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Routine Depression Screening in an HIV Clinic Cohort Identifies Patients with Complex Psychiatric Co-morbidities Who Show Significant Response to Treatment

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Abstract

This study described characteristics, psychiatric diagnoses and response to treatment among patients in an outpatient HIV clinic who screened positive for depression. Depressed (25 %) were less likely to have private insurance, less likely to have suppressed HIV viral loads, had more anxiety symptoms, and were more likely to report current substance abuse than not depressed. Among depressed, 81.2 % met diagnostic criteria for a depressive disorder; 78 % for an anxiety disorder; 61 % for a substance use disorder; and 30 % for co-morbid anxiety, depression, and substance use disorders. Depressed received significantly more treatment for depression and less HIV primary care than not depressed patients. PHQ-9 total depression scores decreased by 0.63 from baseline to 6-month follow-up for every additional attended depression treatment visit. HIV clinics can routinely screen and treat depressive symptoms, but should consider accurate psychiatric diagnosis as well as co-occurring mental disorders.

Resumen

Este estudio describe las características, diagnósticos psiquiátricos y respuesta al tratamiento entre pacientes externos de una clínica de VIH (virus de inmunodeficiencia humana) que fueron positivos a un escrutinio de depresión. Los pacientes deprimidos (25 %) fueron menos probables de tener seguro privado, menos probables de tener cargas virales de VIH suprimidas, estar más ansiosos y reportar más abuso de substancias que los no deprimidos. Entre los deprimidos, 81.2 % cumplieron los criterios para un desorden depresivo, 78 % para un desorden de ansiedad; 61 % para un desorden de abuso de substancias y 30 % para una ansiedad comorbida, depresión y abuso de substancias. Los pacientes deprimidos recibieron significativamente más tratamiento para depresión y menos cuidado primario para VIH que los no deprimidos. El puntaje total para depresión usando la escala de PHQ-9 disminuyó 0.63 del puntaje basal a los 6 meses de seguimiento por cada visita para tratamiento de depresión adicional. Las clínicas de VIH pueden rutinariamente escrutinizar y tratar síntomas de depresión, pero deberían considerar los diagnósticos psiquiátricos así como la co-ocurrencia de enfermedades mentales.

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References

  1. Israelski DM, Prentiss DE, Lubega S, Balmas G, Garcia P, Muhammad M, et al. Psychiatric co-morbidity in vulnerable populations receiving primary care for HIV/AIDS. AIDS Care. 2007;19(2):220–5.

    Article  PubMed  CAS  Google Scholar 

  2. Pence BW, Miller WC, Whetten K, Eron JJ, Gaynes BN. Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the Southeastern United States. J Acquir Immune Defic Syndr. 2006;42(3):298–306.

    Article  PubMed  Google Scholar 

  3. Brinkman K, ter Hofstede HJ, Burger DM, Smeitink JA, Koopmans PP. Adverse effects of reverse transcriptase inhibitors: mitochondrial toxicity as common pathway. AIDS. 1998;12(14):1735–44.

    Article  PubMed  CAS  Google Scholar 

  4. Vinet-Oliphant H, Alvarez X, Buza E, Borda JT, Mohan M, Aye PP, et al. Neurokinin-1 receptor (NK1-R) expression in the brains of SIV-infected rhesus macaques: implications for substance P in NK1-R immune cell trafficking into the CNS. Am J Pathol. 2010;177(3):1286–97.

    Article  PubMed  CAS  Google Scholar 

  5. Weiser SD, Wolfe WR, Bangsberg DR. The HIV epidemic among individuals with mental illness in the United States. Curr HIV/AIDS Rep. 2004;1(4):186–92.

    Article  PubMed  Google Scholar 

  6. Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006;10(5):473–82.

    Article  PubMed  Google Scholar 

  7. Safren SA, Radomsky AS, Otto MW, Salomon E. Predictors of psychological well-being in a diverse sample of HIV-positive patients receiving highly active antiretroviral therapy. Psychosomatics. 2002;43(6):478–85.

    Google Scholar 

  8. McDowell TL, Serovich JM. The effect of perceived and actual social support on the mental health of HIV-positive persons. AIDS Care. 2007;19(10):1223–9.

    Article  PubMed  CAS  Google Scholar 

  9. Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.

    Article  PubMed  CAS  Google Scholar 

  10. Tegger MK, Crane HM, Tapia KA, Uldall KK, Holte SE, Kitahata MM. The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals. AIDS Patient Care STDS. 2008;22(3):233–43.

    Article  PubMed  Google Scholar 

  11. Basu S, Chwastiak LA, Bruce RD. Clinical management of depression and anxiety in HIV-infected adults. AIDS. 2005;19(18):2057–67.

    Article  PubMed  Google Scholar 

  12. Protopopescu C, Raffi F, Brunet-Francois C, Salmon D, Verdon R, Reboud P, et al. Incidence, medical and socio-behavioural predictors of psychiatric events in an 11-year follow-up of HIV-infected patients on antiretroviral therapy. Antivir Ther. 2012;17(6):1079–83.

    Google Scholar 

  13. Reif S, Mugavero M, Raper J, Thielman N, Leserman J, Whetten K, et al. Highly stressed: stressful and traumatic experiences among individuals with HIV/AIDS in the deep South. AIDS Care. 2011;23(2):152–62.

    Article  PubMed  Google Scholar 

  14. Barskova T, Oesterreich R. Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: a systematic review. Disabil Rehabil. 2009;31(21):1709–33.

    Article  PubMed  Google Scholar 

  15. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  PubMed  CAS  Google Scholar 

  16. Martin A, Rief W, Klaiberg A, Braehler E. Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. Gen Hosp Psychiatry. 2006;28(1):71–7.

    Google Scholar 

  17. Crane HM, Lober W, Webster E, Harrington RD, Crane PK, Davis TE, et al. Routine collection of patient-reported outcomes in an HIV clinic setting: the first 100 patients. Curr HIV Res. 2007;5(1):109–18.

    Article  PubMed  CAS  Google Scholar 

  18. Shacham E, Nurutdinova D, Satyanarayana V, Stamm K, Overton ET. Routine screening for depression: identifying a challenge for successful HIV care. AIDS Patient Care STDS. 2009;23(11):949–55.

    Article  PubMed  CAS  Google Scholar 

  19. Lawrence ST, Willig JH, Crane HM, Ye J, Aban I, Lober W, et al. Routine, self-administered, touch-screen, computer-based suicidal ideation assessment linked to automated response team notification in an HIV primary care setting. Clin Infect Dis. 2010;50(8):1165–73.

    Article  PubMed  Google Scholar 

  20. Pence BW. The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. J Antimicrob Chemother. 2009;63(4):636–40.

    Article  PubMed  CAS  Google Scholar 

  21. Olatunji BO, Mimiaga MJ, O’Cleirigh C, Safren SA. Review of treatment studies of depression in HIV. Top HIV Med. 2006;14(3):112–24.

    Google Scholar 

  22. Safren SA, O’Cleirigh C, Tan JY, Raminani SR, Reilly LC, Otto MW, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol. 2009;28(1):1–10.

    Article  PubMed  Google Scholar 

  23. Ferrando SJ, Freyberg Z. Treatment of depression in HIV positive individuals: a critical review. Int Rev Psychiatry. 2008;20(1):61–71.

    Article  PubMed  Google Scholar 

  24. Soller M, Kharrazi N, Prentiss D, Cummings S, Balmas G, Koopman C, et al. Utilization of psychiatric services among low-income HIV-infected patients with psychiatric comorbidity. AIDS Care. 2011;23(11):1351–9.

    Article  PubMed  Google Scholar 

  25. Alabama Department of Public Health. Alabama Department of Public Health: HIV/AIDS slides 20052005: Available from: http://www.adph.org/aids/HIVAIDS%20slides%202005.pdf. Accessed 2010.

  26. Kitahata MM, Rodriguez B, Haubrich R, Boswell S, Mathews WC, Lederman MM, et al. Cohort profile: the Centers for AIDS Research Network of Integrated Clinical Systems. Int J Epidemiol. 2008;37(5):948–55.

    Article  PubMed  Google Scholar 

  27. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282(18):1737–44.

    Article  PubMed  CAS  Google Scholar 

  28. Lowe B, Grafe K, Zipfel S, Spitzer RL, Herrmann-Lingen C, Witte S, et al. Detecting panic disorder in medical and psychosomatic outpatients: comparative validation of the hospital anxiety and depression scale, the patient health questionnaire, a screening question, and physicians’ diagnosis. J Psychosom Res. 2003;55(6):515–9.

    Article  PubMed  Google Scholar 

  29. Spitzer RL, Williams JB, Kroenke K, Hornyak R, McMurray J. Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obstet Gynecol. 2000;183(3):759–69.

    Article  PubMed  CAS  Google Scholar 

  30. Lowe B, Schenkel I, Carney-Doebbeling C, Gobel C. Responsiveness of the PHQ-9 to psychopharmacological depression treatment. Psychosomatics. 2006;47(1):62–7.

    Google Scholar 

  31. Kroenke K, Strine T, Spitzer R, Williams J, Berry J, Mokdad A. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114:163–73.

    Article  PubMed  Google Scholar 

  32. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. Alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998;158(16):1789–95.

    Article  PubMed  CAS  Google Scholar 

  33. Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, et al. Two brief alcohol-screening tests from the alcohol use disorders identification test (AUDIT): validation in a female veterans affairs patient population. Arch Intern Med. 2003;163(7):821–9.

    Article  PubMed  Google Scholar 

  34. WHO ASSIST Working Group. The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction. 2002;97(9):1183–94.

    Article  Google Scholar 

  35. Newcombe DA, Humeniuk RE, Ali R. Validation of the World Health Organization alcohol, smoking and substance involvement screening test (ASSIST): report of results from the Australian site. Drug Alcohol Rev. 2005;24(3):217–26.

    Article  PubMed  Google Scholar 

  36. Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care. 2000;12(3):255–66.

    Article  PubMed  CAS  Google Scholar 

  37. First M, Spitzer R, Gibbon M, Williams J. Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition (SCID-I/P), biometrics research. New York: New York State Psychiatric Institute; 2002.

    Google Scholar 

  38. Willig JH, Abroms S, Westfall AO, Routman J, Adusumilli S, Varshney M, et al. Increased regimen durability in the era of once-daily fixed-dose combination antiretroviral therapy. AIDS. 2008;22(15):1951–60.

    Article  PubMed  Google Scholar 

  39. Crane PK, Gibbons LE, Willig JH, Mugavero MJ, Lawrence ST, Schumacher JE, et al. Measuring depression levels in HIV-infected patients as part of routine clinical care using the nine-item Patient Health Questionnaire (PHQ-9). AIDS Care. 2010;22(7):874–85.

    Article  PubMed  CAS  Google Scholar 

  40. Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, et al. The patient-reported outcomes measurement information system (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol. 2010;63(11):1179–94.

    Article  PubMed  Google Scholar 

  41. Gibbons LE, Feldman BJ, Crane HM, Mugavero M, Willig JH, Patrick D, et al. Migrating from a legacy fixed-format measure to CAT administration: calibrating the PHQ-9 to the PROMIS depression measures. Qual Life Res. 2011;20(9):1349–57.

    Google Scholar 

  42. Kempf MC, McLeod J, Boehme AK, Walcott MW, Wright L, Seal P, et al. A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural southeastern United States: implications for targeted interventions. AIDS Patient Care STDS. 2010;24(8):515–20.

    Article  PubMed  Google Scholar 

  43. Kozak MS, Mugavero MJ, Ye J, Aban I, Lawrence ST, Nevin CR, et al. Patient reported outcomes in routine care: advancing data capture for HIV cohort research. Clin Infect Dis. 2012;54(1):141–7.

    Article  PubMed  Google Scholar 

  44. Moneyham L, McLeod J, Boehme A, Wright L, Mugavero M, Seal P, et al. Perceived barriers to HIV care among HIV-infected women in the Deep South. J Assoc Nurses AIDS Care. 2010;21(6):467–77.

    Google Scholar 

  45. Mugavero M, Ostermann J, Whetten K, Leserman J, Swartz M, Stangl D, et al. Barriers to antiretroviral adherence: the importance of depression, abuse, and other traumatic events. AIDS Patient Care STDS. 2006;20(6):418–28.

    Article  PubMed  Google Scholar 

  46. Mugavero MJ, Lin HY, Allison JJ, Giordano TP, Willig JH, Raper JL, et al. Racial disparities in HIV virologic failure: do missed visits matter? J Acquir Immune Defic Syndr. 2009;50(1):100–8.

    Article  PubMed  Google Scholar 

  47. Mugavero MJ, Lin HY, Allison JJ, Willig JH, Chang PW, Marler M, et al. Failure to establish HIV care: characterizing the “no show” phenomenon. Clin Infect Dis. 2007;45(1):127–30.

    Article  PubMed  Google Scholar 

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Acknowledgments

This research was sponsored by a Grant from Boehringer-Ingelheim. The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE) and were fully responsible for all aspects of manuscript development.

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Authors and Affiliations

  1. Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Joseph E. Schumacher & Zhiying You

  2. Division of Consultation & Liaison, Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA

    Cheryl McCullumsmith

  3. Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Michael J. Mugavero, Paige E. Ingle-Pang, James L. Raper, James H. Willig, Charles Wright & Michael S. Saag

  4. Behavioral Science Core, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA

    D. Scott Batey & Sarah T. Lawrence

  5. Department of Medicine, University of Washington, Seattle, WA, USA

    Heidi Crane

  6. Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA

    Glenn Treisman

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  1. Joseph E. Schumacher
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  2. Cheryl McCullumsmith
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Correspondence to Joseph E. Schumacher.

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Schumacher, J.E., McCullumsmith, C., Mugavero, M.J. et al. Routine Depression Screening in an HIV Clinic Cohort Identifies Patients with Complex Psychiatric Co-morbidities Who Show Significant Response to Treatment. AIDS Behav 17, 2781–2791 (2013). https://doi.org/10.1007/s10461-012-0342-7

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