(Boston)--In a new study to investigate the relationship among depressive disorders or symptoms, HIV status and mortality, researchers report that symptoms of depression are moderately associated with death among Veterans with HIV but not among those without HIV infection.
Depression is the most frequently reported mental health condition in people living with HIV in the U.S, with a prevalence ranging from 20 to 40 percent. Depressive disorders have been associated with increased mortality in persons with chronic diseases, including heart disease, end-stage renal disease and diabetes. Several studies have described similar associations in the context of HIV infection, although conflicting data exist.
Using data from participants of the Veteran's Aging Cohort Study, researchers from Boston University School of Medicine (BUSM) compared the risk of death among U.S. Veterans who were depressed to those not suffering with depression. They then compared the association between depression and death among those with HIV to those without HIV. Depression was measured in two ways, by clinical diagnostic codes and by a depressive symptoms questionnaire.
Among those with HIV infection, they found a 23 percent increased mortality risk associated with elevated depressive symptoms ascertained by the questionnaire but no significantly increased mortality risk when depression was ascertained by the codes. For HIV-uninfected people, there was a six percent increased mortality risk associated with depressive disorders measured by the codes but no significant increased mortality risk for elevated depressive symptoms assessed by the questionnaire.
According to the researchers, it is important to screen for and treat depression particularly among those living with HIV since significant gains have been made in life expectancy with life saving antiretroviral therapy. "Our findings reinforce the need to assess and treat depressive symptoms and major depressive disorder in patients with and without HIV infection to potentially reduce mortality risk," explained corresponding author Kaku So-Armah, PhD, assistant professor of medicine at BUSM.
The researchers point out that despite clinical guidelines recommending routine screening for depressive symptoms, there is varying success in implementation resulting in under diagnosis of depression among people with HIV infection. "This needs to be improved; better understanding of barriers to and facilitators of effective depression screening and integration of depression treatment into HIV primary care is needed."
These findings appear online in the journal HIV Medicine.
Funding for this study was provided by a grant from the National Heart Lung and Blood Institute at the National Institutes of Health (grant numbers R01 HL126557 to SKG and K01 HL134147 to KS).
Disclosure: KS-A reports funding from the National Institutes of Health. SKG reports funding from the National Institutes of Health, Indiana University, and Gilead Sciences; advisory board fees from Gilead Sciences and GlaxoSmithKline/ViiV; and travel support to present data at scientific conferences from Gilead Sciences and Bristol-Myers Squibb. SK reports funding from the National Institutes of Health. JCS reports funding from the National Institutes of Health. JLG reports funding from the National Institutes of Health, the Department of Veterans Affairs, and the Department of Defense. MB reports funding from the National Institutes of Health. MCR-B reports funding from the National Institutes of Health and Kowa Pharmaceuticals. VCM reports funding from the National Institutes of Health, Centers for Disease Control and Prevention, the Department of Veterans Affairs, GlaxoSmithKline/ViiV, Gilead Sciences, and Bayer. MSF reports funding from the National Institutes of Health. SC reports funding from the Agency for Healthcare Quality and Research, the National Institutes of Health, and the Patient-Centered Outcomes Research Institute. CLG reports funding from the National Institutes of Health. RB reports grant funding from Merck & Co, Bristol-Myers Squibb, Theratechnologies, and Gilead Sciences. C-CHC reports funding from the National Institutes of Health. JJS has no disclosures to report.