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“Even modest increases in time spent depressed led to clinically meaningful upticks in negative outcomes,” lead author Brian Pence, Ph.D., of the University of North Carolina at Chapel Hill, told Psychiatric News by email. “The implication [of these findings] is that regular depression screening and rapid, evidence-based depression treatment—by shortening the duration of depression—hold the potential to have a meaningful impact on HIV outcomes,” he said.
To examine the association between the persistence of depression and multiple HIV care continuum indicators, Pence and colleagues analyzed data on adult patients who received HIV care at six U.S. academic medical centers participating in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) between September 22, 2005, and August 6, 2015. As part of routine clinical visits, patients were regularly given the PHQ-9 every six or so months.
Pence and colleagues focused their analysis on information collected on CNICS participants with two or more consecutive PHQ-9 measures (defined as two PHQ-9 measures separated by less than 365 days). Patients entered and remained in the analysis until one of the following occurred: death, a lapse in PHQ-9 measures (12 months after the last consecutive PHQ-9 measure), loss to care (≥12 months without an HIV primary care appointment), six years’ follow-up, or until the end of the available data from the patient’s site. The main outcomes assessed during the follow-up period included missed HIV primary care appointments, detectable HIV viral load (HIV RNA viral load measure of 75 copies/mL or more), and all-cause mortality.
A total of 5,927 participants were included in the analysis. During the follow-up period, Pence and colleagues found that the participants’ median percentage of days with depression was 14%, 10,361 of 55,040 scheduled visits (18.8) were missed, 6,191 of 28,455 viral loads (21.8%) were detectable, and the mortality rate was 1.5 deaths per 100 person-years.
“Increasing PDD [percentage of days with depression] was associated in a dose-response fashion with an increased risk of missed appointments, increased risk of detectable viral load, and accelerated mortality. Each 25% increase in PDD led to an 8% increase in the risk that a particular scheduled appointment would be missed, a 5% increase in the risk that a particular viral load would be detectable, and a 19% increase in the mortality hazard,” the authors wrote.
For related information, see the Psychiatric News article “Advisory Council Member Offers Voice for Psychiatry in New HIV/AIDS Strategy.”
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