Description: From the Quarterly Research Summary for Title IV Clinicians, July - September 2004.
Depression and HIV disease progression in women
Relevance for Title IV Providers: There are several reasons why depression is an important clinical issue when caring for women with HIV infection.
 | Women are about two times more likely to experience depression than men. |
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| HIV-positive women with symptoms of depression are less likely to take the most effective types of antiretroviral (ARV) treatments for HIV (called HAART). |
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| Persons with depression are also more likely to have problems taking ARVs regularly (poor adherence). |
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| Depression in women with HIV infection is associated with an increased chance of dying from non-AIDS-related causes such as deaths caused by accident, drug overdose, violence). |
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It is not completely clear whether or not depression affects progression of HIV disease. Only one other study that followed women's health over time (the HIV Epidemiologic Research Study or HERS) has shown that chronic (long lasting) symptoms of depression were associated with a greater chance of dying from AIDS. This study was done to confirm those findings and to look at whether women who receive mental health services may have better outcomes.
Study Question(s):
| Do depressive symptoms increase the likelihood of AIDS-related deaths among women with HIV? |
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| Does the use of mental health services lower the risk of women dying from AIDS? |
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| Compared to surviving women, do women in the final stage of their AIDS-related illnesses have more symptoms of depression before death? |
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Study Participants: Women were enrolled in the Women's Interagency HIV Study (WIHS) at 6 urban sites in the U.S. during 1994-1995 and then were followed every 6 months. This study looked at a subgroup of 1716 WIHS participants who completed at least three study visits.
Study Methods:
| Symptoms of depression were measured by the CES-D, a self-report tool. Women had chronic depression if they reported depressive symptoms at three-fourths of their study visits. |
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| Cause of death information was collected. |
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| When studying the relationship between depression and risk of AIDS related death, the researchers took into account other factors including viral load and CD4 count, race/ethnicity, age, use of illicit drugs, education level, employment status, adherence to HIV treatment, and use of mental health services. |
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Study Findings:
| About 31 percent of women reported chronic depression symptoms. |
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| AIDS-related deaths were almost twice as likely to occur in women with chronic depression symptoms than in women with intermittent depression or those with few/no symptoms. |
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| More than two-thirds of women in the study received mental health services. |
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| Women who used mental health services were less likely to die from AIDS-related causes during the study period; the risk of death was reduced by about 50 percent. |
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| Women who died from HIV/AIDS were more likely to have had recent depression symptoms than surviving women. |
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| Recent depression symptoms were less likely in women who received HAART for 12 or more months. |
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Limitations:
| Depression was assessed with a self-report tool (the CES-D) rather than a diagnostic interview. Although widely used in studies of HIV-positive individuals, the CES-D only gives the individual's view of depressive symptoms. |
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| Information on the cause of death may not have always been accurate; however, death certificates are commonly used in studies of this type. |
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Lessons Learned: This study shows there is a relationship between depression and HIV disease progression in women. It also expands our understanding of the benefits of mental health services to include a reduced risk of AIDS-related death. Like several other studies, women taking HAART were less likely to report depression. This shows the possible role of intensive ARV treatment in fighting depression in women with HIV infection.
Implications for Title IV Providers: Results highlight the importance of healthcare providers' roles in depression screening and in helping HIV-infected women access mental health services through referrals and case management. The association between use of HAART and reduced depressive symptoms points out the potential impact of Title IV services aimed at providing HAART and supporting women in adhering to treatment.
Title IV providers need to consider their strategies for routine depression screening and referral protocols to mental health professionals. Caring for women with HIV must include access to appropriate and sensitive mental health treatment and is particularly important for women with advanced disease who are more likely to experience depression. These types of services can improve clinical and quality of life outcomes for women.
Source: Cook JA, Grey D, Burke J, Cohen MH, Gurtman AC, Richardson JL, Wilson TE, Young MA, Hessol NA. Depressive Symptoms and AIDS-Related Mortality among a Multisite Cohort of HIV-Positive Women. American Journal of Public Health, 2004 July; 94(7): 1133-1140.
ALTERNATIVE PARAGRAPH VERSION:
Depression is associated with HIV disease progression in women. Studies have shown that those who use mental health services had a lower risk of AIDS-related death. This study provided a new and important finding about the benefits of mental health services for women with HIV. Women taking the most effective kind of ARV therapy (HAART) were less likely to report depression. This shows the possible role of intensive ARV treatment in fighting depression in women with HIV infection.
Implications for Title IV Providers: Results highlight the importance of healthcare providers' roles in depression screening and in helping HIV-infected women access mental health services through referrals and case management. The association between use of HAART and reduced depressive symptoms points out the potential impact of Title IV services aimed at providing HAART and supporting women in adhering to treatment.
Title IV providers need to consider their strategies for routine depression screening and referral protocols to mental health professionals. Caring for women with HIV must include access to appropriate and sensitive mental health treatment and is particularly important for women with advanced disease who are more likely to experience depression. These types of services can improve clinical and quality of life outcomes for women.
Source: Cook JA, Grey D, Burke J, Cohen MH, Gurtman AC, Richardson JL, Wilson TE, Young MA, Hessol NA. Depressive Symptoms and AIDS-Related Mortality among a Multisite Cohort of HIV-Positive Women. American Journal of Public Health, 2004 July; 94(7): 1133-1140.
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