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December 1, 1993

Depressive Symptoms as Predictors of Medical Outcomes in HIV Infection

Author Affiliations

Baltimore, Md.—The Johns Hopkins School of Hygiene and Public Health; Chicago, Ill.—Howard Brown Memorial Clinic—Northwestern University Medical School; Los Angeles, Calif.— UCLA Schools of Public Health and Medicine; Pittsburgh, Pa.—University of Pittsburgh Graduate School of Public Health; Data Coordinating Center.—The Johns Hopkins School of Hygiene and Public Health; National Institutes of Health, Bethesda, Md.—National Institute of Allergy and Infectious Diseases; National Cancer Institute
From the Departments of Psychiatry and Behavioral Sciences (Drs Lyketsos and Treisman), Mental Hygiene (Drs Lyketsos and Treisman), and Epidemiology (Dr Hoover and Ms Guccione), Schools of Medicine and Public Health, The Johns Hopkins University, Baltimore, Md; Department of Epidemiology (Mr Senterfitt and Dr Morgenstern), UCLA School of Public Health, Los Angeles, Calif; Department of Psychiatry, School of Medicine, and Department of Epidemiology, School of Public Health, University of Pittsburgh (Pa) (Dr Dew); The Howard Brown Memorial Clinic, Northwestern University, Chicago, III (Dr Wesch); and National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (Mr VanRaden).

JAMA. 1993;270(21):2563-2567. doi:10.1001/jama.1993.03510210049026

Objective.  —To ascertain whether depressive symptoms as determined by the Center for Epidemiologic Studies—Depression scale (CES-D) predict accelerated mortality and worse medical outcomes in patients infected with human immunodeficiency virus (HIV).

Design.  —Eight-year cohort study with semiannual follow-up.

Setting.  —Community volunteers.

Participants.  —A total of 1809 HIV-seropositive homosexual men without the acquired immunodeficiency syndrome (AIDS) who entered the Multicenter AIDS Cohort Study in 1984 or 1985. Eight-year follow-up data were available on 75% of eligible participants.

Outcome Measures.  —Times to AIDS, death, and prophylactic treatment, and slopes describing the decline in CD4 count for each individual participant.

Results.  —Using a conventional definition of depression (CES-D ≥16 at the first study visit), 21.3% of participants were classified as depressed. Depressed participants had lower CD4 counts and reported more AIDS-related symptoms. There were no significant differences between depressed and nondepressed participants on any of the outcome measures (P>.05 in all cases). In contrast, men reporting AIDS-related symptoms had shorter times to AIDS and to death even after adjusting for CD4 counts (P<.01). The analyses were repeated, with similar results, using different definitions of depression based on the CES-D.

Conclusions.  —We find no evidence that depressive symptoms independently prognosticate worse outcomes in HIV infection. Because of associations of depression with symptom reports, CD4 counts, and indicators of socioeconomic status, future studies of the relationship between depression and HIV outcome should consider these variables as confounders.(JAMA. 1993;270:2563-2567)