1
|
Petersen KJ, Yu X, Masters MC, Lobo JD, Lu T, Letendre S, Ellis RJ, McCutchan JA, Sundermann E. Sex-specific associations between plasma interleukin-6 and depression in persons with and without HIV. Brain Behav Immun Health 2023; 30:100644. [PMID: 37347049 PMCID: PMC10279778 DOI: 10.1016/j.bbih.2023.100644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/19/2023] [Accepted: 05/25/2023] [Indexed: 06/23/2023] Open
Abstract
Background Persons with HIV (PWH) have both more frequent depression and higher levels of plasma inflammatory biomarkers compared to persons without HIV (PWoH). Inflammation and depressive symptoms are linked, including in PWH; however, it is unclear whether these associations differ by HIV serostatus and biological sex. Methods Six plasma inflammatory biomarkers were assessed using samples from PWH and PWoH who participated in six NIH-funded studies through the UCSD HIV Neurobehavioral Research Program (HNRP) from 2011 to 2019. Factor analysis was performed to identify intercorrelated groups of biomarkers. Factors and their components were then examined for relationships with Beck Depression Inventory-II (BDI-II) and modifying effects of sex or HIV serostatus using multivariable linear regression, adjusting for demographics, substance use diagnoses, and relevant co-morbidities. Results Participants included 150 PWH (age = 48.3 ± 13.1 yr; 88% biologically male) and 138 PWoH (age = 46.3 ± 15.9; 56% male). Two inflammatory factors were identified: Factor 1 loaded on interleukin-6 (IL-6), C-reactive protein (CRP), and D-dimer; Factor 2 loaded on interleukin-8, chemokine C-C ligand 2 (CCL2), and chemokine C-X-C ligand 10 (CXCL10). Sex modified the effect of Factor 1 on BDI-II, with a more positive association for men than women (p = 0.04). No significant association between Factor 2 and BDI-II was found. Of the biomarkers in Factor 1, only IL-6 was significantly associated with BDI-II and was modified by sex (p = 0.003). In sex-stratified analysis, a positive association was found for men (β = 5.42; 95% confidence interval = [1.32, 9.52]) but not women (β = -3.88; 95% C.I. = [-11.02, 3.26]). No HIV-related interactions were detected. Interpretation We identified a depression-associated inflammatory factor present in both PWH and PWoH, consistent with prior studies of PWH only. The association was driven by a correlation between IL-6 and depression exclusively in men, suggesting that the depression-inflammation link differs by sex. Future studies of depression etiology or treatment, including those on persons with HIV, should consider the impact of biological sex in both design and analysis.
Collapse
Affiliation(s)
- Kalen J. Petersen
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Xiaoying Yu
- Department of Biostatistics & Data Science, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mary Clare Masters
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Judith D. Lobo
- Department of Psychiatry, The University of California San Diego, San Diego, CA, USA
| | - Tina Lu
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Scott Letendre
- Department of Psychiatry, The University of California San Diego, San Diego, CA, USA
- Department of Medicine, The University of California San Diego, San Diego, CA, USA
| | - Ronald J. Ellis
- Department of Psychiatry, The University of California San Diego, San Diego, CA, USA
| | - J. Allen McCutchan
- Department of Medicine, The University of California San Diego, San Diego, CA, USA
| | - Erin Sundermann
- Department of Psychiatry, The University of California San Diego, San Diego, CA, USA
| |
Collapse
|
2
|
Yator O, Khasakhala L, Stewart GJ, Kumar M. Acceptability and impact of group interpersonal therapy (IPT-G) on Kenyan adolescent mothers living with human immunodeficiency virus (HIV): a qualitative analysis. BMC Womens Health 2022; 22:240. [PMID: 35717156 PMCID: PMC9206094 DOI: 10.1186/s12905-022-01807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Task shifting is a well-tested implementation strategy within low- and middle-income countries that addresses the shortage of trained mental health personnel. Task shifting can increase access to care for patients with mental illnesses. In Kenya, community health workers (CHWs) are a combination of community health assistants and community health volunteers and have played a crucial role on this front. In our study, we seek to assess the acceptability and feasibility of Group Interpersonal Psychotherapy (IPT-G) delivered by CHWs among depressed postpartum adolescents (PPAs) living with human immunodeficiency virus (HIV). Method The study used theoretical framework of behaviour change including: Capability, Opportunity and Motivation (COM-B model) to help understand behavioural changes due to IPT-G intervention delivered by the CHWs. 24 PPAs were administered IPT-G by trained CHWs from two health centres. A two-arm study design (IPT-G intervention and treatment as usual) with an intent to treat was used to assess the acceptability and feasibility of IPT-G. With purposeful sampling, participants who scored > 10 on the Edinburgh postnatal depression scale and who were 6–12 weeks postpartum were eligible for the study. Participants were equally distributed into two groups: one group for intervention and another as a wait-listed group. This was achieved by randomly allocating numerical numbers and separating those with odd numbers (intervention group) and even numbers (wait-listed group). Focus group discussions and in-depth interviews ascertained the experiences and perceptions of the PPAs and the CHWs during IP-G delivery process. In addition to weekly face-to-face continuous supportive supervision for the CHWs, the researchers also utilized phone calls, short messages services and WhatsApp instant messaging services. Results The CHWs found the intervention useful for their own knowledge and skill-set. With regards to participation, 21 out of the 24 adolescents attended all sessions. Most of the adolescents reported an improvement in their interpersonal relationships with reduced distress and lessening of HIV-related stigma. Primary healthcare workers embraced the intervention by accommodating the sessions in their routine clinic activities. Conclusion Our study demonstrates the possible benefits of task shifting in addressing mental health problems within low-resource settings in Kenya, and IPT-G is demonstrated to be both acceptable and feasible by health workers and adolescents receiving care. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01807-w.
Collapse
Affiliation(s)
- Obadia Yator
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P. O. Box 799-00517, Nairobi, Kenya.
| | - Lincoln Khasakhala
- Department of Psychiatry, University of Nairobi, P. O. Box 30197-00100, Nairobi, Kenya
| | - Grace-John Stewart
- University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA
| | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O. Box 47074-00100, Nairobi, Kenya.,Department of Psychology, University College London, London, UK
| |
Collapse
|
3
|
Singhvi DG, Nouraie M, Kessinger C, McMahon DK, Weinman R, Crothers K, Huang L, Bon J, Morris A, Merlin J. Brief Report: Association Between Pain, Pulmonary Function, and Respiratory Symptoms in People With HIV. J Acquir Immune Defic Syndr 2021; 87:1161-1166. [PMID: 33871410 PMCID: PMC8263479 DOI: 10.1097/qai.0000000000002696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND People with HIV (PWH) experience chronic pain and respiratory symptoms, which are closely related in the general population. Pain may affect the impaired pulmonary function seen in PWH beyond its association with HIV alone. Our objective was to investigate the relationship of pain severity to pulmonary function, respiratory symptoms, and sleep disturbance in PWH. SETTING Study sites included the University of Pittsburgh, University of California San Francisco, and University of Washington. METHODS Pain, dyspnea, and sleep were assessed using the Brief Chronic Pain Questionnaire, St. George's Respiratory Questionnaire, and Pittsburgh Sleep Quality Index. Participants performed prebronchodilator and postbronchodilator spirometry and 6-minute walk test. Associations between pain severity, lung function, dyspnea, and sleep were assessed with bivariate and multiple quantile regression analysis adjusted for age, sex, race, body mass index, and smoking status. RESULTS Of 159 PWH, the median age was 56 years with 30.8% women. Two-thirds experienced pain in the past week, with 40.3% reporting chronic pain. Pain severity was higher with female sex (P = 0.038), non-White race (P = 0.005), current smoking (P = 0.003), and lower CD4+ count (P = 0.035). In adjusted analysis, higher pain severity was correlated with reduced postbronchodilator forced expiratory volume in 1 second %predicted (P = 0.008), reduced postbronchodilator forced vital capacity %predicted (P = 0.019), and chronic obstructive pulmonary disease (P = 0.032). Greater pain severity was strongly associated with a higher St. George's Respiratory Questionnaire score (P < 0.001) and sleep disturbance (P < 0.001). CONCLUSIONS In PWH, pain is common and associated with airflow obstruction, dyspnea, and sleep disturbance. Future studies assessing pain severity and pulmonary function over time could clarify the direction of this association and the impact on quality of life.
Collapse
Affiliation(s)
- Deepti G Singhvi
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mehdi Nouraie
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Cathy Kessinger
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Renee Weinman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Kristina Crothers
- Department of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, WA
| | - Laurence Huang
- Division of HIV, Infectious Diseases, and Global Medicine and Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General, University of California San Francisco, San Francisco, CA
| | - Jessica Bon
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Department of Medicine, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA; and
| | - Alison Morris
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA
| | - Jessica Merlin
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
4
|
Abraham AG, Ervin A, Swenor B, Ramulu P, Channa R, Kong X, Stosor V, Friedman MR, Detels R, Plankey M. Prevalence and Consequences of Perceived Vision Difficulty in Aging Adults with HIV Infection. Am J Ophthalmol 2020; 218:268-278. [PMID: 32621897 PMCID: PMC9230650 DOI: 10.1016/j.ajo.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Despite well-known ocular complications of HIV-related immune suppression, few studies have examined the prevalence and consequences of visual impairment among aging long-term survivors of HIV. DESIGN Retrospective cohort study. METHODS Aging HIV-infected (HIV+) men who have sex with men (MSM) and HIV-uninfected (HIV-) MSM controls reported their difficulty performing 6 vision-dependent tasks (difficulty defined as: no, a little, moderate, and extreme difficulty). Relationships were examined using logistic regression, regressing each outcome separately on categorical visual function responses, with missing data multiply imputed. RESULTS There were 634 age-matched pairs for a total sample of 1,268 MSM of 1,700 MSM with available data. The median age was 60 years old (interquartile range [IQR], 54, 66), and 23% were African American. Among HIV+ men, 95% were virally suppressed (viral load <400 copies/mL). HIV+ men were more likely to report moderate or extreme difficulty performing at least 1 task (21% for HIV+ compared to 13% for HIV-; P < .01). Participants reporting extreme vision-related difficulty performing at least 1 task had 11.2 times the odds of frailty (95% confidence interval [CI], 5.2-23.9), 2.6 times the odds of a slow gait speed (95% CI, 1.4-4.8), and 3.2 times the odds of impaired instrumental activities of daily living (95% CI: 1.6-6.3) compared to those reporting no vision-related difficulty on any task. CONCLUSIONS Perceived vision difficulty was more common among older HIV+ MSM than age-matched HIV- MSM controls and was associated with higher risk of depression and physical function loss among MSM.
Collapse
Affiliation(s)
- Alison G Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| | - Ann Ervin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Bonnie Swenor
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pradeep Ramulu
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Roomasa Channa
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Xiangrong Kong
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Valentina Stosor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roger Detels
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, USA
| | - Michael Plankey
- Division of Infectious Diseases, Department of Medicine, Georgetown University, Washington, DC, USA
| |
Collapse
|
5
|
Lu H, Surkan PJ, Irwin MR, Treisman GJ, Breen EC, Sacktor N, Stall R, Wolinsky SM, Jacobson LP, Abraham AG. Inflammation and Risk of Depression in HIV: Prospective Findings From the Multicenter AIDS Cohort Study. Am J Epidemiol 2019; 188:1994-2003. [PMID: 31642472 DOI: 10.1093/aje/kwz190] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 08/05/2019] [Accepted: 08/15/2019] [Indexed: 12/13/2022] Open
Abstract
Studies suggest that inflammation might be involved in the pathogenesis of depression. Individuals with human immunodeficiency virus (HIV) have a higher risk of depression and elevated inflammatory profiles. Despite this, research on the link between inflammation and depression among this high-risk population is limited. We examined a sample of men who have sex with men from the Multicenter AIDS Cohort Study in prospective analyses of the association between inflammation and clinically relevant depression symptoms, defined as scores >20 on Center for Epidemiological Studies Depression Scale. We included 1,727 participants who contributed 9,287 person-visits from 1984 to 2010 (8,218 with HIV (HIV+) and 1,069 without (HIV-)). Exploratory factor analysis (EFA) was used to characterize underlying inflammatory processes from 19 immune markers. Logistic regression with generalized estimating equations was used to evaluate associations between inflammatory processes and depressive symptoms stratified by HIV serostatus. Three EFA-identified inflammatory processes (EIPs) were identified. EIP-1 scores-described by soluble tumor necrosis factor receptor 2 (sTNF-R2), soluble interleukin-2 receptor α (sIL-2Rα), sCD27, B-cell activating factor, interferon γ-induced protein 10 (IP-10), soluble interleukin-6 receptor (sIL-6R), sCD14, and sGP130-were significantly associated with 9% higher odds of depressive symptoms in HIV+ participants (odds ratio = 1.09; 95% confidence interval: 1.03, 1.16) and 33% higher odds in HIV- participants (odds ratio = 1.33; 95% confidence interval: 1.09, 1.61). Findings suggest that immune activation might be involved in depression risk among both HIV+ and HIV- men who have sex with men.
Collapse
|
6
|
Haines C, Loades ME, Coetzee BJ, Higson-Sweeney N. Which HIV-infected youth are at risk of developing depression and what treatments help? A systematic review focusing on Southern Africa. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2019-0037/ijamh-2019-0037.xml. [PMID: 31393831 DOI: 10.1515/ijamh-2019-0037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/16/2019] [Indexed: 01/26/2023]
Abstract
Background Depression is common in people with HIV and is associated with lower quality of life, reduced medication adherence, worse disease progression and higher risk of transmission to others. While the majority of HIV-infected youth live in Southern Africa, research has largely focused on adults from Western countries, with limited generalisability across these populations. This review sought to identify and synthesise research on the risk factors for depression in HIV-infected youth in Southern Africa, and to summarise the available evidence on psychosocial interventions to reduce depression. Method A systematic review was conducted of studies using a validated measure of depression in HIV-infected youth (aged ≤19) in Southern Africa. Eligible studies included either analysis of variables associated with depression, or evaluation of the impact of psychosocial interventions on depression in this population. Results Twelve studies met inclusion criteria for assessing risk factors, based on nine independent samples, constituting 3573 HIV-infected youth (aged 9-19 years). Study quality varied, with heterogeneous methodology limiting comparability and conclusions. There is some evidence that female gender, older age, food insecurity, exposure to abuse and internalised stigma are risk factors for depression, while disclosure of HIV status, satisfaction with relationships and social support are protective. Only one study met inclusion criteria for assessing psychosocial interventions (n = 65; aged 10-13 years). The intervention study did not successfully reduce depression, demonstrating a need for low-cost, large scale interventions to be developed and trialled. Conclusion This review has highlighted the dearth of research into depression in HIV-infected youth in Southern Africa. Disclosing HIV status could be an important protective factor.
Collapse
Affiliation(s)
- Cara Haines
- Department of Psychology, University of Bath, Bath, UK
| | - Maria E Loades
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Bronwynè J Coetzee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | | |
Collapse
|
7
|
Jiang H, Chen S, Huang X, Huang R, Lin P, Cheng W, Xu M, Yang F, Liu J, Li Y, Gao Y, Yang Y. Prevalence of and factors associated with major depressive disorder among HIV-positive individuals in Guangdong, China. J Affect Disord 2019; 246:474-479. [PMID: 30599371 DOI: 10.1016/j.jad.2018.12.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/03/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND People living with HIV may suffer from mental disorders. We aimed to explore the prevalence of and factors associated with major depressive disorder (MDD) among HIV-positive individuals in Guangdong, China, about which little is known. METHODS A cross-sectional study was conducted to recruit HIV-positive individuals from the Centers for Disease Prevention and Control of Guangzhou, Zhongshan, and Yangjiang from September 2007 to September 2008. Data were collected by questionnaires. MDD was diagnosed and assessed by two psychiatrists using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P) based on the DSM-IV criteria. Multiple logistic regression analyses were conducted to explore the factors associated with MDD. RESULTS The prevalences of lifetime MDD and current MDD among the 339 included participants were 22.71% (95% confidence interval [CI]: 18.25-27.17%) and 12.09% (95%CI: 8.62%-15.57%), respectively. The results of multiple logistic regression showed that patients with AIDS had a higher risk of lifetime MDD (odds ratio [OR] = 2.69, 95%CI: 1.38-5.26) and current MDD (OR = 3.51, 95%CI: 1.59-7.75) than HIV-infected individuals. Participants with more number of negative life events were more likely to have lifetime MDD (OR = 2.33, 95%CI: 1.34-4.06) and current MDD (OR = 3.77, 95%CI: 1.76-8.09) than individuals with fewer negative life events. Individuals with higher score of social support were less likely to have lifetime MDD (OR = 0.45, 95%CI: 0.26-0.80) and current MDD (OR = 0.46, 95%CI: 0.21-0.97) than individuals with less social support. CONCLUSIONS The prevalence of MDD was high among HIV-positive individuals in China. AIDS diagnosis, decreased social support, and an increased number of negative life events were risk factors for MDD.
Collapse
Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Shuyi Chen
- The Second People's Hospital of Bao'an District (Group) General Hospital, Shenzhen, China
| | | | - Ruoyan Huang
- Guangzhou Psychiatric Hospital, Guangzhou, China
| | - Peng Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Weibin Cheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Meizhen Xu
- Haizhu District Center for Disease Control and Prevention, Guangzhou, China
| | - Fang Yang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jun Liu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yan Li
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yanhui Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China.
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China.
| |
Collapse
|
8
|
Belayneh Z, Alemu W, Mekuriaw B, Abebe Z. Bipolar spectrum disorders and associated factors among adults attending an antiretroviral therapy clinic in Gedeo zone health centers, southern Ethiopia. Neuropsychiatr Dis Treat 2019; 15:503-509. [PMID: 30863072 PMCID: PMC6388964 DOI: 10.2147/ndt.s187669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Bipolar spectrum disorders (BPSDs) are more common among HIV-positive individuals than the general population. Although BPSDs have very diverse and devastating consequences (immune suppression, cognitive impairment and poor medication adherence), little is known about BPSDs among HIV-positive individuals in Ethiopia. Therefore, this study was aimed to assess the prevalence and associated factors of BPSDs among adults attending antiretroviral therapy (ART) clinics in Gedeo zone health centers, southern Ethiopia. PATIENTS AND METHODS An institutional-based cross-sectional study was conducted by screening 412 randomly selected HIV-positive individuals using Mood Disorder Questionnaire. SPSS version 20 was used for data analysis. Bivariable and multivariable logistic regression models were fitted to identify factors associated with BPSDs. Adjusted OR (AOR) with corresponding 95% CI was computed to determine the association. RESULTS Of the total 412 participants, 11.2% were screened positive for BPSDs. Lower CD4 count (AOR =2.97; 95% CI: 1.11, 7.90), past history of mental health problem (AOR =3.35; 95% CI: 1.576, 7.144), poor social support (AOR =2.6; 95% CI: 1.06, 6.63) and poor ART drug adherence (AOR =3.59; 95% CI: 1.78, 7.21) had a positive association with BPSDs. CONCLUSION In this study, the prevalence of BPSDs was high among adult patients attending ART clinics in Gedeo zone health centers. Poor social support, poor ART drug adherence, lower CD4 level and history of mental illness had statistically significant association with BPSDs. This demonstrates a need for the integration of Mental Health and Psycho Social Support with HIV/AIDS care services. Moreover, establishing good social support and controlling ART adherence were found to be very crucial too.
Collapse
Affiliation(s)
- Zelalem Belayneh
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia,
| | - Wagaye Alemu
- Department of Epidemiology and Biostatistics, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Birhanie Mekuriaw
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia,
| | - Zegeye Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
9
|
Pharmacokinetic Considerations with the Use of Antiepileptic Drugs in Patients with HIV and Organ Transplants. Curr Neurol Neurosci Rep 2018; 18:89. [PMID: 30302572 DOI: 10.1007/s11910-018-0897-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Antiepileptic drugs are frequently administered to patients with HIV infection or in recipients of organ transplants. The potentially serious drug-drug interactions between the "classic" antiepileptic drugs, antiretrovirals, and immunosuppressants have been extensively studied. Evidence-based information on the second and third generation of antiepileptic drugs is almost non-existent. The purpose of this review is to analyze the pharmacokinetic profile of these newer agents to assess their potential for drug interactions with antiretrovirals and immunosuppressants. RECENT FINDINGS As a group, the newer generations of antiepileptic drugs have shown a more favorable drug interaction potential compared to the "classic" ones. A group of moderate enzyme-inducing drugs includes eslicarbazepine acetate, oxcarbazepine, rufinamide, and topiramate. These drugs are not as potent inducers as the "classic" drugs but may potentially decrease the serum concentrations of some antiretrovirals and immunosuppressants. Antiepileptic drugs with no or minimal enzyme-inducing properties include brivaracetam, gabapentin, lacosamide, lamotrigine, levetiracetam, perampanel, pregabalin, and vigabatrin. The newer generations of antiepileptic drugs have expanded the therapeutic options in patients with HIV infection or organ transplants.
Collapse
|
10
|
Irwin MR, Archer G, Olmstead R, Brown TT, Teplin LA, Patel SR, Abraham AG, Breen EC. Increased risk of depression in non-depressed HIV infected men with sleep disturbance: Prospective findings from the Multicenter AIDS Cohort Study. EBioMedicine 2018; 36:454-460. [PMID: 30249545 PMCID: PMC6197498 DOI: 10.1016/j.ebiom.2018.09.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/07/2018] [Accepted: 09/17/2018] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Sleep disturbance is a known risk factor for depression, but it is not known whether sleep disturbance contributes to greater risk of depression in those infected with human immunodeficiency virus (HIV+) as compared to those uninfected with HIV (HIV-). METHODS Using data from the Multicenter AIDS Cohort Study, a population-based prospective study of men who have sex with men (MSM), self-reported sleep disturbance (>2 weeks) and depressive symptoms (Clinical Epidemiologic Scale for Depression, CES-D) were assessed every 6 months over 12 years of follow-up. Adjusted mixed effects logistic regression analyses tested whether sleep disturbance predicted depression (CES-D ≥ 16) at the immediate subsequent visit, and so on over 12 years, in non-depressed HIV+(N = 1054; 9556 person-visits) and non-depressed HIV- (N = 1217; 12,680 person-visits). In HIV+ vs. HIV- MSM, linearly estimated average incidence of depression and normalized cumulative rate of depression over 12 years were compared. RESULTS In the HIV+ MSM, sleep disturbance was associated with a significant increase in depression 6 months later (OR = 1.6; 95% CI, 1.30, 1.96), which was significantly greater (P < .05) than in HIV- MSM (OR = 1.16; 95% CI, 0.94, 1.44). HIV status and sleep disturbance interacted (P < .001), such that incidence of depression and normalized cumulative rate of depression were greater in HIV+ with sleep disturbance than in HIV+ without sleep disturbance and HIV- groups (all P's < 0.001). CONCLUSIONS HIV+ persons who report sleep disturbance represent a high risk group to be monitored for depression, and possibly targeted for insomnia treatment to prevent depression. FUND: National Institute of Allergy and Infectious Diseases.
Collapse
Affiliation(s)
- Michael R Irwin
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, 300 UCLA Medical Plaza #3109, Los Angeles, CA 90095, United States; Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Boulevard, UCLA, David Geffen School of Medicine, Los Angeles, CA 90095, United States.
| | - Gemma Archer
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, 300 UCLA Medical Plaza #3109, Los Angeles, CA 90095, United States; Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Boulevard, UCLA, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, 300 UCLA Medical Plaza #3109, Los Angeles, CA 90095, United States; Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Boulevard, UCLA, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Todd T Brown
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University, 1830 East, Monument Street, Suite 333, Baltimore, MD, 21287, United States
| | - Linda A Teplin
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Department of Medicine, Infectious Disease, 710 N. Lake Shore Drive, Chicago, IL 60657, United States
| | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research, Department of Medicine, University of Pittsburgh, 3459 Fifth Avenue, NW 628 MUH, Pittsburgh, PA 15213, United States
| | - Alison G Abraham
- Department of Ophthalmology, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, United States
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience, 300 UCLA Medical Plaza #3109, Los Angeles, CA 90095, United States; Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Boulevard, UCLA, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| |
Collapse
|
11
|
Drury A, Gleadow-Ware S, Gilfillan S, Ahrens J. HIV and mental illness in Malawi and the neuropsychiatric sequelae of efavirenz. Malawi Med J 2018; 30:40-45. [PMID: 29868159 PMCID: PMC5974386 DOI: 10.4314/mmj.v30i1.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/18/2017] [Accepted: 11/05/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction Little is published about mental disorders in Malawi, specifically in relation to Human Immunodeficiency Virus (HIV) and it's treatment. Efavirenz is a medication commonly used as part of triple therapy for HIV treatment. Indeed, in 2013, Malawi introduced 5A with Efavirenz as part of it's 1st line treatment for HIV. There exists some literature documenting known psychiatric side effects of Efavirenz, which include anxiety, mood changes, nightmares, psychosis and suicidal ideation. Little is known about what features are most common in the presentation and what factors in the patient and drug which may make this reaction more likely. Aim The aim of this commentary is to review the association between HIV and psychiatric disorder, and consider the neuropsychiatric side-effects of Efavirenz. Method An evaluative literature review was completed by means of multiple electronic database search as well as an additional manual search to obtain published works identified through the electronic search. Search terms used were: Efavirenz, Acquired Immunodeficiency Syndrome, Africa, Antiretroviral Therapy, Developing Countries, Malawi, Mental Disorders, Public Health, and Psychiatry. Conclusion This is an important area of study, as potentially large numbers of individuals with HIV are being placed on Efavirenz as first line treatment, yet 60% may experience some form of neuropsychiatric side effects.
Collapse
Affiliation(s)
- Andrew Drury
- South London and Maudsley NHS Foundation Trust
- Scotland Malawi Mental Health Education Project
| | - Selena Gleadow-Ware
- Scotland Malawi Mental Health Education Project
- Honorary lecturer in psychiatry, University of Aberdeen
| | - Sheila Gilfillan
- Scotland Malawi Mental Health Education Project
- Herdmanflat Hospital, NHS Lothian
| | - Jen Ahrens
- Scotland Malawi Mental Health Education Project
- College of Medicine, Blantyre, Malawi
| |
Collapse
|
12
|
Eshun‐Wilson I, Siegfried N, Akena DH, Stein DJ, Obuku EA, Joska JA. Antidepressants for depression in adults with HIV infection. Cochrane Database Syst Rev 2018; 1:CD008525. [PMID: 29355886 PMCID: PMC6491182 DOI: 10.1002/14651858.cd008525.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Rates of major depression among people living with HIV (PLWH) are substantially higher than those seen in the general population and this may adversely affect antiretroviral treatment outcomes. Several unique clinical and psychosocial factors may contribute to the development and persistence of depression in PLWH. Given these influences, it is unclear if antidepressant therapy is as effective for PLWH as the general population. OBJECTIVES To assess the efficacy of antidepressant therapy for treatment of depression in PLWH. SEARCH METHODS We searched The Cochrane Common Mental Disorders Group's specialised register (CCMD-CTR), the Cochrane Library, PubMed, Embase and ran a cited reference search on the Web of Science for reports of all included studies. We conducted additional searches of the international trial registers including; ClinicalTrials.gov, World Health Organization Trials Portal (ICTRP), and the HIV and AIDS - Clinical trials register. We searched grey literature and reference lists to identify additional studies and contacted authors to obtain missing data. We applied no restrictions on date, language or publication status to the searches, which included studies conducted between 1 January 1980 and 18 April 2017. SELECTION CRITERIA We included randomized controlled trials of antidepressant drug therapy compared to placebo or another antidepressant drug class. Participants eligible for inclusion had to be aged 18 years and older, from any setting, and have both HIV and depression. Depression was defined according to Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases criteria. DATA COLLECTION AND ANALYSIS Two review authors independently applied the inclusion criteria and extracted data. We presented categorical outcomes as risk ratios (RR) with 95% confidence intervals (CIs). Continuous outcomes were presented mean (MD) or standardized mean differences (SMD) with standard deviations (SD). We assessed quality of evidence using the GRADE approach. MAIN RESULTS We included 10 studies with 709 participants in this review. Of the 10 studies, eight were conducted in high income countries (USA and Italy), seven were conducted prior to 2000 and seven had predominantly men. Seven studies assessed antidepressants versus placebo, two compared different antidepressant classes and one had three arms comparing two antidepressant classes with placebo.Antidepressant therapy may result in a greater improvement in depression compared to placebo. There was a moderate improvement in depression when assessed with the Hamilton Depression Rating Scale (HAM-D) score as a continuous outcome (SMD 0.59, 95% CI 0.21 to 0.96; participants = 357; studies = 6; I2 = 62%, low quality evidence). However, there was no evidence of improvement when this was assessed with HAM-D score as a dichotomized outcome (RR 1.10, 95% CI 0.89 to 1.35; participants = 434; studies = 5; I2 = 0%, low quality evidence) or Clinical Global Impression of Improvement (CGI-I) score (RR 1.28, 95% CI 0.93 to 1.77; participants = 346; studies = 4; I2 = 29%, low quality evidence). There was little to no difference in the proportion of study dropouts between study arms (RR 1.28, 95% CI 0.91 to 1.80; participants = 306; studies = 4; I2 = 0%, moderate quality evidence).The methods of reporting adverse events varied substantially between studies, this resulted in very low quality evidence contributing to a pooled estimate (RR 0.88, 95% CI 0.64 to 1.21; participants = 167; studies = 2; I2 = 34%; very low quality evidence). Based on this, we were unable to determine if there was a difference in the proportion of participants experiencing adverse events in the antidepressant versus placebo arms. However, sexual dysfunction was reported commonly in people receiving selective serotonin reuptake inhibitors (SSRIs). People receiving tricyclic antidepressants (TCAs) frequently reported anticholinergic adverse effects such as dry mouth and constipation. There were no reported grade 3 or 4 adverse events in any study group.There was no evidence of a difference in follow-up CD4 count at study termination (MD -6.31 cells/mm3, 95% CI -72.76 to 60.14; participants = 176; studies = 3; I2 = 0%; low quality evidence). Only one study evaluated quality of life score (MD 3.60, 95% CI -0.38 to 7.58; participants = 87; studies = 1; very low quality evidence), due to the poor quality evidence we could not draw conclusions for this outcome.There were few studies comparing different antidepressant classes. We are uncertain if SSRIs differ from TCAs with regard to improvement in depression as evaluated by HAM-D score (MD -3.20, 95% CI -10.87 to 4.47; participants = 14; studies = 1; very low quality evidence). There was some evidence that mirtazapine resulted in a greater improvement in depression compared to an SSRI (MD 9.00, 95% CI 3.61 to 14.39; participants = 70; studies = 1; low quality evidence); however, this finding was not consistent for all measures of improvement in depression for this comparison.No studies reported on virological suppression or any other HIV specific outcomes.The studies included in this review had an overall unclear or high risk of bias due to under-reporting of study methods, high risk of attrition bias and inadequate sequence generation methods. Heterogeneity between studies and the limited number of participants, and events lead to downgrading of the quality of the evidence for several outcomes. AUTHORS' CONCLUSIONS This review demonstrates that antidepressant therapy may be more beneficial than placebo for the treatment of depression in PLWH. The low quality of the evidence contributing to this assessment and the lack of studies representing PLWH from generalized epidemics in low- to middle-income countries make the relevance of these finding in today's context limited. Future studies that evaluate the effectiveness of antidepressant therapy should be designed and conducted rigorously. Such studies should incorporate evaluation of stepped care models and health system strengthening interventions in the study design. In addition, outcomes related to HIV care and antiretroviral therapy should be reported.
Collapse
Affiliation(s)
- Ingrid Eshun‐Wilson
- Stellenbosch UniversityCentre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health SciencesFrancie van Zyl Drive, Tygerberg, 7505, ParowCape TownWestern CapeSouth Africa7505
| | - Nandi Siegfried
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitTygerbergSouth Africa
- University of Cape TownDepartment of Psychiatry and Mental HealthCape TownSouth Africa
| | - Dickens H Akena
- Makerere University, College of Health SciencesDepartment of PsychiatryKampalaUganda
| | - Dan J Stein
- University of Cape TownDepartment of Psychiatry and Mental HealthCape TownSouth Africa
| | - Ekwaro A Obuku
- College of Health Sciences, Makerere UniversityAfrica Centre for Systematic Reviews & Knowledge TranslationKampalaUganda
| | - John A Joska
- University of Cape TownDepartment of Psychiatry and Mental HealthCape TownSouth Africa
| | | |
Collapse
|
13
|
Brandt CP, Paulus DJ, Jardin C, Heggeness L, Lemaire C, Zvolensky MJ. Examining anxiety sensitivity as an explanatory construct underlying HIV-related stigma: Relations to anxious arousal, social anxiety, and HIV symptoms among persons living with HIV. J Anxiety Disord 2017; 48:95-101. [PMID: 27527687 PMCID: PMC5293677 DOI: 10.1016/j.janxdis.2016.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 12/01/2022]
Abstract
Persons living with HIV (PLHIV) are a health disparity subgroup of the overall population for mental and physical health problems. HIV-related stigma has been shown to increase anxiety symptoms and HIV symptoms among PLHIV. However, little is known about factors that may impact the relations between HIV-related stigma and anxiety symptoms and HIV symptoms among PLHIV. To address this gap in the literature, the current study examined anxiety sensitivity (i.e., the extent to which individuals believe anxiety and anxiety-related sensations) in the relation between HIV-related stigma, social anxiety, anxious arousal, and HIV symptoms among a sample of 87 PLHIV (60.9% cis gender male, 52.9% Black, non-Hispanic). Results indicated that anxiety sensitivity mediated the relations between HIV-related stigma and the dependent variables, with effect sizes indicating moderate to large effects of anxiety sensitivity on these relations. Findings suggest that anxiety sensitivity be a mechanistic factor in the relations between HIV-related stigma and social anxiety, anxious arousal, and HIV symptoms, and therefore, be important element in efforts to reduce mental/physical health disparity among this population.
Collapse
Affiliation(s)
- Charles P. Brandt
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204,Baylor College of Medicine. 1 Baylor Plaza, Houston, Texas 77030,Corresponding author may be reached at
| | - Daniel J. Paulus
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204
| | - Charles Jardin
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204
| | - Luke Heggeness
- Kent State University, Department of Psychology. 144 Kent Hall, Kent, Ohio 44242
| | - Chad Lemaire
- Legacy Community Health. 1415 California St, Houston, Texas 77006
| | - Michael J. Zvolensky
- University of Houston, Department of Psychology. 3695 Cullen Blvd. Room 126, Houston, Texas 77204,The University of Texas MD Anderson Cancer Center, Department of Behavioral Science. 1515 Holcombe Blvd, Houston, Texas 77030
| |
Collapse
|
14
|
Park SC, Lee HY, Lee DW, Hahn SW, Park SH, Kim YJ, Choi JS, Lee HS, Lee SI, Na KS, Jung SW, Shim SH, Kim KW, Paik JW, Kwon YJ. Screening for Depressive Disorder in Elderly Patients with Chronic Physical Diseases Using the Patient Health Questionnaire-9. Psychiatry Investig 2017; 14:306-313. [PMID: 28539949 PMCID: PMC5440433 DOI: 10.4306/pi.2017.14.3.306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/22/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We aimed to identify depressive symptom profiles that indicated the presence of depressive disorder and present optimal cut-off sub-scores for depressive symptom profiles for detecting depressive disorder in elderly subjects with chronic physical diseases including diabetes, chronic obstructive pulmonary disease/asthma, and coronary artery disease, using the Patient Health Questionnaire-9 (PHQ-9). METHODS Two hundred and thirty-one elderly patients with chronic physical diseases were recruited consecutively from a university-affiliated general hospital in South Korea. RESULTS Greater severities of all 9 depressive symptoms in the PHQ-9 were presented in those with depressive disorder rather than those without depressive disorder. A binary logistic regression modeling presented that little interest [adjusted odds ratio (aOR)=4.648, p<0.001], reduced/increased sleep (aOR=3.269, p<0.001), psychomotor retardation/agitation (aOR=2.243, p=0.004), and concentration problem (aOR=16.116, p<0.001) were independently associated with increased likelihood of having depressive disorder. Receiver operating characteristics (ROC) curve analysis presented that the optimal cut-off value of score on the items for little interest, reduced/increased sleep, psychomotor retardation/agitation and concentration problem (PHQ-9) for detecting depressive disorder was 4 with 61.9% of sensitivity and 91.5% of specificity [area under curve (AUC)=0.937, p<0.001]. CONCLUSION Our findings suggested that the diagnostic weighting of little interest, reduced/increased sleep, psychomotor retardation/agitation, and concentration problem is needed to detect depressive disorder among the elderly patients with chronic physical diseases.
Collapse
Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Inje University College of Medicine and Haeundae Paik Hospital, Busan, Republic of Korea
| | - Hwa-Young Lee
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Dong-Woo Lee
- Department of Psychiatry, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Sang-Woo Hahn
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Sang-Ho Park
- Department of Cardiology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Yeo Ju Kim
- Department of Endocrinology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Jae Sung Choi
- Department of Pulmonology and Allergy, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Ho-Sung Lee
- Department of Pulmonology and Allergy, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Sung Won Jung
- Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Ki Won Kim
- National Institute of Dementia, Seongnam, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong-Woo Paik
- Department of Psychiatry, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Young-Joon Kwon
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| |
Collapse
|
15
|
Immune and Neuroendocrine Mechanisms of Stress Vulnerability and Resilience. Neuropsychopharmacology 2017; 42:62-80. [PMID: 27291462 PMCID: PMC5143517 DOI: 10.1038/npp.2016.90] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 12/15/2022]
Abstract
Diagnostic criteria for mood disorders including major depressive disorder (MDD) largely ignore biological factors in favor of behavioral symptoms. Compounding this paucity of psychiatric biomarkers is a need for therapeutics to adequately treat the 30-50% of MDD patients who are unresponsive to traditional antidepressant medications. Interestingly, MDD is highly prevalent in patients suffering from chronic inflammatory conditions, and MDD patients exhibit higher levels of circulating pro-inflammatory cytokines. Together, these clinical findings suggest a role for the immune system in vulnerability to stress-related psychiatric illness. A growing body of literature also implicates the immune system in stress resilience and coping. In this review, we discuss the mechanisms by which peripheral and central immune cells act on the brain to affect stress-related neurobiological and neuroendocrine responses. We specifically focus on the roles of pro-inflammatory cytokine signaling, peripheral monocyte infiltration, microglial activation, and hypothalamic-pituitary-adrenal axis hyperactivity in stress vulnerability. We also highlight recent evidence suggesting that adaptive immune responses and treatment with immune modulators (exogenous glucocorticoids, humanized antibodies against cytokines) may decrease depressive symptoms and thus represent an attractive alternative to the current antidepressant treatments.
Collapse
|
16
|
Costa D, Mendes A, Abreu W. Health and mood among HIV-positive outpatients attending an ART Clinic of a University Hospital. J Clin Nurs 2016; 25:3209-3218. [PMID: 27523649 DOI: 10.1111/jocn.13342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To evaluate how individuals at different stages of infection with HIV perceive their health status and its association with mood states. BACKGROUND With the introduction of Highly Active Antiretroviral Therapy in 1996, the quality of life of people living with HIV has improved. However, the literature emphasises the negative effects of the disease on the mental health of individuals suffering from this condition and the high incidence of depression among infected individuals. Although people diagnosed and living with HIV are overwhelmed by emotions, we found that various emotional manifestations are understudied within this group of patients. DESIGN A cross-sectional study was conducted in an outpatient unit of a University Hospital (antiretroviral therapy clinic), with a consecutive sample composed of 152 patients. METHODS Data were collected through a questionnaire used to assess the sociodemographic and clinical characteristics, the Short Form (36) Health Survey, and the Profile of Mood States scale. RESULTS AND CONCLUSIONS The health status negatively affects the role at the emotional and mental health dimensions. The participants showing a worse health condition than in the previous year had higher levels of tension/anxiety, depression/dejection, fatigue/inertia and confusion/bewilderment. The stage of disease and the profile of mood state emerged as independent phenomena. RELEVANCE TO CLINICAL PRACTICE The results of this study indicate that nurses worldwide should be aware of the emotional aspects (negative emotions strongly impact health) related to the subjective perception of a worsening health status, regardless of the stage of the disease.
Collapse
Affiliation(s)
| | - Aida Mendes
- Nursing School of Coimbra, Coimbra, Portugal
| | | |
Collapse
|
17
|
Phillips KD, Moneyham L, Murdaugh C, Boyd MR, Tavakoli A, Jackson K, Vyavaharkar M. Sleep Disturbance and Depression as Barriers to Adherence. Clin Nurs Res 2016; 14:273-93. [PMID: 15995155 DOI: 10.1177/1054773805275122] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the relationships among subjective sleep disturbance, depressive symptoms, and adherence to medications among HIV-infected women. HIV-infected women ( N = 173) were recruited through community AIDS service organizations throughout South Carolina. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Centers for Epidemiological Studies Depression Scale (CES-D), and a modified version of the Adults AIDS Clinical Trials Group Adherence Baseline Questionnaire. Women who reported greater sleep disturbance also reported a higher level of depressive symptoms and reported poor adherence to their medication regimen. Depression helped to explain the relationship between sleep quality and adherence. Results indicate that assessment and management of sleep disturbance and depressive symptoms in women with HIV disease is important to promote medication adherence.
Collapse
|
18
|
van Luenen S, Kraaij V, Spinhoven P, Garnefski N. An Internet-based self-help intervention for people with HIV and depressive symptoms: study protocol for a randomized controlled trial. Trials 2016; 17:172. [PMID: 27036970 PMCID: PMC4815219 DOI: 10.1186/s13063-016-1292-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 03/15/2016] [Indexed: 01/09/2023] Open
Abstract
Background Many people living with HIV suffer from depressive symptoms. In a previous pilot study, self-help cognitive behavioral therapy (in booklet format) was found to be effective in treating depressive symptoms in people with HIV. We developed an online self-help program in Dutch and English (based on the booklet) for people with HIV and depressive symptoms. Besides the main question regarding the effectiveness of the program aimed at lowering depressive symptoms, sub-questions will focus on the moderators of treatment success (for which patients is the program especially beneficial?) and the mechanisms of change underlying the treatment outcome (which mediators affect the outcome of treatment?). In this paper, the protocol of the study will be described. Methods/design The effectiveness of the program will be investigated by comparing the intervention group with a waiting list-control group in a randomized controlled design, by including a pretest and three post-tests. The self-help program contains four main components: activation, relaxation, changing maladaptive cognitions, and goal attainment. Participants with mild to moderate depressive symptoms will work on the program for 6 to 10 weeks, during which a coach will provide motivational support by telephone once a week. Participants in the control condition will receive weekly minimal support from a coach for 8 weeks, and after the second post-test, they can gain access to the self-help program. Depressive symptoms and possible mediators (e.g., activation, cognitive coping, self-efficacy, and goal adjustment) will be assessed by self-report three times during the intervention/waiting period and at the pretest and first post-test. Discussion The proposed study aims to evaluate the effectiveness of an online self-help intervention for people with HIV and depressive symptoms. If the intervention is shown to be effective, the program will be implemented. Consequently, many patients with HIV could be reached, and their psychological care may be improved. Trial registration Netherlands Trial Register: NTR5407 Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1292-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sanne van Luenen
- Institute of Psychology, Section of Clinical Psychology, Leiden University, Faculty of Social and Behavioral Sciences, P.O. Box 9555, 2300, RB, Leiden, The Netherlands.
| | - Vivian Kraaij
- Institute of Psychology, Section of Clinical Psychology, Leiden University, Faculty of Social and Behavioral Sciences, P.O. Box 9555, 2300, RB, Leiden, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Section of Clinical Psychology, Leiden University, Faculty of Social and Behavioral Sciences, P.O. Box 9555, 2300, RB, Leiden, The Netherlands
| | - Nadia Garnefski
- Institute of Psychology, Section of Clinical Psychology, Leiden University, Faculty of Social and Behavioral Sciences, P.O. Box 9555, 2300, RB, Leiden, The Netherlands
| |
Collapse
|
19
|
Perugi G, Quaranta G, Belletti S, Casalini F, Mosti N, Toni C, Dell'Osso L. General medical conditions in 347 bipolar disorder patients: clinical correlates of metabolic and autoimmune-allergic diseases. J Affect Disord 2015; 170:95-103. [PMID: 25237732 DOI: 10.1016/j.jad.2014.08.052] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/29/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with bipolar disorder (BD) suffer from greater physical morbidity and mortality than the general population. The aim of the present study is to explore the prevalence and clinical correlates of General Medical Conditions (GMC) in a large consecutive sample of patients with BD. METHOD The study sample comprised of 347 patients who met DSM-IV-TR criteria for BD I (n=207, 59.7%), BD II or Cyclothymic Disorder (n=140, 40.3). Diagnostic information was collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders- Clinical Version (SCID-I), and information about personal and family history were collected by the Semi-Structured Interview for Mood Disorder-Revised (SIMD-R). Standardized procedure was used to assess the diagnosis of GMC, which was considered present only if a specific therapy to treat the condition was prescribed by a specialist or a general practitioner. In order to explore possible relationships between physical comorbidity and clinical features of BD, we compared patients with (MD) and without (No-MD) Metabolic Diseases (MD) and patients with (AAD) and without (No-AAD) Autoimmune-Allergic Diseases (AAD). RESULTS The most commonly reported GMCs were: Headache, Hypercholesterolemia (>200mg/dl), Chronic Constipation, Obesity, Arterial Hypertension (BP >140/90 mmHg), Hypothyroidism, Allergic Rhino-Conjunctivitis, Irritable Bowel Syndrome, Hypertriglyceridemia (>150 mg/dl), Metabolic Syndrome, Hiatus Hernia, Dysmenorrhea, Urticaria, Atopic Dermatitis, Psoriasis, Seborrheic Dermatitis, Diabetes Mellitus, Bronchial Asthma, Cardiac Arrhythmias, Biliary Lithiasis, and COPD. In our sample, MD (n=148, 42.7%) and AAD (n=167, 48.1%) were the most common categories of GMCs. Interestingly, the lifetime prevalence of cancer and neoplastic diseases was very low: 1 patient (.3%) reported Lung Adenocarcinoma and 2 (.6%) patients Bowel Cancer. In the group comparisons, length of pharmacological treatment (OR=1.054; 95% CI=1.030-1.078), age at onset of first major episode (OR=1.043; 95% CI=1.019-1.067), length of the current episode (OR=1.025; 95% CI=1.020-1.533) and absence of lifetime comorbid substance abuse (OR=.373; 95% CI=.141-.989) were statistically associated with the presence of comorbid MD; while only AD-induced hypomania (OR=1.62; 95% CI=1.011-2.597), and cyclothymic temperament (OR=1.051; 95% CI=1.016-1.087) were statistically associated with the presence of comorbid AAD. LIMITATIONS Possible referral and selection bias; retrospective, non-blind, cross-sectional evaluation. CONCLUSION MD and AAD were highly represented in our sample, while cancer and neoplastic diseases were uncommon. The clinical correlates of different sub-groups of GMC suggest different interpretations. The presence of MD seems to be correlated with the progression of BD and the chronic medication exposure, while comorbid AAD seems to correlate with a specific clinical subtype of BD, characterized by mood reactivity and temperamental mood instability. If the link with autoimmune-allergic diathesis will be confirmed, it could provide an interesting new paradigm for the study of the "systemic" nature of mood disorders and a promising target for future treatment options.
Collapse
Affiliation(s)
- Giulio Perugi
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy; Institute of Behavioural Sciences "G. De Lisio", Pisa, Italy.
| | - Giuseppe Quaranta
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy
| | - Serena Belletti
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy
| | - Francesca Casalini
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy
| | - Nicola Mosti
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy
| | - Cristina Toni
- Institute of Behavioural Sciences "G. De Lisio", Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Clinica Psichiatrica Università di Pisa, Via Roma, 67, Pisa 56126, Italy
| |
Collapse
|
20
|
Abbasowa L, Heegaard NHH. A systematic review of amyloid-β peptides as putative mediators of the association between affective disorders and Alzheimer׳s disease. J Affect Disord 2014; 168:167-83. [PMID: 25058309 DOI: 10.1016/j.jad.2014.06.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 06/27/2014] [Accepted: 06/28/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Affective disorders are associated with an increased occurrence of cognitive deficits and have been linked to cognitive impairment and Alzheimer׳s disease. The putative molecular mechanisms involved in these associations are however not clear. The aim of this systematic review was to explore clinically founded evidence for amyloid-β peptides in cerebrospinal fluid and blood as putative biomarkers for affective disorders. METHOD Systematic searches in Embase and PubMed databases yielded 23 eligible, observational studies. RESULTS Despite inconsistencies that were partly ascribed to the application of different assay formats, study results indicate a potentially altered amyloid-β metabolism in affective disorder. LIMITATIONS Since most studies used a cross-sectional design, causality is difficult to establish. Moreover, methodological rigor of included studies varied and several studies were limited by very low sample numbers. Finally, different assays for amyloid-β were utilized in the different studies, thus hampering comparisons. CONCLUSION To unravel possible risk relations and causalities between affective disorder and Alzheimer׳s disease and to determine how amyloid-β concentrations change over time and are associated with cognition as well as affective symptomatology, future research should include prospective, longitudinal studies, implemented in large study populations, where peripheral and central amyloid-β ratios are quantified concomitantly and continuously across various affective phases. Also, to enable inter-survey comparisons, the use of standardized pre-analytical/analytical procedures is crucial.
Collapse
Affiliation(s)
- Leda Abbasowa
- Department of Medicine, Kabbeltoft 25, DK-7100 Vejle, Denmark.
| | - Niels H H Heegaard
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, University of Southern Denmark, Denmark; Department of Clinical Biochemistry, Immunology & Genetics, Statens Serum Institut, Copenhagen, Denmark
| |
Collapse
|
21
|
Prevalence of Psychiatric and Substance Abuse Symptomatology Among HIV-Infected Gay and Bisexual Men in HIV Primary Care. PSYCHOSOMATICS 2014; 56:470-8. [PMID: 25656425 DOI: 10.1016/j.psym.2014.08.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND The presence of psychiatric symptoms in gay/bisexual men managing HIV are underidentified and undertreated and can interfere with optimal HIV disease management. There is a paucity of prevalence reports of these symptoms in this group, identified in the primary HIV care setting. Few studies have compared prevalence rates based on empirically supported screening tools in relation to diagnoses made in primary care. OBJECTIVE The purpose of this study was to identify the prevalence of psychiatric symptoms and substance abuse in HIV-infected gay/bisexual men and to estimate the proportion of those who had been diagnosed within their primary medical care setting. METHOD Participants (n = 503) were HIV-infected gay/bisexual men screened for participation in a HIV prevention trial and completed psychosocial assessment. Data were also extracted from patients׳ electronic medical record. RESULTS More than 47% of participants met diagnostic screen-in criteria for any anxiety disorder, of whom approximately one-third were identified in primary care. More than 22% screened in for a depressive mood disorder, approximately 50% of whom had been identified in primary care. A quarter of the sample had elevated substance abuse symptoms, 19.4% of whom were identified in primary care. Of those with symptoms of alcohol abuse (19.9%), 9.0% of those were identified in primary care. CONCLUSION These results provide some evidence suggesting that mood, anxiety, and substance abuse symptomatology are prevalent among HIV-infected gay/bisexual men and are underidentified in primary care. Increased mental health and substance use screening integrated into HIV primary care treatment settings may help to identify more gay/bisexual men in need of treatment.
Collapse
|
22
|
Eshun-Wilson I, Akena DH, Siegfried N, Obuku E, Stein DJ, Joska JA. Antidepressants for depression in adults with HIV infection. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd008525.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Ingrid Eshun-Wilson
- University of Cape Town; Department of Family Medicine; Cape Town South Africa
| | - Dickens H Akena
- Makerere University, College of Health Sciences; Department of Psychiatry; KAMPALA Uganda
| | - Nandi Siegfried
- University of Cape Town; Department of Psychiatry and Mental Health; Education Centre, Valkenberg Hospital Private Bag X1, Observatory Cape Town South Africa 7925
- University of California, San Francisco; Department of Epidemiology and Biostatistics; San Francisco California USA
- School of Public Health and Family Medicine, University of Cape Town; Centre for Infectious Disease and Epidemiology Research (CIDER); Cape Town South Africa
| | - Ekwaro Obuku
- College of Health Sciences, Makerere University; Africa Centre for Systematic Reviews & Knowledge Translation; Kampala Uganda
| | - Dan J Stein
- University of Cape Town; Department of Psychiatry and Mental Health; Education Centre, Valkenberg Hospital Private Bag X1, Observatory Cape Town South Africa 7925
| | - John A. Joska
- University of Cape Town; Department of Psychiatry and Mental Health; Education Centre, Valkenberg Hospital Private Bag X1, Observatory Cape Town South Africa 7925
| |
Collapse
|
23
|
Rodkjaer L, Chesney M, Lomborg K, Ostergaard L, Laursen T, Sodemann M. HIV-infected individuals with high coping self-efficacy are less likely to report depressive symptoms: a cross-sectional study from Denmark. Int J Infect Dis 2014; 22:67-72. [DOI: 10.1016/j.ijid.2013.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/04/2013] [Accepted: 12/07/2013] [Indexed: 01/28/2023] Open
|
24
|
Spies G, Seedat S. Depression and resilience in women with HIV and early life stress: does trauma play a mediating role? A cross-sectional study. BMJ Open 2014; 4:e004200. [PMID: 24566532 PMCID: PMC3939658 DOI: 10.1136/bmjopen-2013-004200] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The present study sought to assess the relationship between depressive symptomatology and resilience among women infected with HIV and to investigate whether trauma exposure (childhood trauma, other discrete lifetime traumatic events) or the presence of post-traumatic stress symptomatology mediated this relationship. DESIGN Cross-sectional study. SETTING Western Cape, South Africa. PARTICIPANTS A convenience sample of 95 women infected with HIV in peri-urban communities in the Western Cape, South Africa. All women had exposure to moderate-to-severe childhood trauma as determined by the Childhood Trauma Questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES We examined the relationship between depressive symptomatology and resilience (the Connor-Davidson Resilience Scale) and investigated whether trauma exposure or the presence of post-traumatic stress symptomatology mediated this relationship through the Sobel test for mediation and PLS path analysis. RESULTS There was a significant negative correlation between depressive symptomatology and resilience (p=<0.01). PLS path analysis revealed a significant direct effect between depression and resilience. On the Sobel test for mediation, distal (childhood trauma) and proximal traumatic events did not significantly mediate this association (p=> 0.05). However, post-traumatic stress symptomatology significantly mediated the relationship between depression and resilience in trauma-exposed women living with HIV. CONCLUSIONS In the present study, higher levels of resilience were associated with lower levels of self-reported depression. Although causal inferences are not possible, this suggests that in this sample, resilience may act as protective factor against the development of clinical depression. The results also indicate that post-traumatic stress symptoms (PTSS), which are highly prevalent in HIV-infected and trauma exposed individuals and often comorbid with depression, may further explain and account for this relationship. Further investigation is required to determine whether early identification and treatment of PTSS in this population may ameliorate the onset and persistence of major depression.
Collapse
Affiliation(s)
- Georgina Spies
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Soraya Seedat
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa
| |
Collapse
|
25
|
Psaros C, O'Cleirigh C, Bullis JR, Markowitz SM, Safren SA. The influence of psychological variables on health-related quality of life among HIV-positive individuals with a history of intravenous drug use. J Psychoactive Drugs 2014; 45:304-12. [PMID: 24377169 DOI: 10.1080/02791072.2013.825030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Intravenous drug use (IDU) remains a prominent pathway of HIV transmission in the United States, though little is known about modifiable factors influencing quality of life among IDUs. The goal of this study was to evaluate the influence of psychological variables (e.g., depression and anxiety) on health-related quality of life among HIV-positive individuals with a history of IDU who were enrolled in outpatient treatment for opioid dependence. METHOD 108 HIV-positive individuals with a history of IDU and participating in current outpatient treatment for opiate dependence who were screened for participation in a depression and adherence study reported sociodemographic data, depressive and anxiety symptoms, and health-related quality of life (HRQoL; Multidimensional Health Assessment using the ACTG-SF 21). RESULTS Multiple regression models controlling for disease stage and background characteristics identified significant negative relationships between General Health Perception and Functioning without Pain for anxiety and depression, and between Role Functioning and Physical Functioning for anxiety. CD4 cell count was significantly related to Physical Functioning only. CONCLUSIONS Results indicate that distress (both depression and anxiety) contribute significantly to variation in HRQoL over and above the effects of disease variables. Effective depression and anxiety treatment may result in improved overall functioning.
Collapse
Affiliation(s)
- Christina Psaros
- Behavioral Medicine Service, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Conall O'Cleirigh
- Behavioral Medicine Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jacqueline R Bullis
- Behavioral Medicine Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sarah M Markowitz
- Behavioral Medicine Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Steven A Safren
- Behavioral Medicine Service, Massachusetts General Hospital, Boston, MA 02114, USA
| |
Collapse
|
26
|
Spies G, Asmal L, Seedat S. Cognitive-behavioural interventions for mood and anxiety disorders in HIV: a systematic review. J Affect Disord 2013; 150:171-80. [PMID: 23688915 PMCID: PMC8811152 DOI: 10.1016/j.jad.2013.04.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 04/19/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mood and anxiety disorders are highly prevalent and comorbid with HIV/AIDS. However, there is a paucity of research on the effectiveness of cognitive-behavioural interventions (CBI) for common mental disorders in HIV-infected adults. The present study sought to review the existing literature on the use of CBI for depression and anxiety in HIV-positive adults and to assess the effect size of these interventions. METHODS We did duplicate searches of databases (from inception to 17-22 May 2012). The following online databases were searched: PubMed, The Cochrane Central Register of Controlled Trials and PsychArticles. RESULTS We identified 20 studies suitable for inclusion. A total of 2886 participants were enroled in these studies, of which 2173 participants completed treatment. The present review of the literature suggests that CBI may be effective in the treatment of depression and anxiety in individuals living with HIV/AIDS. Significant reductions in depression and anxiety were reported in intervention studies that directly and indirectly targeted depression and/or anxiety. Effect sizes ranged from 0.02 to 1.02 for depression and 0.04 to 0.70 for anxiety. LIMITATIONS Some trials included an immediate postintervention assessment but no follow-up assessments of outcome. This omission makes it difficult to determine whether the intervention effects are sustainable over time. CONCLUSION The present review of the literature suggests that CBI may have a positive impact on the treatment of depression and anxiety in adults living with HIV/AIDS.
Collapse
Affiliation(s)
- G. Spies
- South African Research Chairs Initiative (SARChI), PTSD program, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - L. Asmal
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - S. Seedat
- South African Research Chairs Initiative (SARChI), PTSD program, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa,MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa,Correspondence to: Department of Psychiatry, Faculty of Medicine and Health Sciences, PO Box 19063, Tygerberg, South Africa. Tel.: +27 21 9389116; fax: +27 21 9335790. (S. Seedat)
| |
Collapse
|
27
|
Pellowski JA, Kalichman SC, Matthews KA, Adler N. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. AMERICAN PSYCHOLOGIST 2013; 68:197-209. [PMID: 23688088 PMCID: PMC3700367 DOI: 10.1037/a0032694] [Citation(s) in RCA: 300] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The U.S. HIV/AIDS epidemic has evolved over the past 30 years and is now concentrated in socially marginalized and disenfranchised communities. The health disparities in this epidemic are striking, with most HIV infections occurring in sexual minorities and communities of color. While widely recognized, the health disparities in HIV and AIDS are not often discussed. In this article, we examine the factors underlying health disparities in the U.S. HIV epidemic. We first discuss the interlocking relationships between biological, social, and behavioral factors that drive HIV/AIDS epidemics. Guided by a well-established conceptual model of health disparities, we then describe the social positions of those most affected by HIV and AIDS, particularly racial and gender groups. Structural and economic conditions-including environmental resources, constraints, access to care, and psychosocial influences-are examined in relation to HIV disease trajectories. Greater attention to contextual factors and comorbidities is needed to reduce the health disparities in HIV/AIDS.
Collapse
|
28
|
Abstract
Research models show a strong interrelationship between sleep quality and immune function. The proinflammatory cytokines, interleukin-1, interleukin-6, and tumor necrosis factor α are classified as official sleep-regulatory substances. However, sleep-promoting properties are also possessed by several other immune and proinflammatory cellular classes. This article reviews the current physiologic evidence for the prominent somnogenic and sleep-regulatory properties inherent to these immune substances. Clinical examples of this relationship are discussed from the perspective of infectious and primarily immune-related conditions associated with significant sleep disruption and from the perspective of immune dysregulation associated with several primary sleep disorders.
Collapse
Affiliation(s)
- Charlene E Gamaldo
- Neurology, Pulmonary and Critical Care Medicine, Johns Hopkins Sleep Disorders Center, 600 North Wolfe Street, Meyer 6-119, Baltimore, MD 21287, USA.
| | | | | |
Collapse
|
29
|
Nakimuli-Mpungu E, Bass JK, Alexandre P, Mills EJ, Musisi S, Ram M, Katabira E, Nachega JB. Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: a systematic review. AIDS Behav 2012; 16:2101-18. [PMID: 22116638 DOI: 10.1007/s10461-011-0087-8] [Citation(s) in RCA: 249] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study evaluated estimates of depression symptoms, major depression, alcohol use or disorders and their association with ART adherence in sub-Saharan Africa. Studies published between January 1, 2006 and July 31, 2011 that documented rates of these mental health problems were identified through electronic databases. A pooled analysis of 23 studies reporting rates of depression symptoms and six studies reporting rates of major depression indicated a pooled estimate of 31.2% (95% CI 25.5-38.2%, Tau(2) = 0.23) and 18% (95% CI 12.3-25.8%, Tau(2) = 0.19) respectively. Few studies reported rates of alcohol use or disorders, and so we did not pool their estimates. Likelihood of achieving good adherence was 55% lower among those with depression symptoms compared to those without (pooled OR = 0.45 (95% CI 0.31-0.66, Tau(2) = 0.20, P value = 0.000). Interventions to improve mental health of HIV-positive individuals and to support adherence are desperately needed in sub-Saharan Africa.
Collapse
Affiliation(s)
- Etheldreda Nakimuli-Mpungu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, Hampton House, Baltimore, MD, 21205, USA.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Peterson K, Togun T, Klis S, Menten J, Colebunders R. Depression and posttraumatic stress disorder among HIV-infected Gambians on antiretroviral therapy. AIDS Patient Care STDS 2012; 26:589-96. [PMID: 22989270 DOI: 10.1089/apc.2012.0089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mood disorders are more frequent among people with HIV infection than among non-HIV-infected individuals of the same age, socioeconomic status, and HIV risks. They have been associated with worse adherence and clinical outcomes, yet remain underdiagnosed and undertreated in sub-Saharan Africa. We explored the relationship between mood disorders using the 10-item depression scale of the Centers for Epidemiological Studies (CES-D10) and the 22-item Impact of Events Scale-Revised (IES-R) for posttraumatic stress disorder, and a range of demographic and HIV-related variables among 252 consecutive subjects on antiretroviral therapy (ART). The study was conducted in the Genito-Urinary Medicine Clinic of the Medical Research Council's Gambia Unit. These screening tests were positive in 7% and 30%, respectively, of the patients, with higher scores (more depression or more post-traumatic stress) associated with female gender, more advanced WHO clinical stage, and lower Karnofsky Perfomance Scale rating. Higher CES-D10 scores were also seen among those on their second ART regimen. No relationship was seen with age, time on ART, viral load, or CD4 cell count. Compared to an earlier study at the same site in subjects prior to starting ART, the prevalence of depression in those stabilized on ART was dramatically reduced (by 34%, from 41%) while that of PTSD dropped less (by 13%, from 43%). Integrating the CES-D10 or a similar instrument into patient preparation for ART is recommended in order to identify those who may benefit from further mental health investigations, specific therapy, or closer follow-up during early ART.
Collapse
Affiliation(s)
- Kevin Peterson
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Toyin Togun
- Medical Research Council (UK) The Gambia Unit, Vaccinology Theme, Banjul, The Gambia
| | - Sandor Klis
- Department of Internal Medicine, University of Groningen, Groningen, The Netherlands
| | - Joris Menten
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Robert Colebunders
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Epidemiology and Social Medicine, Universitgy of Antwerp, Wilrijk, Belgium
| |
Collapse
|
31
|
Cruess DG, Kalichman SC, Amaral C, Swetzes C, Cherry C, Kalichman MO. Benefits of adherence to psychotropic medications on depressive symptoms and antiretroviral medication adherence among men and women living with HIV/AIDS. Ann Behav Med 2012; 43:189-97. [PMID: 22076697 DOI: 10.1007/s12160-011-9322-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Psychotropic medications are commonly used for depressive symptoms among people living with HIV/AIDS. PURPOSE We examined the relationships between adherence to psychotropic medications, depressive symptoms, and antiretroviral adherence. METHODS We assessed depressive symptoms among 324 people living with HIV/AIDS across a 3-month period (70% men; mean age 45 years; 90% African-American). Psychotropic and antiretroviral adherence was assessed using monthly, unannounced telephone pill counts. Multiple-regression and mediation analyses were utilized to examine associations under investigation. RESULTS Greater depressive symptoms were associated with lower antiretroviral and psychotropic medication adherence. Greater adherence to psychotropic medications regardless of medication class was positively related to higher antiretroviral adherence. Greater adherence to psychotropic medications also significantly mediated the association between depressive symptoms and antiretroviral adherence. CONCLUSIONS This study demonstrates the benefits of adherence to psychotropic medications on both depressive symptoms and antiretroviral adherence. Future work examining psychotropic medication adherence on disease outcomes in people living with HIV/AIDS is warranted.
Collapse
Affiliation(s)
- Dean G Cruess
- Department of Psychology, University of Connecticut, Storrs, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Stein L, Hechler D, Jessen AB, Neumann K, Jessen H, Beneke R. Sports behaviour among HIV-infected versus non-infected individuals in a Berlin cohort. Int J STD AIDS 2012; 23:25-9. [PMID: 22362683 DOI: 10.1258/ijsa.2009.009342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Physical activity has been recommended based on beneficial effects described in HIV-infected patients. However, such guidelines do not take into account actual sport behaviours and general attitudes towards physical activity. To evaluate actual sport activity and attitudes towards sport in HIV-infected versus non-infected individuals we conducted an anonymous questionnaire investigating the prevalence, as well as possible changes, in sports engagement and the overall attitude to physical activity. A total of 283 patients of a general care facility specialized in the treatment of HIV/AIDS in Berlin, Germany, participated; 124 were HIV infected and 159 were non-infected, mostly men who have sex with men (MSM) (88%), with a median age of 35 years. The HIV-infected participants had a median CD4+ count of 554 cells/µL and 48.8% of them were using antiretroviral therapy (ART) at the time of survey. The proportion of patients actually performing physical activity was significantly lower (P = 0.028) within the HIV-infected group (61.3%) than within the non-infected group (74.2%). This difference remained significant after accounting for possible confounders such as age, gender, injecting drug use and sexual preferences. Previously reported sport activity prevalence was similar in both groups on leaving school. From our data we could not identify an association between the time of HIV diagnosis and changes in sports activity. In conclusion, fewer HIV-infected individuals report physical activity than non-infected individuals. Sociodemographic studies to evaluate potential differences in sports behaviour are required in order to inform exercise guidelines for HIV-infected patients.
Collapse
Affiliation(s)
- L Stein
- Private Medical Practice Jessen-Jessen-Stein, Berlin, Germany.
| | | | | | | | | | | |
Collapse
|
33
|
Kaestner F, Anneken K, Mostert C, Reichelt D, Rothermundt M, Evers S, Husstedt IW. Depression associated with antiretroviral drug therapy in HIV: case report and overview. Int J STD AIDS 2012; 23:e14-9. [DOI: 10.1258/ijsa.2009.009451] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Depression is the main psychiatric symptom in patients living with HIV. Genetic predisposition, stress from disease as well as the antiretroviral therapy itself are discussed as pathogenic factors. We report a 35-year-old HIV-positive man suffering from bipolar disorder who developed major depression shortly after commercing combination antiretroviral therapy (cART) on three occasions. The first two times the patient ceased therapy autonomously, and the depression disappeared completely. The close connection between cART and major depression in the present case supports the depression-inducing potential of cART. Additionally, we present an overview of literature.
Collapse
Affiliation(s)
| | | | | | - D Reichelt
- Department of Internal Medicine D, University of Muenster, Albert-Schweitzer-Str. 11, D-48129 Muenster, Germany
| | | | | | | |
Collapse
|
34
|
Posada C, Moore DJ, Deutsch R, Rooney A, Gouaux B, Letendre S, Grant I, Atkinson JH. Sustained attention deficits among HIV-positive individuals with comorbid bipolar disorder. J Neuropsychiatry Clin Neurosci 2012; 24:61-70. [PMID: 22450615 PMCID: PMC3575087 DOI: 10.1176/appi.neuropsych.11010028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Difficulties with sustained attention have been found among both persons with HIV infection (HIV+) and bipolar disorder (BD). The authors examined sustained attention among 39 HIV+ individuals with BD (HIV+/BD+) and 33 HIV-infected individuals without BD (HIV+/BD-), using the Conners' Continuous Performance Test-II (CPT-II). A Global Assessment of Functioning (GAF) score was also assigned to each participant as an overall indicator of daily functioning abilities. HIV+/BD+ participants had significantly worse performance on CPT-II omission errors, hit reaction time SE (Hit RT SE), variability of SE, and perseverations than HIV+/BD- participants. When examining CPT-II performance over the six study blocks, both HIV+/BD+ and HIV+/BD- participants evidenced worse performance on scores of commission errors and reaction times as the test progressed. The authors also examined the effect of current mood state (i.e., manic, depressive, euthymic) on CPT-II performance, but no significant differences were observed across the various mood states. HIV+/BD+ participants had significantly worse GAF scores than HIV+/BD- participants, which indicates poorer overall functioning in the dually-affected group; among HIV+/BD+ persons, significant negative correlations were found between GAF scores and CPT-II omission and commission errors, detectability, and perseverations, indicating a possible relationship between decrements in sustained attention and worse daily-functioning outcomes.
Collapse
|
35
|
Akincigil A, Wilson IB, Walkup JT, Siegel MJ, Huang C, Crystal S. Antidepressant treatment and adherence to antiretroviral medications among privately insured persons with HIV/AIDS. AIDS Behav 2011; 15:1819-28. [PMID: 21484284 DOI: 10.1007/s10461-011-9938-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In order to examine relationships between depression treatments (antidepressant and/or psychotherapy utilization) and adherence to antiretroviral therapy (ART), we conducted a retrospective analysis of medical and pharmacy insurance claims for privately insured persons living with HIV/AIDS (PLWHA) diagnosed with depression (n = 1,150). Participants were enrolled in 80 insurance plans from all 50 states. Adherence was suboptimal. Depression treatment initiators were significantly more likely to be adherent to ART than the untreated. We did not observe an association between psychotherapy utilization and ART adherence, yet given the limitations of the data (e.g., there is no information on types of psychological treatment and its targets), the lack of association should not be interpreted as lack of efficacy.
Collapse
Affiliation(s)
- Ayse Akincigil
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, USA.
| | | | | | | | | | | |
Collapse
|
36
|
Watkins CC, Pieper AA, Treisman GJ. Safety considerations in drug treatment of depression in HIV-positive patients: an updated review. Drug Saf 2011; 34:623-39. [PMID: 21751824 DOI: 10.2165/11592070-000000000-00000] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Major depressive disorder (MDD) is one of the most prevalent illnesses associated with HIV infection, and negatively affects medication adherence, disease progression and mortality in HIV disease. Co-morbid treatment of major depression in HIV disease is the optimal therapeutic approach, but discriminating MDD from normal fluctuations in mood state, personality or physiology is difficult. Definitive diagnosis of MDD is critical for drug safety and for avoiding unnecessary exposure to psychotropic medications. HIV patients respond to antidepressant treatment like the general population, and medication adverse effects and patient adherence are the best predictors of treatment outcome. This review attempts to assist the medical provider with the diagnosis and treatment of MDD in HIV patients. We outline the initial steps in screening and psychiatric referral, the antidepressants that are particularly useful in HIV-infected patients, and the adverse effects and pharmacological strategies for overcoming potential barriers to medication adherence. Potential interactions between the various classes of antidepressants and HIV/antiretroviral therapy, as well as management of HIV medication-related psychiatric adverse effects, are also discussed.
Collapse
Affiliation(s)
- Crystal C Watkins
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | | | | |
Collapse
|
37
|
Rodkjaer L, Laursen T, Christensen NB, Lomborg K, Ostergaard L, Sodemann M. Changes in depression in a cohort of Danish HIV-positive individuals: time for routine screening. Sex Health 2011; 8:214-21. [PMID: 21592436 DOI: 10.1071/sh10067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 09/07/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study was to follow a cohort of HIV-positive individuals for 3 years in order to assess changes in depression, adherence, unsafe sex and emotional strains from living with HIV. METHODS Participants were assessed for depression, adherence, emotional strain and unsafe sex via a questionnaire. The Beck Depression Inventory II (BDI) was used to assess the prevalence and severity of depressive symptoms. Patients with a BDI score of 20 or above (moderate to major depression) were offered a clinical evaluation by a consultant psychiatrist. RESULTS In 2005, 205 HIV-positive individuals participated in the study. Symptoms of depression (BDI >14) were observed in 77 (38%) and major depression (BDI ≥20) in 53 (26%) individuals. In 2008, 148 participants were retested (72% of original sample). Depression (BDI >14) was observed in 38 (26%) and symptoms of major depression (BDI ≥20) in 24 (16%) individuals. Patients at risk of moderate to major depression were more likely to be non-adherent to medications, to practice unsafe sex and to suffer from emotional strains compared with patients not at risk of depression, both at baseline (2005) and follow-up (2008). CONCLUSION This study demonstrated a decline in depression scores over time and an association between the risk of depression and low medication adherence, stress and unsafe sex. We recommend routine screening for depression to be conducted regularly to provide full evaluations and relevant psychiatric treatment.
Collapse
Affiliation(s)
- Lotte Rodkjaer
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, DK-8200 Aarhus N., Denmark.
| | | | | | | | | | | |
Collapse
|
38
|
Forkmann T, Norra C, Wirtz M, Vehren T, Volz-Sidiropoulou E, Westhofen M, Gauggel S, Boecker M. Prevalence and psychopathological characteristics of depression in consecutive otorhinolaryngologic inpatients. BMC EAR, NOSE, AND THROAT DISORDERS 2011; 11:7. [PMID: 21880128 PMCID: PMC3178470 DOI: 10.1186/1472-6815-11-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 08/31/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND High prevalence of depression has been reported in otorhinolaryngologic patients (ORL). However, studies using a semi-structured interview to determine the prevalence of depression in ORL are lacking. Therefore the present study sought to determine the depression prevalence in ORL applying a semi-structured diagnostic interview and to further characterize the pathopsychological and demographic characteristics of depression in these patients. METHODS One-hundred inpatients of the otorhinolaryngologic department of a German university hospital participated voluntarily (age M = 38.8 years, SD = 13.9; 38.0% female). Depression was assessed using a clinical interview in which the International Diagnostic Checklist for depression (IDCL) was applied. Patients completed the Brief Symptom Inventory (BSI) which constitutes three composite scores and nine symptom scales and the Beck Depression Inventory (BDI). Multivariate analyses of variance, correlations and effect sizes were conducted. RESULTS A prevalence of depression of 21.0% was determined, 38.0% of the depressed patients were female. Depressed patients showed higher scores on the BSI-scales "interpersonal sensitivity", "depression", "anxiety", "phobic anxiety" and "psychoticism" with medium effect sizes. CONCLUSIONS High prevalence of depression was found which is in accordance with results of prior studies. Depressed patients showed higher psychological distress as compared to non-depressed patients. The results call for carrying on in engaging in depression research and routine depression screening in ORL.
Collapse
Affiliation(s)
- Thomas Forkmann
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Sherr L, Clucas C, Harding R, Sibley E, Catalan J. HIV and depression--a systematic review of interventions. PSYCHOL HEALTH MED 2011; 16:493-527. [PMID: 21809936 DOI: 10.1080/13548506.2011.579990] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HIV-positive individuals are more likely to be diagnosed with major depressive disorder than HIV-negative individuals. Depression can precede diagnosis and be associated with risk factors for infection. The experience of illness can also exacerbate depressive episodes and depression can be a side effect to treatment. A systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review aims to provide a comprehensive understanding of evaluated interventions related to HIV and depression and provide some insight on questions of prevalence and measurement. Standard systematic research methods were used to gather quality published papers on HIV and depression. From the search, 1015 articles were generated and hand searched resulting in 90 studies meeting adequacy inclusion criteria for analysis. Of these, 67 (74.4%) were implemented in North America (the US and Canada) and 14 (15.5%) in Europe, with little representation from Africa, Asia and South America. Sixty-five (65.5%) studies recruited only men or mostly men, of which 31 (35%) recruited gay or bisexual men. Prevalence rates of depression ranged from 0 to 80%; measures were diverse and rarely adopted the same cut-off points. Twenty-one standardized instruments were used to measure depression. Ninety-nine interventions were investigated. The interventions were diverse and could broadly be categorized into psychological, psychotropic, psychosocial, physical, HIV-specific health psychology interventions and HIV treatment-related interventions. Psychological interventions were particularly effective and in particular interventions that incorporated a cognitive-behavioural component. Psychotropic and HIV-specific health psychology interventions were generally effective. Evidence is not clear-cut regarding the effectiveness of physical therapies and psychosocial interventions were generally ineffective. Interventions that investigated the effects of treatments for HIV and HIV-associated conditions on depression generally found that these treatments did not increase but often decreased depression. Interventions are both effective and available, although further research into enhancing efficacy would be valuable. Depression needs to be routinely logged in those with HIV infection during the course of their disease. Specific data on women, young people, heterosexual men, drug users and those indiverse geographic areas are needed. Measurement of depression needs to be harmonized and management into care protocols incorporated.
Collapse
Affiliation(s)
- Lorraine Sherr
- Department of Infection and Population Health, University College London, London, UK.
| | | | | | | | | |
Collapse
|
40
|
Klis S, Velding K, Gidron Y, Peterson K. Posttraumatic stress and depressive symptoms among people living with HIV in the Gambia. AIDS Care 2011; 23:426-34. [PMID: 21271395 DOI: 10.1080/09540121.2010.507756] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to assess the prevalence and clinical and psychosocial correlates of psychiatric symptoms in a sample of HIV patients in the Gambia. Data from 44 HIV-positive outpatients were collected at a Genito-Urinary Medicine clinic in Fajara, the Gambia. Translated versions of the Impact of Event Scale Revised and the Centre for Epidemiologic Studies Short Depression Scale were used to assess posttraumatic stress disorder (PTSD) symptoms and depressive symptoms, respectively. The Pictorial Representation of Illness and Self Measure revised was used to assess illness perception (IP). All other data (e.g., CD4 counts) were retrieved from medical charts or through standardised questions. The prevalence of PTSD symptoms (43.2%) and depressive symptoms (40.9%) was high. Not having an independent income and having a CD4 count under 200 cells/µl were independent correlates of depressive symptoms. Only IP was an independent correlate of PTSD symptoms. Finally, IP tended to moderate the relationship between CD4 cell counts and depressive symptoms. These findings indicate that routine screening for psychiatric symptoms is both necessary and feasible among HIV patients in the Gambia. In addition, any intervention targeting these symptoms should take IP into account.
Collapse
Affiliation(s)
- Sandor Klis
- Department of Psychology and Health, Tilburg University, Tilburg, The Netherlands.
| | | | | | | |
Collapse
|
41
|
Spiegel DR, Bayne CE, Wilcox L, Somova M. A case of mania due to cryptococcal meningitis, successfully treated with adjunctive olanzapine, in a patient with acquired immunodeficiency syndrome. Gen Hosp Psychiatry 2011; 33:301.e3-6. [PMID: 21601730 DOI: 10.1016/j.genhosppsych.2010.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 11/05/2010] [Accepted: 11/05/2010] [Indexed: 11/18/2022]
Abstract
We report on the case of a patient with acquired immune deficiency syndrome- and Cryptococcus neoformans meningitis-related mania in which olanzapine was successfully used adjunctively and transiently to antifungal therapy.
Collapse
Affiliation(s)
- David R Spiegel
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
| | | | | | | |
Collapse
|
42
|
Improving treatment adherence in patients with bipolar disorder and substance abuse: rationale and initial development of a novel psychosocial approach. J Psychiatr Pract 2011; 17:5-20. [PMID: 21266890 PMCID: PMC3071706 DOI: 10.1097/01.pra.0000393840.18099.d6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Patients with comorbid bipolar and substance use disorders are at particularly high risk for treatment nonadherence and a host of negative consequences. However, no previous interventions have been designed specifically to address this problem. In the current study, we describe the rationale for and initial development of an adjunctive psychosocial intervention that targets adherence in patients with bipolar disorder who are substance abusers. The intervention involves brief in-person sessions and follow-up phone contacts with the patient and a significant other/family member. We describe the effects of this novel intervention on adherence and other psychiatric outcomes in a series of cases treated as part of our initial development work. Results suggest that the intervention is feasible and acceptable to patients and could be helpful in enhancing the effects of existing treatments. Given these promising results, we plan to test the intervention further in a randomized clinical trial.
Collapse
|
43
|
Uldall KK, Palmer NB, Whetten K, Mellins C. Adherence in people living with HIV/AIDS, mental illness, and chemical dependency: a review of the literature. AIDS Care 2010; 16 Suppl 1:S71-96. [PMID: 15736823 DOI: 10.1080/09540120412331315277] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Adherence to antiretroviral medications is central to reducing morbidity and mortality among people living with HIV/AIDS. Relatively few studies published to date address HIV adherence among special populations. The purpose of this article is to review the existing literature on HIV antiretroviral adherence, with an emphasis on studies among the triply diagnosed population of people living with HIV/AIDS, mental illness, and chemical dependency. In order to reflect the most current information available, data from conference proceedings, federally funded studies in progress, and the academic literature are presented for consideration.
Collapse
Affiliation(s)
- K K Uldall
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104, USA.
| | | | | | | |
Collapse
|
44
|
Kraaij V, van Emmerik A, Garnefski N, Schroevers MJ, Lo-Fo-Wong D, van Empelen P, Dusseldorp E, Witlox R, Maes S. Effects of a cognitive behavioral self-help program and a computerized structured writing intervention on depressed mood for HIV-infected people: a pilot randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2010; 80:200-204. [PMID: 19781889 DOI: 10.1016/j.pec.2009.08.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 08/18/2009] [Accepted: 08/20/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The aim of the present study was to examine whether low-resource, cost-effective intervention programs can be effective in improving depressed mood in people with HIV. The efficacy of a cognitive-behavioral self-help program (CBS) and a computerized structured writing intervention (SWI) were tested in a pilot randomized controlled trial. METHODS Participants were members of a patient organization. They completed a pretest and posttest. The questionnaire included the HADS. Participants were randomly allocated to CBS (n=24), SWI (n=25) or a waiting list condition (WLC, n=24). To evaluate changes in the continuous outcome measure, a 3 x 2 (group x time) repeated measures ANCOVA was performed. Also, an ANCOVA was performed using change scores. RESULTS Respondents who followed the CBS improved significantly compared to the WLC. However, for people in the SWI condition no significant improvement on depression was found. CONCLUSION This pilot study suggests that a low-resource, cost-effective CBS program seems to be effective in reducing depressed mood in people living with HIV. PRACTICE IMPLICATIONS Because self-help programs can be delivered through regular mail or the internet, a high number of people could be reached while overcoming geographical and social barriers to treatment.
Collapse
Affiliation(s)
- Vivian Kraaij
- Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Lee K, Vivithanaporn P, Siemieniuk RA, Krentz HB, Maingat F, Gill MJ, Power C. Clinical outcomes and immune benefits of anti-epileptic drug therapy in HIV/AIDS. BMC Neurol 2010; 10:44. [PMID: 20565780 PMCID: PMC2902446 DOI: 10.1186/1471-2377-10-44] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Accepted: 06/17/2010] [Indexed: 11/10/2022] Open
Abstract
Background Anti-epileptic drugs (AEDs) are frequently prescribed to persons with HIV/AIDS receiving combination antiretroviral therapy (cART) although the extent of AED use and their interactions with cART are uncertain. Herein, AED usage, associated toxicities and immune consequences were investigated. Methods HIV replication was analysed in proliferating human T cells during AED exposure. Patients receiving AEDs in a geographically-based HIV care program were assessed using clinical and laboratory variables in addition to assessing AED indication, type, and cumulative exposures. Results Valproate suppressed proliferation in vitro of both HIV-infected and uninfected T cells (p <0.05) but AED exposures did not affect HIV production in vitro. Among 1345 HIV/AIDS persons in active care between 2001 and 2007, 169 individuals were exposed to AEDs for the following indications: peripheral neuropathy/neuropathic pain (60%), seizure/epilepsy (24%), mood disorder (13%) and movement disorder (2%). The most frequently prescribed AEDs were calcium channel blockers (gabapentin/pregabalin), followed by sodium channel blockers (phenytoin, carbamazepine, lamotrigine) and valproate. In a nested cohort of 55 AED-treated patients receiving cART and aviremic, chronic exposure to sodium and calcium channel blocking AEDs was associated with increased CD4+ T cell levels (p <0.05) with no change in CD8+ T cell levels over 12 months from the beginning of AED therapy. Conclusions AEDs were prescribed for multiple indications without major adverse effects in this population but immune status in patients receiving sodium or calcium channel blocking drugs was improved.
Collapse
Affiliation(s)
- Kathy Lee
- Southern Alberta Clinic, Alberta Health Services, Calgary, AB, Canada
| | | | | | | | | | | | | |
Collapse
|
46
|
Lewis IS, Joska JA, Siegfried N. Antidepressants for depression in adults with HIV infection. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
47
|
Gonzalez A, Zvolensky MJ, Solomon SE, Miller CT. Exploration of the relevance of anxiety sensitivity among adults living with HIV/AIDS for understanding anxiety vulnerability. J Health Psychol 2010; 15:138-46. [PMID: 20064893 DOI: 10.1177/1359105309344898] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This investigation explored facets of anxiety sensitivity (AS-social, physical and mental concerns) in regard to somatization, anxiety and depression symptoms among people with HIV/AIDS. Significant relations were found for AS-physical concerns and somatization symptoms (beta = .52, p = .007) and AS-mental concerns and anxiety symptoms (beta = .29, p < .05), controlling for negative affectivity, gender and shared variance with other AS subscales. Together, AS subscales were significantly related to depression symptoms (DeltaR(2) = .11; p = .006), but no one subscale was independently related. Findings are discussed in terms of examining AS in better understanding the HIV/AIDS-anxiety relation.
Collapse
|
48
|
Benton T, Blume J, Dubé B. Treatment considerations for psychiatric syndromes associated with HIV infection. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/hiv.10.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Psychiatric syndromes associated with HIV disease were recognized early in the AIDS epidemic. Public education, new technologies and antiretroviral therapies have resulted in earlier recognition and therapautic interventions of HIV infection, improving the physical health for individuals living with HIV. While HIV-associated psychiatric symptoms have been recognized for more than 20 years, our understanding of the mechanisms underlying psychiatric symptoms among HIV-infected individuals and treatments for these symptoms have not kept pace with advances in HIV therapies. In this article, we discuss current knowledge of the psychiatric symptoms occurring with HIV disease, specifically mood, anxiety and psychotic disorders, evidence-based treatments and treatment considerations, new strategies for the treatments of psychiatric symptoms in HIV disease are also discussed.
Collapse
Affiliation(s)
- Tami Benton
- Child & Adolescent Psychiatry, The Children’s Hospital of Philadelphia Behavioral Health Center, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA
| | - Joshua Blume
- Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, USA
| | - Benoit Dubé
- Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, PA 19104, USA
| |
Collapse
|
49
|
Nakimuli-Mpungu E, Mutamba B, Nshemerirwe S, Kiwuwa M, Musisi S. Effect of HIV infection on time to recovery from an acute manic episode. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2010; 2:185-9. [PMID: 22096397 PMCID: PMC3218699 DOI: 10.2147/hiv.s9978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Understanding factors affecting the time to recovery from acute mania is critical in the management of manic syndromes. The aim of this study was to determine the effect of HIV infection on time to recovery from acute mania. METHODS We performed a retrospective study in which medical charts of individuals who were treated for acute mania were reviewed. Survival analysis with Cox regression models were used to compare time to recovery from an acute manic episode between human immunodeficiency virus (HIV)-positive individuals and HIV-negative individuals. RESULTS Median survival time was one week for HIV-positive individuals and more than four weeks for HIV-negative individuals (χ(2) = 18.4, P value = 0.000). HIV infection was the only marginally significant independent predictor of survival probability on the acute admission ward (hazards ratio 2.87, P = 0.06). CONCLUSION Acute mania in HIV-infected persons responds faster to psychotropic drugs compared with that in HIV-negative persons.
Collapse
Affiliation(s)
- E Nakimuli-Mpungu
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | |
Collapse
|
50
|
Hammoud DA, Endres CJ, Hammond E, Uzuner O, Brown A, Nath A, Kaplin AI, Pomper MG. Imaging serotonergic transmission with [11C]DASB-PET in depressed and non-depressed patients infected with HIV. Neuroimage 2009; 49:2588-95. [PMID: 19853044 DOI: 10.1016/j.neuroimage.2009.10.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 09/10/2009] [Accepted: 10/13/2009] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Site-selective imaging can provide significant insight into the mechanism of HIV-associated neurological disease. The goal of this study was to evaluate the involvement of serotonergic transmission in HIV-associated depression using [(11)C]DASB, a serotonin transporter (5-HTT)-specific radiopharmaceutical for positron emission tomography (PET). METHODS Nine depressed HIV+ subjects (HIV-D), 9 non-depressed HIV+ subjects (HIV-ND) and 7 healthy controls (HC) underwent an MRI scan and a [(11)C]DASB-PET scan. The outcome measure was 5-HTT binding potential normalized to non-displaceable tissue radioligand (BP(ND)). RESULTS HIV-ND subjects had lower mean regional 5-HTT BP(ND) estimates across regions compared to HC, while HIV-D subjects demonstrated higher mean regional binding values than HIV-ND subjects in most regions. Prior to correction for the false discovery rate, HIV-ND had significantly lower BP(ND) values compared to HC subjects in two regions (insula and anterior cingulate) and all HIV+ patients had significantly lower binding than HC in all regions except for the midbrain, thalamus and pons. After correction for the false discovery rate, only the insula showed significantly lower binding in HIV+ subjects compared to HC (P<0.0045). Despite a significant difference in the duration of illness between the HIV-D and HIV-ND groups, there was no definite correlation between the duration of illness and BP(ND). CONCLUSION Lower [(11)C]DASB binding in HIV+ patients compared to HC may reflect serotonergic neuronal loss as a component of generalized HIV-associated neurodegeneration. Higher mean regional BP(ND) values in HIV-D compared to HIV-ND subjects could reflect increased density of 5-HTT, leading to increased clearance of serotonin from the synapse, which could account, in part, for symptoms of depression. The lack of correlation between duration of illness and binding argues against these findings being the result of differential neurodegeneration only. Our findings suggest a possible role for dysregulated serotonergic transmission in HIV-associated depression.
Collapse
Affiliation(s)
- Dima A Hammoud
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center, Bethesda, MD, USA
| | | | | | | | | | | | | | | |
Collapse
|