Underdiagnosis of depression in HIV
Who are we missing?
Cite this article as: Asch, S.M., Kilbourne, A.M., Gifford, A.L. et al. J GEN INTERN MED (2003) 18: 450. doi:10.1046/j.1525-1497.2003.20938.x Abstract OBJECTIVE: To determine the sociodemographic and service delivery correlates of depression underdiagnosis in HIV. DESIGN: Cross-sectional survey. PATIENTS/PARTICIPANTS: National probability sample of HIV-infected persons in care in the contiguous United States who have available medical record data. MEASUREMENTS AND MAIN RESULTS: We interviewed patients using the Composite International Diagnostic Interview (CIDI) survey from the Mental Health Supplement. Patients also provided information regarding demographics, socioeconomic status, and HIV disease severity. We extracted patient medical record data between July 1995 and December 1997, and we defined depression underdiagnosis as a diagnosis of major depressive disorder based on the CIDI and no recorded depression diagnosis by their principal health care provider in their medical records between July 1995 and December 1997. Of the 1,140 HIV Cost and Services Utilization Study patients with medical record data who completed the CIDI, 448 (37%) had CIDI-defined major depression, and of these, 203 (45%) did not have a diagnosis of depression documented in their medical record. Multiple logistic regression analysis revealed that patients who had less than a high school education ( P<.05) were less likely to have their depression documented in the medical record compared to those with at least a college education. Patients with Medicare insurance coverage compared to those with private health insurance ( P<.01) and those with ≥3 outpatient visits ( P<.05) compared to <3 visits were less likely to have their depression diagnosis missed by providers. CONCLUSIONS: Our results suggest that providers should be more attentive to diagnosing comorbid depression in HIV-infected patients. Key words depression HIV diagnosis
The HIV Cost and Services Utilization Study is being conducted under cooperative agreement U-01HS08578 (M. F. Shapiro, Pl; S. A. Bozzette, Co-Pl) between RAND and the Agency for Healthcare Research and Quality (AHRQ, formerly the Agency for Health Care Policy and Research). Substantial additional funding for this cooperative agreement was provided by the Health Resources and Services Administration, the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institutes of Health Office of Research on Minority Health through the National Institute of Dental Research. Additional support was provided by VA HSR&D Career Development Awards (Dr. Asch and Dr. Kilbourne), the Robert Wood Johnson Foundation, Merck and Company, Glaxo-Wellcome, Inc., the National Institute on Aging, and the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services. Drs. Bozzette and Asch are Health Services Research and Development Senior Research Associates of the Department of Veterans’ Affairs.
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