Mortality, CD4 Cell Count Decline, and Depressive Symptoms Among HIV-Seropositive Women [Ickovics JR, et al. JAMA 2001;285:1466]: This is a report from HERS, a cohort of 871 HIV-infected women at four sites who were enrolled from 1993-95 and for whom there is now follow-up data through March 2000. The test instrument was the Center for Epidemiologic Studies Depression Scale (CES-D), which contains 20 questions regarding depression. A score >16 is classified as "probable depression," which is found in 20% of the general population. Results of this test were correlated with viral load, CD4 cell count, and mortality. The results showed that 42% were categorized as having chronic depression, and 35% had intermittent depression. The median CES-D score in the former group was 30.4, and for the second group it was 19.2. Multivariate analysis controlling for clinical features, substance abuse, sociodemographic factors, and treatment showed chronic depression conferred a two-fold risk for mortality. Women with chronic depression also had a significantly greater decline in CD4 cell counts. For women who were asymptomatic at baseline, the probability of mortality was 3.6 times higher in those with chronic depression. This risk persisted even when somatic symptoms of depression were eliminated, thus suggesting that depression was a unique factor in lethal outcome.
Comment: The association between depression and mortality has been shown in other studies and other conditions, but the pathophysiological mechanism is unexplained [Annu Rev Psychol 1996;47:114]. Perhaps the most important message here concerns the importance of recognition of depression and the use of standard therapeutic interventions, which have proven highly effective in HIV-infected patients.
posted 4/13/2001

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