Predictors of Depression Recovery in HIV-Infected Individuals Managed Through Measurement-Based Care in Infectious Disease Clinics
BACKGROUND:
Treatment
of comorbid chronic disease, such as depression, in people living with HIV/AIDS
(PLWHA) increasingly falls to HIV treatment providers. Guidance in who will
best respond to depression treatment and which patient-centered symptoms are
best to target is limited.
METHODS:
Bivariable
analyses were used to calculate hazard ratios for associations between baseline
demographic, mental health-related, and HIV-related factors on time to first
depression remission among PLWHA enrolled in a randomized trial of
measurement-based antidepressant management. Time-updated factors also were
analyzed at time of antidepressant (AD) initiation/adjustment and 8 weeks post
AD initiation/adjustment.
RESULTS:
Baseline
comorbid depression and anxiety; comorbid depression, anxiety and substance
abuse; and generalized anxiety disorder predicted a slower time to first
remission. Being on ART but non-adherent, having panic disorder, having a
history of a major depressive episode, or having been in HIV care for >10
years prior to study initiation predicted a faster time to first remission.
Sleep difficulty or fatigue at the time of AD initiation/adjustment predicted a
slower time to remission. In non-remitters at 8 weeks post AD
initiation/adjustment, sleep difficulty, anxiety, and fatigue each predicted a
slower time to remission.
LIMITATIONS:
Remission
was determined by PHQ-9 scores, not diagnostic criteria. The results may apply
only to depression recovery in this particular model of treatment. We conducted
only exploratory analyses to determine magnitude of effects.
CONCLUSIONS:
Baseline
comorbid anxiety with or without substance abuse predicts slower time to
depression remission among PLWHA treated in HIV clinics. Targeting anxiety or
fatigue at the time of AD initiation/adjustment or sleep difficulty, anxiety,
and fatigue at 8 weeks post AD initiation/adjustment could shorten time to
depression remission in this model.
- 1Department of Psychiatry, University of North Carolina School of Medicine (http://www.med.unc.edu/psych), Chapel Hill, NC, USA. Electronic address: nathaniel_sowa@med.unc.edu.
- 2Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC, USA.
- 3Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
- J Affect Disord. 2015 Dec 22;192:153-161. doi: 10.1016/j.jad.2015.12.031.
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