Persons Newly Diagnosed with HIV Infection are at High Risk for Depression and Poor Linkage to Care: Results from the Steps Study
First Online: 14 August 2010 DOI:
Cite this article as: Bhatia, R., Hartman, C., Kallen, M.A. et al. AIDS Behav (2011) 15: 1161. doi:10.1007/s10461-010-9778-9 Abstract
Little is known about the prevalence and impact of depression in persons newly diagnosed with HIV infection. The Steps Study is a prospective, observational cohort study of persons newly diagnosed with HIV infection. Participants were administered a battery of instruments, including the CES-D. Linkage to care was defined as attending at least one clinic appointment in each of the first two 90-day intervals following diagnosis. Of 180 participants, 67% screened positive for depression. In multivariate analysis, depression was associated with female sex, income <$25,000, recent substance abuse, baseline poor access to medical care, and low self-efficacy. Fifty-six and sixty-eight percent of depressed and not depressed participants linked to care, respectively. In multivariate analysis, depression was a borderline significant predictor of poor linkage. Depression is very prevalent in persons newly diagnosed with HIV infection. Interventions targeting linkage to care should address depression, substance abuse, and barriers to care.
Keywords HIV/AIDS Depression Cohort study Adherence Linkage to care References
Batki SL. Drug abuse, psychiatric disorders, and AIDS. Dual and triple diagnosis. West J Med. 1990;152(5):547–52.
Campos LN, Guimaraes MD, Remien RH. Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil. AIDS Behav. 2008;14:289–99.
Savetsky JB, Sullivan LM, Clarke J, Stein MD, Samet JH. Evolution of depressive symptoms in human immunodeficiency virus-infected patients entering primary care. J Nerv Ment Dis. 2001;189(2):76–83.
Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–30.
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.
Vranceanu AM, Safren SA, Lu M, et al. The relationship of post-traumatic stress disorder and depression to antiretroviral medication adherence in persons with HIV. AIDS Patient Care STDS. 2008;22(4):313–21.
Cook JA, Cohen MH, Burke J, et al. Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV-seropositive women. J Acquir Immune Defic Syndr. 2002;30(4):401–9.
Herrmann S, McKinnon E, John M, et al. Evidence-based, multifactorial approach to addressing non-adherence to antiretroviral therapy and improving standards of care. Intern Med J. 2008;38(1):8–15.
Horberg MA, Silverberg MJ, Hurley LB, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr. 2008;47(3):384–90.
Lazo M, Gange SJ, Wilson TE, et al. Patterns and predictors of changes in adherence to highly active antiretroviral therapy: longitudinal study of men and women. Clin Infect Dis. 2007;45(10):1377–85.
Maru DS, Bruce RD, Walton M, et al. Initiation, adherence, and retention in a randomized controlled trial of directly administered antiretroviral therapy. AIDS Behav. 2008;12(2):284–93.
Applebaum AJ, Richardson MA, Brady SM, Brief DJ, Keane TM. Gender and other psychosocial factors as predictors of adherence to highly active antiretroviral therapy (HAART) in adults with comorbid HIV/AIDS, psychiatric and substance-related disorder. AIDS Behav. 2009;13(1):60–5.
Ironson G, O’Cleirigh C, Fletcher MA, et al. Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med. 2005;67(6):1013–21.
Farinpour R, Miller EN, Satz P, et al. Psychosocial risk factors of HIV morbidity and mortality: findings from the Multicenter AIDS Cohort Study (MACS). J Clin Exp Neuropsychol. 2003;25(5):654–70.
Antelman G, Kaaya S, Wei R, et al. Depressive symptoms increase risk of HIV disease progression and mortality among women in Tanzania. J Acquir Immune Defic Syndr. 2007;44(4):470–7.
Leserman J, Pence BW, Whetten K, et al. Relation of lifetime trauma and depressive symptoms to mortality in HIV. Am J Psychiatry. 2007;164(11):1707–13.
Cook JA, Grey D, Burke J, et al. Depressive symptoms and AIDS-related mortality among a multisite cohort of HIV-positive women. Am J Public Health. 2004;94(7):1133–40.
Anastos K, Schneider MF, Gange SJ, et al. The association of race, sociodemographic, and behavioral characteristics with response to highly active antiretroviral therapy in women. J Acquir Immune Defic Syndr. 2005;39(5):537–44.
Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV epidemiology research study. JAMA. 2001;285(11):1466–74.
Lima VD, Geller J, Bangsberg DR, et al. The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating HAART. AIDS. 2007;21(9):1175–83.
Cook JA, Burke-Miller JK, Cohen MH, et al. Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women. AIDS. 2008;22(11):1355–63.
Moskowitz JT. Positive affect predicts lower risk of AIDS mortality. Psychosom Med. 2003;65(4):620–6.
Metsch LR, Pereyra M, Messinger S, et al. HIV transmission risk behaviors among HIV-infected persons who are successfully linked to care. Clin Infect Dis. 2008;47(4):577–84.
Perdue T, Hagan H, Thiede H, Valleroy L. Depression and HIV risk behavior among Seattle-area injection drug users and young men who have sex with men. AIDS Educ Prev. 2003;15(1):81–92.
Schackman BR, Dastur Z, Ni Q, Callahan MA, Berger J, Rubin DS. Sexually active HIV-positive patients frequently report never using condoms in audio computer-assisted self-interviews conducted at routine clinical visits. AIDS Patient Care STDS. 2008;22(2):123–9.
Ryan K, Forehand R, Solomon S, Miller C. Depressive symptoms as a link between barriers to care and sexual risk behavior of HIV-infected individuals living in non-urban areas. AIDS Care. 2008;20(3):331–6.
Chin-Hong PV, Deeks SG, Liegler T, et al. High-risk sexual behavior in adults with genotypically proven antiretroviral-resistant HIV infection. J Acquir Immune Defic Syndr. 2005;40(4):463–71.
Cunningham CO, Sohler NL, Wong MD, et al. Utilization of health care services in hard-to-reach marginalized HIV-infected individuals. AIDS Patient Care STDS. 2007;21(3):177–86.
Yun LW, Maravi M, Kobayashi JS, Barton PL, Davidson AJ. Antidepressant treatment improves adherence to antiretroviral therapy among depressed HIV-infected patients. J Acquir Immune Defic Syndr. 2005;38(4):432–8.
Cook JA, Grey D, Burke-Miller J, et al. Effects of treated and untreated depressive symptoms on highly active antiretroviral therapy use in a US multi-site cohort of HIV-positive women. AIDS Care. 2006;18(2):93–100.
Giordano TP, Gifford AL, White AC Jr, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.
Mugavero MJ, Lin HY, Allison JJ, et al. Racial disparities in HIV virologic failure: do missed visits matter? J Acquir Immune Defic Syndr. 2009;50(1):100–8.
Campos LN, Bonolo PF, Guimara˜es MDC. Anxiety and depression assessment prior to initiating antiretroviral treatment in Brazil. AIDS Care. 2006;18(6):529–36.
Olley BO, Gxamza F, Seedat S, et al. Psychopathology and coping in recently diagnosed HIV/AIDS patients–the role of gender. S Afr Med J. 2003;93(12):928–31.
Lyketsos CG, Hutton H, Fishman M, Schwartz J, Treisman GJ. Psychiatric morbidity on entry to an HIV primary care clinic. AIDS. 1996;10(9):1033–9.
Radloff LS. The CES-D scale: s self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.
Breslau N. Depressive symptoms, major depression, and generalized anxiety: a comparison of self-reports on CES-D and results from diagnostic interviews. Psychiatry Res. 1985;15(3):219–29.
Jones JE, Hermann BP, Woodard JL, et al. Screening for major depression in epilepsy with common self-report depression inventories. Epilepsia. 2005;46(5):731–5.
Thomas JL, Jones GN, Scarinci IC, Mehan DJ, Brantley PJ. The utility of the CES-D as a depression screening measure among low-income women attending primary care clinics. Int J Psychiatry Med. 2001;31(1):25–40.
Moore J, Schuman P, Schoenbaum E, Boland B, Solomon L, Smith D. Severe adverse life events and depressive symptoms among women with, or at risk for, HIV infection in four cities in the United States of America. AIDS. 1999;13(17):2459–68.
Lyketsos CG, Hoover DR, Guccione M, et al. Depressive symptoms as predictors of medical outcomes in HIV infection Multicenter AIDS cohort study. JAMA. 1993;270(21):2563–7.
Kalichman SC, Rompa D, Cage M. Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. J Nerv Ment Dis. 2000;188(10):662–70.
Andersen R, Bozzette S, Shapiro M, et al. Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS consortium. HIV cost and services utilization study. Health Serv Res. 2000;35(2):389–416.
Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984;252(14):1905–7.
Huba GJ, Melchior LA, Staff of the Measurement Group, and HRSA/HAB’s SPNS Cooperative Agreement Steering Committee. The measurement group module 64: self-efficacy form. 1996.
. Accessed 29 Jul 2010.
Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14.
Hall MA, Zheng B, Dugan E, et al. Measuring patients’ trust in their primary care providers. Med Care Res Rev. 2002;59(3):293–318.
O’Malley K, Haidet P, Sharf B, et al. Trust in physician, facility, and system: qualitative difference between ethnic groups. J Gen Intern Med. 2003;18(Suppl 1):184.
Gardner LI, Metsch LR, nderson-Mahoney P, et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS. 2005;19(4):423–31.
Treisman G, Angelino A. Interrelation between psychiatric disorders and the prevention and treatment of HIV infection. Clin Infect Dis. 2007;45(Suppl 4):S313–7.
Lyketsos CG, Hanson A, Fishman M, McHugh PR, Treisman GJ. Screening for psychiatric morbidity in a medical outpatient clinic for HIV infection: the need for a psychiatric presence. Int J Psychiatry Med. 1994;24(2):103–13.
Cleary PD, Singer E, Rogers TF, et al. Sociodemographic and behavioral characteristics of HIV antibody-positive blood donors. Am J Public Health. 1988;78(8):953–7.
Brewer TH, Zhao W, Pereyra M, et al. Initiating HIV care: attitudes and perceptions of HIV positive crack cocaine users. AIDS Behav. 2007;11(6):897–904.
Scheyett A, Parker S, Golin C, White B, Davis CP, Wohl D. HIV-infected prison inmates: depression and implications for release back to communities. AIDS Behav. 2010;14(2):300–7.
Rochat TJ, Richter LM, Doll HA, Buthelezi NP, Tomkins A, Stein A. Depression among pregnant rural South African women undergoing HIV testing. JAMA. 2006;295(12):1376–8.
Gardner LI, Marks G, Metsch LR, et al. Psychological and behavioral correlates of entering care for HIV infection: the antiretroviral treatment access study (ARTAS). AIDS Patient Care STDS. 2007;21(6):418–25.
Fumaz CR, Munoz-Moreno JA, Molto J, et al. Sustained antiretroviral treatment adherence in survivors of the pre-HAART era: attitudes and beliefs. AIDS Care. 2008;20(7):796–805.
Torian LV, Wiewel EW, Liu KL, Sackoff JE, Frieden TR. Risk factors for delayed initiation of medical care after diagnosis of human immunodeficiency virus. Arch Intern Med. 2008;168(11):1181–7.
PubMed CrossRef Copyright information
© Springer Science+Business Media, LLC 2010