Sadness in the SUN: Using Computerized Screening to Analyze Correlates of Depression and Adherence in HIV-Infected Adults in the United States

Abstract

We used a standardized screening tool to examine frequency of depression and its relation to antiretroviral medication adherence among HIV-infected persons on highly active antiretroviral therapy (HAART) in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN Study). This is a prospective observational cohort of 700 HIV-infected patients enrolled between March 2004 and June 2006 in four U.S. cities, who completed a confidential audio computer-assisted self-interview [ACASI] with behavioral risk and health-related questions at baseline and 6-month follow-up visits, including the nine-question PRIME-MD depression screener and a validated 3-day antiretroviral adherence question. Among 539 eligible participants receiving HAART, 14% had depression at baseline (22% women, 12% men). In multivariable analysis using generalized estimating equations (GEE) to account for repeated measurements through 24 months of follow-up, persons who reported depression on a given ACASI were twice as likely to report nonadherence to antiretrovirals on the same ACASI (Odds ratio [OR] 2.02, 95% CI: 1.15, 3.57] for mild/moderate depression versus none); such persons were also less likely to have HIV viral load < 400 copies/mL. Self-administered computerized standardized screening tools can identify at-risk individuals with depression who may benefit from interventions to improve antiretroviral adherence.

Abuse and Resilience in Relation to HAART Medication Adherence and HIV Viral Load Among Women with HIV in the United States

“…[22][23][24] Numerous barriers to HIV medication adherence and overall HIV access to care have been reported, including depression, stigma, disclosure, and drug/alcohol use. [25][26][27][28] A history of trauma or abuse among women with HIV has also been linked significantly to medication nonadherence, 3,11,29 as well as to antiretroviral failure and increased mortality. 2,3,8,11,13 Machtinger and colleagues 3 found that among HIV + biological and transgender women, those who reported recent trauma had over four-times the odds of antiretroviral failure in comparison to HIV + women who did not report recent trauma.…”

HIV Testing Among Adults with Mental Illness in the United States

“…18 Moreover, treating mental illness in HIV-infected populations may decrease sexual risk taking, increase prescription of antiretroviral therapy, and improve compliance with HIV treatment. [19][20][21] For these and other reasons, HIV testing is integral to the US National HIV/AIDS Strategy and test-andtreat approaches to HIV prevention. [22][23][24] An evaluation of the 1999 National Health Interview Survey (NHIS) revealed that persons with major depression episodes (including bipolar and schizoaffective disorder), generalized anxiety disorder, and panic attacks were more likely to report ever having had an HIV test than those without these disorders (45.0% vs. 31.1%).…”

Optimizing adherence to highly active antiretroviral therapy among marginalized, HIV-positive women with comorbid depression: the role of the nurse practitioner

“…Findings by Tedaldi et al (2012) supported this association between depression and nicotine dependence. While the mechanism linking depression with nicotine use is not clear, it is important to note that nicotine dependence is associated with increased rate of depression, pain severity and frequency, and non-adherence to HAART (King et al , 2012).…”

“…other mood disorder. Tedaldi et al (2012) found that depression was significantly more prevalent among women (21.9%) compared to men (11.8%, p=0.005). Likewise, Applebaum, Richardson, Brady, Brief and Keane (2009) found that 77% of women, compared with 44% (P = 0.11; P< 0.05) ofmen were depressed, in a study of67 HIV-positive outpatients.…”

“…This is because the majority of the studies were observational retrospective cohort studies, where significant depression was an incidental finding not necessarily the focus of the study. Tedaldi et al (2012) extensively examined depression in the context ofHIV, and found that women were significantly more likely to experience depression than men, and they also correlated increased risk of depression with having no marital/sexual partner, being heterosexual, using injection drugs, being co-infected with Hepatitis C, and personal or family history of depression. In another study that specifically examined factors correlated with depression, Bhatia et al (2011) found that in addition to being associated with female gender, depression directly correlated with income < $25 000, recent substance abuse, poor access to medical care, and low self-efficacy.…”