy between electronically monitored and self-reported adherence. Given the extent of neuropsychological impairment in this sample, future studies should examine the degree to which the impact of neuropsychological impairment may moderate interventions for this population, and the extent to which skills to cope with neuropsychological problems may boost the potential efficacy of such interventions.