Do HIV-Positive Women Receive Depression Treatment that Meets Best Practice Guidelines?

Abstract

This study addressed whether psychopharmacologic and psychotherapeutic treatment of depressed HIV+ women met standards defined in the best practice literature, and tested hypothesized predictors of standard-concordant care. 1,352 HIV-positive women in the multi-center Women’s Interagency HIV Study were queried about depressive symptoms and mental health service utilization using standards published by the American Psychiatric Association and the Agency for Healthcare Quality and Research to define adequate depression treatment. We identified those who: 1) reported clinically significant depressive symptoms (CSDS) using Centers for Epidemiological Studies – Depression Scale (CES-D) scores of ≥ 16; or 2) had lifetime diagnoses of major depressive disorder (MDD) assessed by World Mental Health Composite International Diagnostic Interviews plus concurrent elevated depressive symptoms in the past 12 months. Adequate treatment prevalence was 46.2% (n=84) for MDD and 37.9% (n=211) for CSDS. Multivariable logistic regression analysis found that adequate treatment was more likely among women who saw the same primary care provider consistently, who had poorer role functioning, who paid out-of-pocket for healthcare, and who were not African American or Hispanic/Latina. This suggests that adequate depression treatment may be increased by promoting healthcare provider continuity, outreaching individuals with lower levels of role impairment, and addressing the specific needs and concerns of African American and Hispanic/Latina women.

Gender-Related Risk Factors Improve Mortality Predictive Ability of VACS Index Among HIV-Infected Women

“…Use of antidepressants in women with HIV on antiretroviral therapy was associated with a 29% higher rate of being employed [40]. Nonetheless, Cook et al recently reported that less than half of HIV infected women in WIHS with depressive symptoms actually received appropriate treatment [41]. Efforts to diagnose and treat depression will have direct health and economic benefits for women with HIV, which could be expected to improve their prognosis.…”

Behavioral Activation Theory to Identify Depression among HIV-Positive Women of Color in the U.S. South

“…Related work reports depression as a barrier for PLWH, because it prevents them from obtaining and participating in care. [4,7,12,13] While depressive symptoms may be apparent if patients are specifically questioned, these may not be expressed or recognized as depression by either patient or provider if unquestioned. [4,7,14] Depression may also be compounding factor for many PLWH.…”

“…[4,7,14] Depression may also be compounding factor for many PLWH. [4,7,13] One of the difficulties in diagnosis of depression is the lack of recognition of the presence of depressive symptoms. [4,7,13,14] African American women have been shown to have a difficult time naming and discussing depression.…”

“…[4,7,13] One of the difficulties in diagnosis of depression is the lack of recognition of the presence of depressive symptoms. [4,7,13,14] African American women have been shown to have a difficult time naming and discussing depression. [4] Prior work has shown that cultural norms [4,12,15] play a role in the difficulty that African-American women have in recognizing and reporting depression as compared to White women.…”

“…It has been found that compared to Whites, women of color are more likely to have more negative views towards mental illness and are less likely to seek help. [4,13,16,17] In one study evaluating HIV disclosure, social support and depression among rural African-American women, [4,12] many of the women reported high levels of depressive symptoms upon entry into the study. But researchers found that 40% of those women had never been diagnosed with depression [12] and of those who had been previously diagnosed with depression, nearly half (48%) were not receiving treatment.…”