Changes in depressive symptoms as AIDS develops. The Multicenter AIDS Cohort Study

Adult Male Psychiatric Status Rating Scales Acquired Immunodeficiency Syndrome Depressive Disorder AIDS-Related Opportunistic Infections Personality Inventory Comorbidity Severity of Illness Index 3. Good health Cohort Studies 03 medical and health sciences 0302 clinical medicine Risk Factors HIV Seropositivity Disease Progression Humans Prospective Studies Follow-Up Studies Probability
DOI: 10.1176/ajp.153.11.1430 Publication Date: 2014-12-17T19:50:12Z
ABSTRACT
The authors sought to determine whether rates of depressive symptoms change from early- to late-stage HIV-1 infection and to determine the predictors of depressive symptoms as AIDS develops.The data for this study were from 911 HIV-seropositive men-community volunteers from four U.S. cities-who entered the 10-year Multicenter AIDS Cohort Study without a diagnosis of AIDS and subsequently developed AIDS. The subjects underwent semiannual follow-ups during the study period. The outcome measures-overall depressive symptoms, nonsomatic depressive symptoms, syndromal depression, and severe depression-were assessed over the 5 years before and the 2 years after AIDS diagnosis from responses on the Center for Epidemiologic Studies Depression Scale (CES-D Scale).Depressive symptoms were stable over time from month 60 to month 18 before AIDS developed. However, beginning 12-18 months before AIDS diagnosis, there was a significant rise in all measures of depression, which reached a plateau within 6 months before AIDS developed. At this plateau, there was a 45% increase in mean CES-D Scale scores above baseline. An elevated CES-D Scale score in the earlier stages of infection, a self-report of AIDS-related symptoms (such as rash and lymphadenopathy), concurrent unemployment, cigarette smoking, and limited social supports were consistent predictors of higher rates of depression as AIDS developed.There is a dramatic, sustained rise in depressive symptoms as AIDS develops, beginning as early as 18 months before clinical AIDS is diagnosed. Prior depression, HIV-disease-related factors, and psychological stressors contribute to this rise. This robust phenomenon invites further characterization.
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