Associate Professor Anne Mijch1,2. Dr Steve Ellen,1,3,5 Associate Professor Jennifer Hoy,1,2 Dr Edwina Wright,1,2 Dr Phyllis Chua5, Ms Tania Gibbie1,5 and Professor Fiona Judd.4
1 Victorian HIV Service, Infectious Diseases Unit, The Alfred Hospital
2 Department of Medicine, Monash University
3 Psychiatry Department, The Alfred Hospital
4 Centre for Rural Mental Health, School of Psychology, Psychiatry and Psychological Medicine, Monash University
5 School of Psychology, Psychiatry and Psychological Medicine, Monash University.
Beyond Blue Victorian Centre of Excellence
Project completion year
Up to 35% of people living with HIV/AIDS suffer from significant depressive symptoms. Depression has been shown to have a negative impact on quality of life, employment, mortality and on adherence to medication in chronic illnesses. Although Highly Active Antiretroviral Therapy (HAART) has resulted in a significant decline in HIV-related disease progression and mortality, many individuals report depression, cognitive impairment and non-adherence to medication.
The aims of this study were to follow a cohort of HIV infected individuals for two years to:
- assess changes in depression and neuropsychological performance over time
- explore the relationship between depression, HIV illness and neuropsychological performance
- to examine the relationship between depression and adherence to HAART.
Participants for the study were recruited from The Alfred Hospital, Melbourne Sexual Health Centre, The Royal Melbourne Hospital and Prahran Market Clinic.
A total of 129 HIV positive individuals completed the first phase of the study, with 80 completing the follow-up phase. Study participants were predominantly men who have sex with men (95%). The average age of the group was 45 years.
The same procedures were completed at both baseline (2001) and follow-up (2003/2004).
The study involved collection of medical and psychiatric history information and completion of questionnaires measuring depressive symptoms, feelings of well-being, and personality traits.
A clinical interview for depression, neuropsychological testing and assessment of IQ (one component of intelligence) using a reading test were also undertaken.
At both baseline and follow-up there was a high rate of depressive symptoms with one third of the group scoring 14 or more on the Beck Depression Inventory (a questionnaire designed to measure severity of depressive symptoms). A score of 14 or more is generally considered an indication of depression, but must be confirmed by a clinical interview.
In the clinical interview, 27% of the group were found to have depression at baseline. On the whole, depression levels decreased between baseline and follow-up, with 14% of participants found to have depression diagnosed through clinical interview at follow-up (an average of two years later).
There was no association between symptoms of depression and severity of HIV infection measured by CD4 cell counts, HIV viral load and the duration of time since the diagnosis of HIV infection.
Participants in close personal relationships had lower levels of depression than those who were not in a relationship. People who were living alone reported significantly more symptoms of depression than those who lived with others. Higher levels of depression seemed to occur in those who were socially isolated and in poorer health.
A very small number of participants (7%) showed impairment in their everyday thinking skills at baseline testing. An overall improvement in everyday thinking skills was found over the study period, however those who had depression were less likely to show this improvement.
Non-adherence to HAART was reported by 30.5% of those prescribed HAART. In multivariate analyses, non-adherence to HAART was significantly associated with limited social support (living alone and not in a relationship), but not depression scores.
Implications for Policy and Practice
A higher prevalence of depression and past depressive episodes in this study group when compared to the Australian population was identified, indicating the presence of compromised psychological health in people living with HIV infection. Lower adherence to HAART was found in people living alone and not in a relationship.
As a result, we believe that people living with HIV/AIDS should seek regular assessment for mood problems. This can be performed with simple screening tests. Wider community level interventions which increase social connectedness may have the potential to improve treatment adherence, physical health and impact on depression in this group.
We are planning a third follow-up phase to this study, to continue to track depression and neurocognitive changes in patients treated with HAART. We have received funding from the Department of Human Services (Victoria) to examine the associations between depression, drug/alcohol use, personality factors and sexual risk behaviour and to develop a screening tool (the RAPAD) to identify those at high risk of HIV transmission.
About the Researchers
We are a group of clinicians and researchers incorporating specialist HIV physicians, psychiatrists and psychologists, who are dedicated to improving the treatment and care of people living with HIV/AIDS.