AIDS and Behavior

, Volume 14, Issue 2, pp 272–279 | Cite as

Depression Symptoms and Treatment Among HIV Infected and Uninfected Veterans

  • Kristen Sueoka
  • Joseph L. Goulet
  • David A. Fiellin
  • David Rimland
  • Adeel A. Butt
  • Cynthia Gibert
  • Maria C. Rodriguez-Barradas
  • Kendall Bryant
  • Stephen Crystal
  • Amy C. Justice
Original Paper

Abstract

Depression is one of the most common comorbid conditions affecting persons with HIV. We compared depressive symptoms and depression treatment using data from the Veterans Aging Cohort Study (VACS), a prospective cohort of HIV-infected and uninfected subjects. We identified subjects with a Patient Health Questionnaire score of 10 or greater. Treatment was defined as prescription of a selective serotonin reuptake inhibitor (SSRI) or mental health counseling. Overall, 16% of 4,480 subjects had depressive symptoms, and HIV-infected patients were more likely to have had depressive symptoms (OR = 1.38, 95% CI = 1.18, 1.62). Geographic site of care and having a mental health provider at the clinic was associated with treatment. In multivariable models restricted to 732 patients with depressive symptoms, receipt of depression treatment did not differ by HIV status (Adjusted OR = 1.11, 95% CI = 0.80, 1.54). Non-Hispanic whites were more likely to receive treatment (Adjusted OR = 2.09, 95% CI 1.04, 4.24). Primary care and HIV providers were equally unlikely to treat active depressive symptoms. Treatment variation by race, site, and availability of a mental health provider, suggests targets for intervention.

Keywords

HIV-infection Depression Psychiatric status rating scales Anti-depressive agents 

References

  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Press, Inc.Google Scholar
  2. Basu, S., Chwastiak, L. A., & Bruce, R. D. (2005). Clinical management of depression and anxiety in HIV-infected adults. AIDS, 19, 2057–2067.Google Scholar
  3. Braithwaite, R. S., Justice, A. C., Chang, C. C., Fusco, J. S., Raffanti, S. R., Wong, J. B., et al. (2005). Estimating the proportion of patients infected with HIV who will die of comorbid diseases. American Journal of Medicine, 118, 890–898.CrossRefPubMedGoogle Scholar
  4. Charbonneau, A., Rosen, A. K., Ash, A. S., Owen, R. R., Kader, B., Spiro, A., III et al. (2003). Measuring the quality of depression care in a large integrated health system. Medical Care, 41, 669–680.CrossRefPubMedGoogle Scholar
  5. Chen, T. M., Huang, F. Y., Chang, C., & Chung, H. (2006). Using the PHQ-9 for depression screening and treatment monitoring for Chinese Americans in primary care. Psychiatric Services, 57, 976–981.CrossRefPubMedGoogle Scholar
  6. Ciesla, J. A., & Roberts, J. E. (2001). Meta-analysis of the relationship between HIV infection and risk for depressive disorders. American Journal of Psychiatry, 158, 725–730.CrossRefPubMedGoogle Scholar
  7. Colibazzi, T., Hsu, T. T., & Gilmer, W. S. (2006). Human immunodeficiency virus and depression in primary care: A clinical review. Primary Care Companion of the Journal of Clinical Psychiatry, 8, 201–211.CrossRefGoogle Scholar
  8. Cooper, L. A., Gonzales, J. J., Gallo, J. J., Rost, K. M., Meredith, L. S., Rubenstein, L. V., et al. (2003). The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Medical Care, 41, 479–489.CrossRefPubMedGoogle Scholar
  9. Fultz, S. L., Goulet, J. L., Weissman, S., Rimland, D., Leaf, D., Gibert, C., et al. (2005). Differences between infectious diseases-certified physicians and general medicine-certified physicians in the level of comfort with providing primary care to patients. Clinical Infectious Diseases, 41, 738–743.CrossRefPubMedGoogle Scholar
  10. Goulet, J., Fultz, S. L., Rimland, D., Butt, A. A., Gibert, C., Rodriguez-Barradas, M., et al. (2007). Do patterns of comorbidity vary by HIV status, age, and HIV severity? Clinical Infectious Diseases, 45, 1593–1601.CrossRefPubMedGoogle Scholar
  11. Huang, F. Y., Chung, H., Kroenke, K., Delucchi, K. L., & Spitzer, R. L. (2006). Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. Journal of General Internal Medicine, 21, 547–552.CrossRefPubMedGoogle Scholar
  12. Justice, A. C., Dombrowski, E., Conigliaro, J., Fultz, S. L., Gibson, D., Madenwald, T., et al. (2006). Veterans Aging Cohort Study (VACS): Overview and description. Medical Care, 44, S13–S24.CrossRefPubMedGoogle Scholar
  13. Kilbourne, A. M., Justice, A. C., Rollman, B. L., McGinnis, K. A., Rabeneck, L., Weissman, S., et al. (2002). Clinical importance of HIV and depressive symptoms among veterans with HIV infection. Journal of General Internal Medicine, 17, 512–520.CrossRefPubMedGoogle Scholar
  14. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefPubMedGoogle Scholar
  15. Liu, C. F., Campbell, D. G., Chaney, E. F., Li, Y. F., McDonell, M., & Fihn, S. D. (2006). Depression diagnosis and antidepressant treatment among depressed VA primary care patients. Administration and Policy in Mental Health, 33, 331–341.CrossRefPubMedGoogle Scholar
  16. Lowe, B., Spitzer, R. L., Grafe, K., Kroenke, K., Quenter, A., Zipfel, S., et al. (2004a). Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. Journal of Affective Disorders, 78(1), 131–140.CrossRefPubMedGoogle Scholar
  17. Lowe, B., Unutzer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K. (2004b). Monitoring depression treatment outcomes with the patient health questionnaire-9. Medical Care, 42(12), 1194–1201.CrossRefPubMedGoogle Scholar
  18. Martin, A., Rief, W., Klaiberg, A., & Braehler, E. (2006). Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. General Hospital Psychiatry, 28, 71–77.CrossRefPubMedGoogle Scholar
  19. Mayne, T. J., Vittinghoff, E., Chesney, M. A., Barrett, D. C., & Coates, T. J. (1996). Depressive affect and survival among gay and bisexual men infected with HIV. Archives of Internal Medicine, 156, 2233–2238.CrossRefPubMedGoogle Scholar
  20. Palella, F. J., Jr, Baker, R. K., Moorman, A. C., Chmiel, J. S., Wood, K. C., Brooks, J. T., et al. (2006). Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. Journal of Acquired Immune Deficiency Syndromes, 43, 27–34.CrossRefPubMedGoogle Scholar
  21. Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791–804.CrossRefPubMedGoogle Scholar
  22. Simpson, S. M., Krishnan, L. L., Kunik, M. E., & Ruiz, P. (2007). Racial disparities in diagnosis and treatment of depression: A literature review. Psychiatric Quarterly, 78(1), 3–14.CrossRefPubMedGoogle Scholar
  23. Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). 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. Journal of the American Medical Association, 282, 1737–1744.CrossRefPubMedGoogle Scholar
  24. Uldall, K. K., Koutsky, L. A., Bradshaw, D. H., & Krone, M. (1998). Use of hospital services by AIDS patients with psychiatric illness. General Hospital Psychiatry, 20, 292–301.CrossRefPubMedGoogle Scholar
  25. Van Voorhees, B. W., Cooper, L. A., Rost, K. M., Nutting, P., Rubenstein, L. V., Meredith, L., et al. (2003). Primary care patients with depression are less accepting of treatment than those seen by mental health specialists. Journal of General Internal Medicine, 18, 991–1000.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Kristen Sueoka
    • 1
  • Joseph L. Goulet
    • 1
    • 2
  • David A. Fiellin
    • 1
  • David Rimland
    • 3
  • Adeel A. Butt
    • 4
  • Cynthia Gibert
    • 5
  • Maria C. Rodriguez-Barradas
    • 6
  • Kendall Bryant
    • 7
  • Stephen Crystal
    • 8
  • Amy C. Justice
    • 1
    • 2
  1. 1.Yale University School of MedicineNew HavenUSA
  2. 2.VA Connecticut Healthcare System—11ACSLGWest HavenUSA
  3. 3.VA Medical Center and Emory University School of MedicineAtlantaUSA
  4. 4.VA Pittsburgh Healthcare System and University of PittsburghPittsburghUSA
  5. 5.VA Medical Center and George Washington University Medical CenterWashingtonUSA
  6. 6.Michael E. De Bakey VAMC and Baylor College of MedicineHoustonUSA
  7. 7.National Institute on Alcohol Abuse and AlcoholismNational Institutes of HealthBethesdaUSA
  8. 8.The Institute for Health, Health Care Policy and Aging ResearchRutgers UniversityNew BrunswickUSA

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