Implications of apathy and depression for everyday functioning in HIV/AIDS in Brazil

Abstract

Background Brazil accounts for the largest number of HIV+ persons in Latin America, and this epidemic poses a significant public health burden in this country. Little is known about the neuropsychiatric and functional consequences of HIV infection in this population. Methods Participants were 43 HIV+ and 29 HIV- individuals who underwent a neuropsychological, psychiatric and neurological evaluation that included self-report measures of mood (Beck Depression Inventory-II; BDI-II), neurocognitive complaints (Patient's Assessment of Own Functioning Inventory) and declines in instrumental activities of daily living (Activities of Daily Living questionnaire). The MINI-Plus generated Major depressive disorder (MDD) diagnoses. Apathy, defined as social withdrawal, decision-making difficulty, loss of interest and pleasure, was measured using items from the BDI-II and the neurological evaluation. Results When compared with seronegative participants, HIV+ individuals endorsed higher levels of apathy spectrum symptoms. After adjusting for mood and other covariates, apathy significantly predicted worse everyday functioning. Limitations: The small sample size, along with the self-report measures used to evaluate apathy and functional difficulties limit the inferences that may be drawn from our findings. Conclusions Our Brazilian HIV+ cohort endorsed apathy and depression as well as significant functional complaints. Although correlated with depression, apathy was uniquely associated with functional difficulties. Clinical attention to apathy and depression in HIV-infected Brazilians may help identify patients at risk for functional difficulties who may benefit from additional support to maintain independence.

Depression and Apathy Among People Living with HIV: Implications for Treatment of HIV Associated Neurocognitive Disorders

“…Raw scores were converted into age and education corrected T scores. T scores greater than 65 were considered clinically elevated, which is consistent with previous literature [13, 22, 34]. In the present sample, 36.6 percent met criteria for clinically significant apathy.…”

“…Additionally, both conditions frequently co-occur in PLWH [11–13]. Furthermore, depression has been associated with reduced adherence to Antiretroviral (ARV) medication [14].…”

“…One study suggests that higher levels of apathy may have negative effects on ARV adherence, among younger, but not older, PLWH [15]. Both conditions have been associated with functional impairment [13]. Though, higher levels of apathy have been associated with greater functional impairment, after adjusting for other covariates, such as depression [11].…”

A Structural Equation Model of the Factors Affecting Morale of a Select Group of Filipino Elderly in a Community Setting

“…Poor functional ability may also be attributed to pain discomfort, which is a symptom of an illness. Albeit there is preponderance of literature indicating depression negatively affects functional ability (Kamat et al, 2013;Scuteri et al, 2011;Lee et al, 2006;Penninx, Deeg, van Eijk, Beekman, & Guralnik;Stuck et al, 1999), results of our study showed that functional ability negatively affects depression. This finding is similar to Vink, Aartsen, and Schoevers's (2008) study indicating that functional limitations is a predictor of depression.…”

Avaliação dos sintomas depressivos somáticos e afetivo-cognitivos de pessoas vivendo com HIV/AIDS

“…(4) In PLHA, it is known for being negatively associated with worse compliance with antiretroviral treatment, (5) therapeutic outcomes and risk behaviors, (6) besides its considerable impact in the treatment and social relationships (7) and in the more rapid progression to Aids and death. (1) Hence, the importance of measuring and understanding the influence of depression in this population is highlighted.…”