Loneliness among people with severe mental illness during the COVID-19 pandemic: Results from a linked UK population cohort study

AIM/GOAL/PURPOSE

Population surveys underrepresent people with severe mental ill health. This paper aims to use multiple regression analyses to explore perceived social support, loneliness and factor associations from self-report survey data collected during the Covid-19 pandemic in a sample of individuals with severe mental ill health.

DESIGN/METHODOLOGY/APPROACH

We sampled an already existing cohort of people with severe mental ill health. Researchers contacted participants by phone or by post to invite them to take part in a survey about how the pandemic restrictions had impacted health, Covid-19 experiences, perceived social support, employment and loneliness. Loneliness was measured by the three item UCLA loneliness scale.

FINDINGS

In the pandemic sub-cohort, 367 adults with a severe mental ill health diagnosis completed a remote survey. 29-34% of participants reported being lonely. Loneliness was associated with being younger in age (adjusted OR = -.98, p = .02), living alone (adjusted OR = 2.04, p = .01), high levels of social and economic deprivation (adjusted OR = 2.49, p = .04), and lower perceived social support (B = -5.86, p < .001). Living alone was associated with lower perceived social support. Being lonely was associated with a self-reported deterioration in mental health during the pandemic (adjusted OR = 3.46, 95%CI 2.03-5.91).

PRACTICAL IMPLICATIONS

Intervention strategies to tackle loneliness in the severe mental ill health population are needed. Further research is needed to follow-up the severe mental ill health population after pandemic restrictions are lifted to understand perceived social support and loneliness trends.

ORIGINALITY

Loneliness was a substantial problem for the severe mental ill health population before the Covid-19 pandemic but there is limited evidence to understand perceived social support and loneliness trends during the pandemic.

Loneliness among people with severe mental illness during the COVID-19 pandemic: Results from a linked UK population cohort study

AIM/GOAL/PURPOSE

Population surveys underrepresent people with severe mental ill health. This paper aims to use multiple regression analyses to explore perceived social support, loneliness and factor associations from self-report survey data collected during the Covid-19 pandemic in a sample of individuals with severe mental ill health.

DESIGN/METHODOLOGY/APPROACH

We sampled an already existing cohort of people with severe mental ill health. Researchers contacted participants by phone or by post to invite them to take part in a survey about how the pandemic restrictions had impacted health, Covid-19 experiences, perceived social support, employment and loneliness. Loneliness was measured by the three item UCLA loneliness scale.

FINDINGS

In the pandemic sub-cohort, 367 adults with a severe mental ill health diagnosis completed a remote survey. 29-34% of participants reported being lonely. Loneliness was associated with being younger in age (adjusted OR = -.98, p = .02), living alone (adjusted OR = 2.04, p = .01), high levels of social and economic deprivation (adjusted OR = 2.49, p = .04), and lower perceived social support (B = -5.86, p < .001). Living alone was associated with lower perceived social support. Being lonely was associated with a self-reported deterioration in mental health during the pandemic (adjusted OR = 3.46, 95%CI 2.03-5.91).

PRACTICAL IMPLICATIONS

Intervention strategies to tackle loneliness in the severe mental ill health population are needed. Further research is needed to follow-up the severe mental ill health population after pandemic restrictions are lifted to understand perceived social support and loneliness trends.

ORIGINALITY

Loneliness was a substantial problem for the severe mental ill health population before the Covid-19 pandemic but there is limited evidence to understand perceived social support and loneliness trends during the pandemic.

Loneliness among people with severe mental illness during the COVID-19 pandemic: Results from a linked UK population cohort study

AIM/GOAL/PURPOSE

Population surveys underrepresent people with severe mental ill health. This paper aims to use multiple regression analyses to explore perceived social support, loneliness and factor associations from self-report survey data collected during the Covid-19 pandemic in a sample of individuals with severe mental ill health.

DESIGN/METHODOLOGY/APPROACH

We sampled an already existing cohort of people with severe mental ill health. Researchers contacted participants by phone or by post to invite them to take part in a survey about how the pandemic restrictions had impacted health, Covid-19 experiences, perceived social support, employment and loneliness. Loneliness was measured by the three item UCLA loneliness scale.

FINDINGS

In the pandemic sub-cohort, 367 adults with a severe mental ill health diagnosis completed a remote survey. 29-34% of participants reported being lonely. Loneliness was associated with being younger in age (adjusted OR = -.98, p = .02), living alone (adjusted OR = 2.04, p = .01), high levels of social and economic deprivation (adjusted OR = 2.49, p = .04), and lower perceived social support (B = -5.86, p < .001). Living alone was associated with lower perceived social support. Being lonely was associated with a self-reported deterioration in mental health during the pandemic (adjusted OR = 3.46, 95%CI 2.03-5.91).

PRACTICAL IMPLICATIONS

Intervention strategies to tackle loneliness in the severe mental ill health population are needed. Further research is needed to follow-up the severe mental ill health population after pandemic restrictions are lifted to understand perceived social support and loneliness trends.

ORIGINALITY

Loneliness was a substantial problem for the severe mental ill health population before the Covid-19 pandemic but there is limited evidence to understand perceived social support and loneliness trends during the pandemic.

Surviving SARS and living through COVID-19: Healthcare worker mental health outcomes and insights for coping

Objective

Explore how previous work during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak affects the psychological response of clinical and non-clinical healthcare workers (HCWs) to the current COVID-19 pandemic.

Methods

A cross-sectional, multi-centered hospital online survey of HCWs in the Greater Toronto Area, Canada. Mental health outcomes of HCWs who worked during the COVID-19 pandemic and the SARS outbreak were assessed using Impact of Events—Revised scale (IES-R), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9).

Results

Among 3852 participants, moderate/severe scores for symptoms of post- traumatic stress disorder (PTSD) (50.2%), anxiety (24.6%), and depression (31.5%) were observed among HCWs. Work during the 2003 SARS outbreak was reported by 1116 respondents (29.1%), who had lower scores for symptoms of PTSD (P = .002), anxiety (P < .001), and depression (P < .001) compared to those who had not worked during the SARS outbreak. Multivariable logistic regression analysis showed non-clinical HCWs during this pandemic were at higher risk of anxiety (OR, 1.68; 95% CI, 1.19–2.15, P = .01) and depressive symptoms (OR, 2.03; 95% CI, 1.34–3.07, P < .001). HCWs using sedatives (OR, 2.55; 95% CI, 1.61–4.03, P < .001), those who cared for only 2–5 patients with COVID-19 (OR, 1.59; 95% CI, 1.06–2.38, P = .01), and those who had been in isolation for COVID-19 (OR, 1.36; 95% CI, 0.96–1.93, P = .05), were at higher risk of moderate/severe symptoms of PTSD. In addition, deterioration in sleep was associated with symptoms of PTSD (OR, 4.68, 95% CI, 3.74–6.30, P < .001), anxiety (OR, 3.09, 95% CI, 2.11–4.53, P < .001), and depression (OR 5.07, 95% CI, 3.48–7.39, P < .001).

Conclusion

Psychological distress was observed in both clinical and non-clinical HCWs, with no impact from previous SARS work experience. As the pandemic continues, increasing psychological and team support may decrease the mental health impacts.

A perception-based study to explore COVID-19 pandemic stress and its factors in Bangladesh

BACKGROUND AND AIMS

Worldwide the COVID-19 pandemic has accelerated sufferings of mental health and behaviour attitudes of people. Many countries, including Bangladesh, reported suicide as extreme consequences of the psychological burden influenced by COVID-19. The present study explores human stress and its factor influenced by COVID-19 in Bangladesh, which significantly affect the quality of life.

METHODS

An online-based questionnaire survey was conducted among 651 adult Bangladeshi populations by capturing socio-demographic information, possible human stress, and consequences of the pandemic. A set of statistical tools such as Pearson's Correlation Matrix (PCM), T-test, Principal Component Analysis (PCA) and Hierarchical Cluster Analysis (HCA) were applied to identify the relationship between different factors and influential factors increasing human stress.

RESULTS

More than 83% of the participants are facing COVID-19 related mental stress, which results in short temper, sleep disorder, and family chaos. PCA and HCA outcomes indicated a significant relationship between the respondents' opinions and human stress factors, which harmonized with the country's existing scenario. PCM results enlighten the relationship between human stress factors and found financial hardship, cutting back daily spending, and food crisis are interconnected together causes stress. Also, hampering students' formal education and future career plans significantly contribute to mental stress.

CONCLUSION

Based on the above findings, it's crucial to introduce a time-oriented strategy and implement precaution monitoring plans for Bangladesh. The rescue plan will help people to manage the pandemic and improve mental health to fight against psychological challenges related to COVID-19 and future pandemics.

Covid-19 pandemic-prevalence of depression, anxiety and insomnia during Covid-19 lockdown and its associated factors in Karachi, Pakistan

We aimed to determine the frequency of depression, anxiety and insomnia; identify associated factors; and compare these outcomes amongst a privileged and underprivileged class of Pakistan. A cross-sectional online and face to face survey was conducted in Karachi from April 2020 to May 2020. Validated depression (World Health Organization self-reporting questionnaire), anxiety (general anxiety and depression scale) and insomnia (insomnia severity index) scales were used. Out of 447 participants, the majority were less than 30 years (63.8%) and females (57.7%); 20.8% study participants belonged to poor or very poor socioeconomic status; 17% respondents were from lower middle status and 38% belonged to the higher middle or rich class. Depression, anxiety and insomnia were identified in 30%, 30.63% and 8.5% of participants, respectively. The prevalence of depression, anxiety and insomnia among privileged people was 37.8%, 16.6% and 11.3% respectively whereas among underprivileged were 17.8%, 16.6% and 4.1% respectively. There were significant differences in frequencies of depression (p<0.001), anxiety (p<0.001) and insomnia (p=0.009) among the privileged and underprivileged classes. We found a high prevalence of depression, anxiety and insomnia among both the privileged and underprivileged Pakistani population and a policy needs to be devised to ensure the mental health of Pakistani population.

Trajectories of Depressive Symptoms, Neurocognitive Function, and Viral Suppression With Antiretroviral Therapy Among Youth With HIV Over 36 months

BACKGROUND

Depression and neurocognitive impairment are highly prevalent among persons living with HIV and associated with poorer clinical outcomes; however, longitudinal studies of depression-neurocognition relationships in youth living with HIV (YLWH), and the role of antiretroviral therapy (ART), are lacking. This study tested whether (1) depressive symptomatology, across somatic, cognitive, and affective symptom domains, improved with ART and (2) more severe depressive symptoms at baseline were associated with poorer neurocognitive function and poorer HIV suppression.

SETTING

Data were collected from 181 YLWH (18-24 years) who were treatment-naive, a subset of whom (n = 116) initiated ART.

METHODS

Participants were categorized into elevated (DS) or nonelevated (non-DS) depressive symptom groups at entry (Beck Depression Inventory-II ≥14) and followed for 36 months. Neurocognition (5-domain battery) and depressive symptoms were repeatedly assessed. Longitudinal models examined depressive symptomatology, neurocognition, and odds of HIV nonsuppression by group.

RESULTS

Greater improvements in depressive symptoms were observed in the DS group over 36 months [beta = -0.14, (-0.24 to -0.03)], particularly within cognitive and affective domains. Verbal learning performance increased in the DS group [beta = 0.13, (0.01 to 0.24)], whereas psychomotor function improved somewhat in the non-DS group [beta = -0.10, (-0.22 to 0.00)]. Adjusted for ART adherence, odds of HIV nonsuppression did not significantly differ by group [odds ratio = 0.22, (0.04 to 1.23)]; however, greater somatic symptoms at study entry were associated with an increased risk of nonsuppression over time [odds ratio = 2.33 (1.07 to 5.68)].

CONCLUSION

Depressive symptoms were associated with differential neurocognitive trajectories, and somatic depressive symptoms at baseline may predict poorer subsequent HIV suppression. Identifying and treating depressive symptoms at ART initiation may benefit neurocognitive and clinical outcomes in YLWH.

Chronic SSRI treatment reverses HIV-1 protein-mediated synaptodendritic damage

HIV-1 infection affects approximately 37 million individuals, and approximately 50% of seropositive individuals will develop symptoms of clinical depression and/or apathy. Dysfunctions of both serotonergic and dopaminergic neurotransmission have been implicated in the pathogenesis of motivational alterations. The present study evaluated the efficacy of a SSRI (escitalopram) in the HIV-1 transgenic (Tg) rat. Behavioral, neurochemical, and neuroanatomical outcomes with respect to HIV-1 and sex were evaluated to determine the efficacy of chronic escitalopram treatment. Escitalopram treatment restored function in each of the behavioral tasks that were sensitive to HIV-1-induced impairments. Further, escitalopram treatment restored HIV-1-mediated synaptodendritic damage in the nucleus accumbens; treatment with escitalopram significantly increased dendritic proliferation in HIV-1 Tg rats. However, restoration did not consistently occur with the neurochemical analysis in the HIV-1 rat. Taken together, these results suggest a role for SSRI therapies in repairing long-term HIV-1 protein-mediated neuronal damage and restoring function.

Distortions to the passage of time during England's second national lockdown: A role for depression

In attempts to control the spread of the Covid-19 virus, many governments have resorted to imposing national lockdowns on their citizens. Previous research has demonstrated the passage of time becomes distorted for many people during these lockdowns. To date, research has only examined how time was experienced early in initial lockdowns. The current study examined whether distortions to the passage of time were also present later into the global pandemic. An online questionnaire was used to collect passage of time judgments for the day, week and 8 month period since the first UK lockdown. In addition, measures of affect, social satisfaction, task-load, compliance and health status were also recorded. The results show that over 80% of people reported experiencing distortion to the passage of time during the second English lockdown in comparison with normal. Depression, satisfaction with social interaction and shielding status were found to be significant predictors of temporal distortion. A slower passage of time was associated with greater depression, shielding and greater dissatisfaction with social interactions. Feeling like it was longer than 8 months since the UK's first lockdown was associated with greater depression, increased dissatisfaction with social interaction and greater change of life as a result of lockdown. The results suggest that distortions to the passage of time are an enduring feature of lockdown life and that different factors predict temporal experience during different points in lockdown.

[Interleukin 6 and depression in patients affected by Covid-19]

Introducción

El incremento de citocinas centrales resultante de infecciones produce cambios neuronales. La Covid-19 permite estudiar los síntomas depresivos en un estrés sostenido y su relación con mecanismos moleculares.

Objetivos

Valorar la correlación entre niveles de IL-6, IL-1β y TNF-α y sintomatología depresiva. Caracterizar los cuadros depresivos presentes.

Métodos

Estudio observacional. Se incluyeron pacientes ingresados por Covid-19 mayores de 60 años con una determinación de interleucinas. Se utilizó la Escala de depresión geriátrica de Yesavage (GDS), asociándose cada ítem con un neurotransmisor.

Resultados

Se incluyeron 27 pacientes. No encontramos correlación entre los niveles de IL-6 y la puntuación de la escala GDS (rho = 0,204; IC95% −0,192 a 0,543); ni con los niveles de IL-1β (rho = −0,126; IC95% −0,490 a 0,276); ni de TNF-α (rho = −0,033; IC95% −0,416 a 0,360). Tres pacientes (11,1%) presentaron una puntuación compatible con cuadro depresivo. Se asoció a déficit de noradrenalina y serotonina.

Conclusiones

No hallamos correlación entre los niveles de IL-6, IL-1β y TNF-α con la puntuación en la GDS. La sintomatología depresiva presenta características similares a las depresiones vasculares.

Effects of progressive muscle relaxation training on negative emotions and sleep quality in COVID-19 patients: A clinical observational study

This study investigates the effect of progressive muscle relaxation training on negative mood and sleep quality in Coronavirus Pneumonia (COVID-19) patients.COVID-19 is an emerging infectious disease, and there is still uncertainty about when the outbreak will be contained and the effectiveness of treatments. Considering that this disease is highly contagious, patients need to be treated in isolation. This may lead to psychological symptoms such as anxiety and depression, and even sleep problems.This study is a clinical observation study.Participants included 79 COVID-19 patients admitted to a designated hospital for COVID-19 patients in Wuhan from February to March, 2020. Patients were selected and assigned to the control group and the observation group according to their wishes, with 40 and 39 cases in each group, respectively. The control group received routine treatment and nursing, and the observation group received progressive muscle relaxation training, in addition to the routine treatment and nursing. We compared scores of the Pittsburgh Sleep Quality Index Scale (PSQI), the Generalized Anxiety Disorder (GAD-7), and the Patient Health Questionnaire (PHQ-9) before and after the intervention.There was no significant difference in PSQI, GAD-7, and PHQ-9 scores between the control group and the observation group before the intervention (P > .05). After the intervention, the difference in scores of PSQI, GAD-7, and PHQ-9 in the 2 groups were statistically significant (P < .05).Progressive muscle relaxation training can significantly reduce anxiety and depression and improve sleep quality in COVID-19 patients during isolation treatment.Progressive muscle relaxation training was shown to improve the treatment effect of patients and is worthy of clinical promotion.

Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: A systematic review and meta-analysis

This review was done to synthesize the existing evidence on the prevalence of various psychological morbidities among general public, healthcare workers and COVID-19 patients amidst this pandemic situation. Systematic searches were conducted in various databases and search engines such as Medline, Chinese national knowledge infrastructure, Cochrane library, ScienceDirect, and Google Scholar from inception until 22 April 2020. Newcastle Ottawa scale was used to assess the quality of included studies. We carried out a meta-analysis with random-effects model and reported pooled prevalence with 95% confidence intervals (CIs).A total of 50 studies were included in the review. Only seven studies (14%) had low risk of bias. Pooled prevalence rate of psychological morbidities includes poor sleep quality (40%), stress (34%), psychological distress (34%), insomnia (30%), post-traumatic stress symptoms (27%), anxiety (26%), depression (26%). Pooled prevalence rate of psychological morbidities with respect to impact of event due to COVID-19 pandemic was 44% (95%CI-42% to 47%). The burden of these psychological morbidities was highest among the COVID-19 patients followed by healthcare workers and general population.

Perceived psychosocial health and its sociodemographic correlates in times of the COVID-19 pandemic: a community-based online study in China

BACKGROUND

Coronavirus disease 2019 (COVID-19) pandemic has been affecting people's psychosocial health and well-being through various complex pathways. The present study aims to investigate the perceived psychosocial health and its sociodemographic correlates among Chinese community-dwelling residents.

METHODS

This cross-sectional survey was carried out online and using a structured questionnaire during April 2020. In total, 4788 men and women with the age range of 11-98 years from eight provinces in eastern, central and western China were included in the analysis. We adopted a tactical approach to capture three key domains of perceived psychosocial health that are more likely to occur during a pandemic including hopelessness, loneliness, and depression. Multiple regression method, binary logistic regression model and variance inflation factor (VIF) were used to conduct data analysis.

RESULTS

Respectively 34.8%, 32.5% and 44.8% of the participants expressed feeling more hopeless, lonely, and depressed during the pandemic. The percentage of all three indicators was comparatively higher among women than among men: hopelessness (50.7% vs 49.3%), loneliness (52.4% vs 47.6%), and depression (56.2% vs 43.8%). Being married was associated with lower odds of loneliness among men (odds ratio [OR] = 0.63, 95% CI: 0.45-0.90). Loneliness was negatively associated with smoking (OR = 0.67, 95% CI: 0.45-0.99) and positively associated with drinking (OR = 1.45, 95% CI: 1.04-2.02). Compared with those in the lowest income bracket (< CNY 10 000), men (OR = 0.34, 95% CI: 0.21-0.55) and women (OR = 0.36, 95% CI: 0.23-0.56) in the highest level of annually housed income (> CNY 40 000) had the lowest odds of reporting perceived hopelessness (OR = 0.35, 95% CI: 0.25-0.48). Smoking also showed negative association with depression only among men (OR = 0.63, 95% CI: 0.43-0.91).

CONCLUSIONS

More than one-third of the participants reported worsening in the experience of hopelessness and loneliness, with more than two-fifth of worsening depression during the pandemic compared with before the outbreak. Several socioeconomic and lifestyle factors were found to be associated with the outcome variables, most notably participants' marital status, household income, smoking, alcohol drinking, existing chronic conditions. These findings may be of significance to treat patients and help them recover from the pandemic.

Omega-3 fatty acids in the psychological and physiological resilience against COVID-19

As the infected cases of COVID-19 reach more than 20 million with more than 778,000 deaths globally, an increase in psychiatric disorders including anxiety and depression has been reported. Scientists globally have been searching for novel therapies and vaccines to fight against COVID-19. Improving innate immunity has been suggested to block progression of COVID-19 at early stages, while omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been shown to have immunomodulation effects. Moreover, n-3 PUFAs have also been shown to improve mood disorders, thus, future research is warranted to test if n-3 PUFAs may have the potential to improve our immunity to counteract both physical and mental impact of COVID-19.

The mental health of frontline and non-frontline medical workers during the coronavirus disease 2019 (COVID-19) outbreak in China: A case-control study

BACKGROUND AND OBJECTIVE

Coronavirus disease 2019 (COVID-19) is a new infectious disease with high transmissibility and morbidity. It has caused substantial mental distress to medical professionals. We aimed to compare the psychological impact of the COVID-19 outbreak between frontline and non-frontline medical workers in China.

METHODS

This case-control study recruited 1173 frontline and 1173 age- and sex-matched non-frontline medical workers during the COVID-19 outbreak (February 11 to 26, 2020). A set of online questionnaires were used to measure mental problems (i.e., anxiety, insomnia, and depressive symptoms), and help-seeking behavior and treatment for these mental problems.

RESULTS

Frontline medical workers had higher rates of any mental problem (52.6% vs. 34.0%, adjusted OR=1.88, 95% CI=1.57-2.25), anxiety symptoms (15.7% vs. 7.4%, adjusted OR=1.95, 95% CI=1.46-2.61), depressed mood (marginally insignificant; 14.3% vs. 10.1%, adjusted OR=1.32, 95% CI=0.99-1.76) and insomnia (47.8% vs. 29.1%, adjusted OR=1.96, 95% CI=1.63-2.36) than non-frontline medical workers. No significant difference was observed in terms of suicidal ideation (12.0% vs. 9.0%, adjusted OR=1.25, 95% CI=0.92-1.71), help-seeking (4.5% vs. 4.5%, adjusted OR=1.00, 95% CI=0.53-1.87) or treatment (3.4% vs. 2.3%, adjusted OR=1.38, 95% CI=0.54-3.52) for mental problems.

LIMITATIONS

The case-control nature of the data precludes causal inferences, and there is a possibility of bias related to self-reports.

CONCLUSIONS

Frontline medical workers had more mental problems but comparable help-seeking behaviors and treatment for these problems than non-frontline medical workers. These findings highlight the timely mental support and intervention for medical workers, especially for those on the frontline.

Investigation of the psychological status of suspected patients during the Coronavirus disease 2019 epidemic

We explored the psychological changes in suspected patients during the coronavirus disease 2019 (COVID-19) epidemic and obtained evidence for early psychological guidance and intervention in this group. A total of 31 inpatients with suspected COVID-19 were identified at our hospital. The depression module of the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder (GAD)-7 scale, and the Self-Reporting Questionnaire (SRQ-20) mental health self-assessment questionnaire were used to assess depression, anxiety, and overall mental health. Among the patients, 32.3% had symptoms of depression and 19.4% had symptoms of anxiety. Levels of anxiety and fear varied. In comparing the PHQ-9 and 7-item Generalized Anxiety Disorder Scale scores of suspected and confirmed patients, there was no significant difference in the distribution of severity of anxiety or depression in the 2 groups. The PHQ-9 scores indicated mild depression symptoms in 25.8% of suspected patients, moderate symptoms in 0%, and severe symptoms in 6.5%. Overall, 50% of confirmed patients had symptoms, with 30.8% classified as mild, 15.4% classified as moderate, and 3.8% classified as severe. The 7-item Generalized Anxiety Disorder Scale scores in the group of suspected patients showed that 9.7% had mild symptoms, 0% had moderate symptoms, and 9.7% had severe symptoms. In the group of confirmed patients, 38.4% had symptoms (34.6% mild, 0% moderate, and 3.8% severe). Diagnosed patients had more visible symptoms of depression and different total PHQ-9 scores. During the COVID-19 epidemic, suspected and diagnosed patients had different levels of mental health problems. Diagnosed patients had more visible symptoms. The performance of suspected patients was higher, but their mental state was more polarized. It may thus be important to monitor the psychological state of suspected patients as early as possible to enable timely interventions that promote psychological rehabilitation.

Prevalence of depression during the SARS, MERS, and COVID-19 pandemics: A protocol for overview of systematic reviews

BACKGROUND

The outbreak of the novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has emerged to be the biggest global health threat worldwide. COVID-19 marks the emergence of the third large-scale epidemic related to the coronavirus, after SARS-CoV in 2002 and Middle-East respiratory syndrome coronavirus (MERSCoV) in 2012. The pandemic has had a harmful effect on the public mental health, especially on depression. Increasing systematic reviews (SRs) of coronavirus were focusing on depression. However, the methodological quality of these SRs is unclear. Therefore, to evaluate and compare the normativity of report of SR, we conducted a comprehensive overview of depression during the SARS, MERS, and COVID-19 pandemics.

METHODS

Two independent reviewers will conduct comprehensively searches in PubMed, EMBASE.com, Web of Science, the Cochrane Library, Chinese biomedical literature database (CBM), Chinese National Knowledge Infrastructure (CNKI), Wan fang Database, Chongqing VIP (CQVIP). Reference lists of articles, gray literature, and conference proceedings will also be searched. We will extract the data and assess the methodological quality using the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) measurement tool and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. General characteristics of the eligible SRs will be summarized and described. We will provide AMSTAR-2 and PRISMA assessments in tabular form for each review, the total percentage of each item will be calculated. Endnote X8 and EXCEL will be used.

RESULTS

Using the draft search strategy of databases, 8 SRs met the a priori criteria and were included. The overview of SRs will be published in a peer-reviewed journal.

CONCLUSION

Our overview will be a comprehensive synthesis of the existing systemic review on depression with SARS, MERS, and COVID-19.

PROTOCOL REGISTRATION

INPLASY202080003.

Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health

This study sought to identify factors associated with depression, anxiety, and PTSD symptomatology in U.S. young adults (18-30 years) during the COVID-19 pandemic. This cross-sectional online study assessed 898 participants from April 13, 2020 to May 19, 2020, approximately one month after the U.S. declared a state of emergency due to COVID-19 and prior to the initial lifting of restrictions across 50 U.S. states. Respondents reported high levels of depression (43.3%, PHQ-8 scores ≥ 10), high anxiety scores (45.4%, GAD-7 scores ≥ 10), and high levels of PTSD symptoms (31.8%, PCL-C scores ≥ 45). High levels of loneliness, high levels of COVID-19-specific worry, and low distress tolerance were significantly associated with clinical levels of depression, anxiety, and PTSD symptoms. Resilience was associated with low levels of depression and anxiety symptoms but not PTSD. Most respondents had high levels of social support; social support from family, but not from partner or peers, was associated with low levels of depression and PTSD. Compared to Whites, Asian Americans were less likely to report high levels across mental health symptoms, and Hispanic/Latinos were less likely to report high levels of anxiety. These factors provide initial guidance regarding the clinical management for COVID-19-related mental health problems.

Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health

This study sought to identify factors associated with depression, anxiety, and PTSD symptomatology in U.S. young adults (18-30 years) during the COVID-19 pandemic. This cross-sectional online study assessed 898 participants from April 13, 2020 to May 19, 2020, approximately one month after the U.S. declared a state of emergency due to COVID-19 and prior to the initial lifting of restrictions across 50 U.S. states. Respondents reported high levels of depression (43.3%, PHQ-8 scores ≥ 10), high anxiety scores (45.4%, GAD-7 scores ≥ 10), and high levels of PTSD symptoms (31.8%, PCL-C scores ≥ 45). High levels of loneliness, high levels of COVID-19-specific worry, and low distress tolerance were significantly associated with clinical levels of depression, anxiety, and PTSD symptoms. Resilience was associated with low levels of depression and anxiety symptoms but not PTSD. Most respondents had high levels of social support; social support from family, but not from partner or peers, was associated with low levels of depression and PTSD. Compared to Whites, Asian Americans were less likely to report high levels across mental health symptoms, and Hispanic/Latinos were less likely to report high levels of anxiety. These factors provide initial guidance regarding the clinical management for COVID-19-related mental health problems.

The relationship between individual characteristics and HIV-related stigma in adults living with HIV: medical monitoring project, Florida, 2015-2016

BACKGROUND

Human Immunodeficiency Virus (HIV) disproportionately affects the Southern United States, accounting for approximately 46% of people living with HIV. HIV-related stigma is recognized as a barrier to testing, treatment, and prevention efforts. However, little is known about HIV-related stigma experiences in Florida. Using data collected from the Florida Medical Monitoring Project, we sought to examine individual characteristics associated with HIV-related stigma.

METHODS

We analyzed secondary data from the 2015-2016 Medical Monitoring Project in Florida (n = 603). Stigma was measured using the 10-item HIV Stigma Scale. Exploratory factor analysis of the HIV Stigma Scale revealed three subscales: negative self-image, anticipated, and personalized stigma. Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV Stigma Scale.

RESULTS

Multivariate analysis indicated that people with severe depression scores (OR: 3.13; CI: 1.38-7.13) and persons with disability (OR: 1.64; CI: 1.03-2.61) had significantly increased odds of higher overall stigma. In the subscale analyses, negative self-image was significantly associated with alcohol misuse (OR: 2.02; CI: 1.15-3.56) depression (OR: 2.81; CI: 1.38-5.72) and/or those who identify as homosexual (OR: 0.54; CI: 0.31-0.93). Anticipated stigma was significantly associated with people who had mild-moderate depression (OR: 3.03; CI: 1.20-7.65), severe depression (OR: 2.87; CI: 1.38-5.98), identified as Black (OR: 0.60; CI: 0.37-0.98), non-injection drug use (OR: 0.55; CI: 0.33-0.91), and/or people aged 50 years and older (OR: 0.28; CI: 0.09-0.82). Personalized stigma was not associated with any of the variables examined.

CONCLUSIONS

The implications of these findings reveal that certain individuals are more vulnerable to stigma. Researchers could consider distinct stigma interventions strategies based on the characteristics of specific individuals (i.e., targeting depression, disability, sexual orientation, avoidant coping, racial/ethnic groups, and youth) in Florida.

Association between social capital and mental health among older people living with HIV: the Sichuan Older HIV-Infected Cohort Study (SOHICS)

BACKGROUND

Mental health problems are common among older people living with HIV and associated with poorer health outcomes. Social capital is an important determinant of mental health problems but under-studied in this population. This study investigated the association between social capital and mental health problems among older people living with HIV in China.

METHODS

The study was based on the baseline data of a cohort study investigating mental health among older people living with HIV in Sichuan, China during November 2018 to February 2019. Participants were people living with HIV aged ≥50 years living in Sichuan province. Stratified multi-stage cluster sampling was used to recruit participants from 30 communities/towns; 529 out of 556 participants being approached completed the face-to-face interview. Social capital was measured by two validated health-related social capital scales: the Individual and Family scale and the Community and Society scale. Presence of probable depression (CES-D-10 score ≥ 10) and probable anxiety (GAD-7 score ≥ 5) were used as dependent variables. Two-level logistic regression models were applied to examine the association between social capital and probable depression/anxiety.

RESULTS

The prevalence of probable depression and probable anxiety was 25.9% (137/529) and 36.3% (192/529), respectively. After adjusting for significant covariates, the individual/family level of social capital was inversely associated with both probable depression (odds ratios (OR): 0.89, 95% CI: 0.84-0.93, p < 0.001) and probable anxiety (OR: 0.90, 95% CI: 0.86-0.95, p < 0.001). The community/society level social capital was associated with probable depression (OR: 0.91, 95% CI: 0.84-0.99, p < 0.001) but not probable anxiety (p > 0.05).

CONCLUSIONS

Interventions building up social capital should be considered to improve mental health of older people living with HIV. Some useful strategies include cognitive processing therapy, improving community networking and engagement, and promoting social bonding with neighborhood.

Resting-state neural signatures of depressive symptoms in acute HIV

Depressive symptoms are often elevated in acute and chronic HIV. Previous neuroimaging research identifies abnormalities in emotion-related brain regions in depression without HIV, including the anterior cingulate cortex (ACC) and amygdala. However, no studies have examined the neural signatures of depressive symptoms in acute HIV infection (AHI). Seed-based voxelwise resting-state functional connectivity (rsFC) for affective seed regions of interest (pregenual ACC, subgenual ACC [sgACC], bilateral amygdala) was computed for 74 Thai males with AHI and 30 Thai HIV-uninfected controls. Group analyses compared rsFC of ACC and amygdala seed regions between AHI and uninfected control groups. Within the AHI group, voxelwise regression analyses investigated the relationship between depressive symptoms and rsFC for these affective seed regions. Group analyses revealed alterations in rsFC of the amygdala in AHI versus uninfected controls. Depressive symptoms associated with decreased rsFC between ACC regions and posterior cingulate/precuneus, medial temporal, and lateral parietal regions in AHI. Symptoms of depression also correlated to increased rsFC between ACC regions and lateral prefrontal cortex, sgACC, and cerebellum in AHI. Similar to the ACC, depressive symptoms associated with decreased rsFC between amygdala and precuneus. Of blood biomarkers, only HIV RNA inversely correlated with rsFC between posterior sgACC and left uncus. We found that depressive symptoms in AHI associate with altered rsFC of ACC and amygdala regions previously implicated in depression. Longitudinal research in this cohort will be necessary to determine whether these early alterations in rsFC of affective network regions are related to persistent depressive symptoms after combination antiretroviral therapy.

Transcription of human endogenous retroviruses in human brain by RNA-seq analysis

Background

Human endogenous retroviruses (HERV) comprise 8% of the human genome and can be classified into at least 31 families. Increased levels of transcripts from the W and H families of HERV have been observed in association with human diseases, such as multiple sclerosis and schizophrenia. Although HERV transcripts have been detected in many tissues and cell-types based on microarray and PCR studies, the extent of HERV expression in different cell-types and diseases state has been less comprehensively studied.

Results

We examined overall transcription of HERV, and particularly of HERV-W and HERV-H elements in human postmortem brain samples obtained from individuals with psychiatric diagnoses (n = 111) and healthy controls (n = 51) by analyzing publicly available RNA sequencing datasets. Sequence reads were aligned to prototypical sequences representing HERV, downloaded from Repbase. We reported a consistent expression (0.1~0.2% of mappable reads) of different HERV families across three regions of human brains. Spearman correlations revealed highly correlated expression levels between three brain regionsacross 475 consensus sequences. By mapping sequences that aligned to the consensus sequences of HERV-W and HERV-H families to individual loci on chromosome 7, more than 60 loci from each family were identified, part of which are being transcribed. The ERVWE1, locus located at chr7q21.2, exhibited high levels of transcription across the three datasets. Notably, we demonstrated a trend of increased expression of overall HERV, as well as HERV-W family in samples from both schizophrenia and bipolar disorder patients.

Conclusions

The current analyses indicate that RNA sequencing is a useful approach for investigating global expression of repetitive elements, such as HERV, in the human genome. HERV-W/H with the tendency of transcription up-regulation in patients suggests potential implication of HERV-W/H in psychiatric diseases.

Gender disparities in depression severity and coping among people living with HIV/AIDS in Kolkata, India

People living with HIV/AIDS (PLH) experience high rates of depression and related psychosocial risk factors that vary by gender. This study examines gender differences in depression severity among antiretroviral therapy (ART) patients (n = 362) from a large government ART clinic in Kolkata, India. Hypotheses for multiple linear regression models were guided by an integrated gendered stress process model focusing on variables reflecting social status (age, partner status), stressors (stigma), and resources (income, social support). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS); 22% of the sample reached the cutoff for severe depression, 56% moderate, and 13% mild depression. Compared to men, women reported lower income, education (50% no formal education vs. 20% men), availability of emotional and instrumental support, and were less likely to be married or cohabiting (53% women vs. 72% of men). However, more women had partners who were HIV-positive (78% women vs. 46% men). Overall, depression severity was negatively associated with availability of emotional support and self-distraction coping, and positively associated with internalized HIV/AIDS stigma, availability of instrumental support, and behavioral disengagement coping. Interactions for instrumental support by income and partner status by age varied significantly by gender. Analyses stratified by gender indicated that: 1) Frequently seeking instrumental support from others was protective for men at all income levels, but only for high-income women; and 2) having a partner was protective for men as they aged, but not for women. These results suggest that gender disparities in depression severity are created and maintained by women’s lower social status and limited access to resources. The effect of stigma on depression severity did not vary by gender. These findings may inform the tailoring of future interventions to address mental health needs of PLH in India, particularly gender disparities in access to material and social resources for coping with HIV.

Trial Registration: ClinicalTrials.gov registration #NCT02118454, registered April 2014.

HIV and symptoms of depression are independently associated with impaired glucocorticoid signaling

Chronic inflammation caused by HIV infection may lead to deficient glucocorticoid (GC) signaling predisposing people living with HIV to depression and other psychiatric disorders linked to GC resistance. We hypothesized that comorbid HIV and depressive symptoms in women would synergistically associate with deficits in GC signaling. This cross-sectional study used samples obtained from the Women's Interagency HIV Study (WIHS). The Centers for Epidemiological Studies (CES-D) was used to define depression in four groups of women from the Women's Interagency HIV Study (WIHS): 1) HIV-negative, non-depressed (n = 37); 2) HIV-negative, depressed (n = 34); 3) HIV-positive, non-depressed (n = 38); and 4) HIV-positive, depressed (n = 38). To assess changes in GC signaling from peripheral blood mononuclear cells (PBMCs), we examined baseline and dexamethasone (Dex)-stimulated changes in the expression of the GC receptor (GR, gene: Nr3c1) and its negative regulator Fkbp5 via quantitative RT-PCR. GR sensitivity was evaluated in vitro by assessing the Dex inhibition of lipopolysaccharide (LPS)-stimulated IL-6 and TNF-α levels. Depressive symptoms and HIV serostatus were independently associated with elevated baseline expression of Fkbp5 and Nr3c1. Depressive symptoms, but not HIV status, was independently associated with reduced LPS-induced release of IL-6. Counter to predictions, there was no interactive association of depressive symptoms and HIV on any outcome. Comorbid depressive symptoms with HIV infection were associated with a gene expression and cytokine profile similar to that of healthy control women, a finding that may indicate further disruptions in disease adaptation.

Characteristics of the musculoskeletal symptoms observed among survivors of Ebola virus disease in the Postebogui cohort in Guinea

Objective

Previous studies show that arthralgia is the most common symptom experienced by Ebola virus disease (EVD) survivors. Nevertheless, specific analyses of rheumatological sequelea are still lacking.

Methods

The Postebogui study is a prospective, multicentre cohort aiming to evaluate the long-term outcomes of EVD survivors infected during the 2014-15 outbreak in Guinea. Of the 216 participants enrolled in the study in October 2015, 44 patients with arthralgia/myalgia underwent a physical examination by a rheumatologist (the Eborheum cohort). Data were collected using a standardized questionnaire.

Results

In the Eborheum cohort, 61% of patients were female, the median age was 31.1 years, and the median time from Ebola Treatment Centre discharge was 8.8 months. Pain manifestation started after Ebola infection in all but one patient. Patients had mainly both mechanical and inflammatory pain (45%) and low back pain (77%). All patients reported pain in at least one peripheral joint. Pain in large joints was more frequently reported than in small joints (73 vs 41%). Oligo- and polyarticular presentations were similar, with symmetrical pain distribution. Furthermore, 36 patients had at least one painful 18-tender point count, most of whom reported extensive pain (n = 19) and symmetrical distribution (91%). Diagnoses were mainly non-specific musculoskeletal disorders (59%) and mechanical back pain (52%). No polyarthritis was observed. We found a higher percentage of depressed patients compared with the remaining Postebogui group (42 vs 11%; P < 0.001).

Conclusion

Results from the study come from the first complete rheumatological examination of a cohort of EVD survivors, nearly 9 months after Ebola Treatment Centre discharge. Importantly, we found that patients with arthralgia/myalgia included in the Eborheum cohort were more likely to experience depression than survivors not reporting these symptoms, highlighting the impact of pain symptoms among survivors.

Association between depression and enterovirus infection: A nationwide population-based cohort study

Enterovirus (EV) infection is common among children and adolescents. Few studies have investigated the relationship of depression after EV infection. This study explores an association between EV infection and subsequent depression in children and adolescents and assesses the risk of depression after EV infection with central nervous system involvement in a nationwide population-based retrospective cohort.A random sample of 1,000,000 people was derived from Taiwan National Health Insurance Research Database and we identified enrollees less than 18 years with EV infection before 2005 and followed up until December 2009. A total 48,010 cases with EV infection and 48,010 healthy controls matched for sex, age, and residence were obtained. Association between EV infection and depression risk was assessed by Cox proportional hazards models to determine the hazard ratios (HRs) and confidence intervals (CIs). We further stratified EV infection into with central nervous system (CNS) involvement and without and compared with matched cohort.Children and adolescents with EV infection had no elevated risk of depression compared with healthy controls (adjusted HR, aHR = 1.00, 95% CI: 0.83-1.21). However, CNS EV infection was associated with increased risk of depression (aHR = 1.62, 95% CI: 1.02-2.58) in the fully adjusted Cox regression model.To the best of our knowledge, this is the first study investigating depression in children and adolescents with CNS EV infection. The results suggested that children and adolescents with CNS EV infection were a susceptible group for subsequent depressive disorders.

Mind the Gap: Gaps in Antidepressant Treatment, Treatment Adjustments, and Outcomes among Patients in Routine HIV Care in a Multisite U.S. Clinical Cohort

BACKGROUND

Depression affects 20-30% of HIV-infected patients and is associated with worse HIV outcomes. Although effective depression treatment is available, depression is largely untreated or undertreated in this population.

METHODS

We quantified gaps in antidepressant treatment, treatment adjustments, and outcomes among US patients in routine HIV care in the nationally distributed CNICS observational clinical cohort. This cohort combines detailed clinical data with regular, self-reported depressive severity assessments (Patient Health Questionnaire-9, PHQ-9). We considered whether participants with likely depression received antidepressants, whether participants on antidepressants with persistently high depressive symptoms received timely dose adjustments, and whether participants achieved depression remission. We considered a cross-sectional analysis (6,219 participants in care in 2011-2012) and a prospective analysis (2,936 participants newly initiating CNICS care when PHQ-9 screening was active).

RESULTS

The cross-sectional sample was 87% male, 53% Caucasian, 25% African American, and 18% Hispanic; the prospective sample was similar. In both samples, 39-44% had likely depression, with 44-60% of those receiving antidepressants. Of participants receiving antidepressants, 20-26% experienced persistently high depressive symptoms; only a small minority of those received antidepressant dose adjustments. Overall, 35-40% of participants on antidepressants achieved full depression remission. Remission among participants with persistently high depressive symptoms was rare regardless of dose adjustments.

CONCLUSIONS

In this large, diverse cohort of US patients engaged in routine HIV care, we observed large gaps in antidepressant treatment, timely dose adjustment to address persistently high depressive symptoms, and antidepressant treatment outcomes. These results highlight the importance of more effective pharmacologic depression treatment models for HIV-infected patients.

Depression and diagnosis of neurocognitive impairment in HIV-positive patients

Neurocognitive impairment (NCI) is frequently observed in patients infected with human immunodeficiency virus (HIV) and results from the compromise of subcortical brain structures by the virus. The manifestations of NCI range from asymptomatic impairment to dementia. In addition to cognitive impairment resulting from HIV infection, other factors such as depression are associated with the loss of cognitive functions. The aim of this study was to estimate the prevalence of NCI in HIV-positive patients in a city in southern Brazil and to establish possible associations for the prevalence of NCI with HIV-related and other risk factors. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected, and all patients underwent psychiatric and neurocognitive evaluations. The prevalence of NCI among the 392 patients was 54.1% when tracked using the IHDS (International HIV Dementia Scale) and 36.2% when the IHDS was associated with a battery of complementary tests. A bivariate analysis suggested an association of NCI with gender, age, educational level, depression, current CD4 count and lowest CD4 count. The association of NCI with depression remained in the Poisson regression (PR=1.96, 95%CI=1.12-3.42). The prevalence of cognitive impairment in HIV-positive patients estimated in this study is in accordance with international and Brazilian data. Of the factors analyzed, depression showed the greatest evidence of association with neurocognitive loss. Based on our findings, the inclusion of instruments to evaluate depression in our services for patients with HIV and acquired immunodeficiency syndrome (AIDS) is recommended.

Physiological and Psychological Correlates of Sleep in HIV Infection

Insomnia, a common problem associated with HIV disease, is most likely caused by a multitude of factors. This study investigated the correlations between a selected group of physiological and psychological factors and sleep quality in an HIV-infected population. A convenience sample of 79 ethnically diverse HIV-positive adults, ages 24 to 63, completed a number of questionnaires and released their laboratory records for CD4+ cell count and viral load information. Variables significantly related to sleep quality were HIV-related symptoms, total pain, fatigue, depression, state anxiety, and the number of adults in the household. Findings support the need for health care providers to consider factors that contribute to impaired sleep when developing effective care for HIV-infected individuals with sleep disturbance.

Prevalence of depressive symptoms in pregnant and postnatal HIV-positive women in Ukraine: a cross-sectional survey

BACKGROUND

Perinatal depression among HIV-positive women has negative implications for HIV-related and other maternal and infant outcomes. The aim of this study was to investigate the burden and correlates of perinatal depression among HIV-positive women in Ukraine, a lower middle income country with one of the largest HIV-positive populations in Europe.

METHODS

Cross-sectional surveys nested within the Ukraine European Collaborative Study were conducted of HIV-positive women at delivery and between 1 and 12 months postpartum. Depressive symptoms in the previous month were assessed using a self-report screening tool. Other data collected included demographics, antiretroviral therapy (ART)-related self-efficacy, and perceptions of risks/benefits of interventions to prevent mother-to-child transmission (PMTCT). Characteristics of women with and without a positive depression screening test result were compared using Fisher's exact test and χ2 test for categorical variables.

RESULTS

A quarter (27% (49/180) antenatally and 25% (57/228) postnatally) of participants screened positive for depressive symptoms. Antenatal risk factors were living alone (58% (7/12) vs. 25% (42/167) p = 0.02), being somewhat/terribly bothered by ART side effects (40% (17/43) vs. 23% (30/129) not /only slightly bothered, p = 0.05) and having lower ART-related self-efficacy (43% (12/28) vs. 23% (25/110) with higher self-efficacy, p = 0.05). Postnatally, single mothers were more likely to screen positive (44% (20/45) vs. 21% (18/84) of cohabiting and 19% (19/99) of married women, p < 0.01) as were those unsure of the effectiveness of neonatal prophylaxis (40% (20/45) vs. 18% (28/154) sure of effectiveness, p < 0.01), those worried that neonatal prophylaxis could harm the baby (30% (44/146) vs. 14% (10/73) not worried p < 0.01) and those not confident to ask for help with taking ART (48% (11/23) vs. 27% (10/37) fairly confident and 15 % (4/26) confident that they could do this). Of women who reported wanting help for their depressive symptoms, 82% (37/45) postnatally but only 31% (12/39) antenatally were already accessing peer counselling, treatment adherence programmes, support groups or social services.

CONCLUSIONS

A quarter of women screened positive for depression. Results highlight the need for proactive strategies to identify depressive symptoms, and an unmet need for provision of mental health support in the perinatal period for HIV-positive women in Ukraine.

Predictors of depression recovery in HIV-infected individuals managed through measurement-based care in infectious disease clinics

BACKGROUND

Treatment of comorbid chronic disease, such as depression, in people living with HIV/AIDS (PLWHA) increasingly falls to HIV treatment providers. Guidance in who will best respond to depression treatment and which patient-centered symptoms are best to target is limited.

METHODS

Bivariable analyses were used to calculate hazard ratios for associations between baseline demographic, mental health-related, and HIV-related factors on time to first depression remission among PLWHA enrolled in a randomized trial of measurement-based antidepressant management. Time-updated factors also were analyzed at time of antidepressant (AD) initiation/adjustment and 8 weeks post AD initiation/adjustment.

RESULTS

Baseline comorbid depression and anxiety; comorbid depression, anxiety and substance abuse; and generalized anxiety disorder predicted a slower time to first remission. Being on ART but non-adherent, having panic disorder, having a history of a major depressive episode, or having been in HIV care for >10 years prior to study initiation predicted a faster time to first remission. Sleep difficulty or fatigue at the time of AD initiation/adjustment predicted a slower time to remission. In non-remitters at 8 weeks post AD initiation/adjustment, sleep difficulty, anxiety, and fatigue each predicted a slower time to remission.

LIMITATIONS

Remission was determined by PHQ-9 scores, not diagnostic criteria. The results may apply only to depression recovery in this particular model of treatment. We conducted only exploratory analyses to determine magnitude of effects.

CONCLUSIONS

Baseline comorbid anxiety with or without substance abuse predicts slower time to depression remission among PLWHA treated in HIV clinics. Targeting anxiety or fatigue at the time of AD initiation/adjustment or sleep difficulty, anxiety, and fatigue at 8 weeks post AD initiation/adjustment could shorten time to depression remission in this model.

Anxiolytic-like effects after vector-mediated overexpression of neuropeptide Y in the amygdala and hippocampus of mice

Neuropeptide Y (NPY) causes anxiolytic- and antidepressant-like effects after central administration in rodents. These effects could theoretically be utilized in future gene therapy for anxiety and depression using viral vectors for induction of overexpression of NPY in specific brain regions. Using a recombinant adeno-associated viral (rAAV) vector, we addressed this idea by testing effects on anxiolytic- and depression-like behaviours in adult mice after overexpression of NPY transgene in the amygdala and/or hippocampus, two brain regions implicated in emotional behaviours. In the amygdala, injections of rAAV-NPY caused significant anxiolytic-like effect in the open field, elevated plus maze, and light-dark transition tests. In the hippocampus, rAAV-NPY treatment was associated with anxiolytic-like effect only in the elevated plus maze. No additive effect was observed after combined rAAV-NPY injection into both the amygdala and hippocampus where anxiolytic-like effect was found in the elevated plus maze and light-dark transition tests. Antidepressant-like effects were not detected in any of the rAAV-NPY injected groups. Immobility was even increased in the tail suspension and forced swim tests after intra-amygdaloid rAAV-NPY. Taken together, the present data show that rAAV-NPY treatment may confer non-additive anxiolytic-like effect after injection into the amygdala or hippocampus, being most pronounced in the amygdala.

Select neurocognitive impairment in HIV-infected women: associations with HIV viral load, hepatitis C virus, and depression, but not leukocyte telomere length

BACKGROUND

Through implementation of combination antiretroviral therapy (cART) remarkable gains have been achieved in the management of HIV infection; nonetheless, the neurocognitive consequences of infection remain a pivotal concern in the cART era. Research has often employed norm-referenced neuropsychological scores, derived from healthy populations (excluding many seronegative individuals at high risk for HIV infection), to characterize impairments in predominately male HIV-infected populations.

METHODS

Using matched-group methodology, we assessed 81 HIV-seropositive (HIV+) women with established neuropsychological measures validated for detection of HIV-related impairments, as well as additional detailed tests of executive function and decision-making from the Cambridge Neuropsychological Test Automated Battery (CANTAB).

RESULTS

On validated tests, the HIV+ women exhibited impairments that were limited to significantly slower information processing speed when compared with 45 HIV-seronegative (HIV-) women with very similar demographic backgrounds and illness comorbidities. Additionally, select executive impairments in shifting attention (i.e., reversal learning) and in decision-making quality were revealed in HIV+ participants. Modifiers of neurocognition in HIV-infected women included detectable HIV plasma viral load, active hepatitis C virus co-infection, and self-reported depression symptoms. In contrast, leukocyte telomere length (LTL), a marker of cellular aging, did not significantly differ between HIV+ and HIV- women, nor was LTL associated with overall neurocognition in the HIV+ group.

CONCLUSIONS

The findings suggest that well-managed HIV infection may entail a more circumscribed neurocognitive deficit pattern than that reported in many norm-referenced studies, and that common comorbidities make a secondary contribution to HIV-related neurocognitive impairments.

Human immunodeficiency virus-associated depression: contributions of immuno-inflammatory, monoaminergic, neurodegenerative, and neurotrophic pathways

In the era of greatly improved pharmacological treatment of HIV infection through highly active antiretroviral therapy (HAART), HIV patients experience reduced viral loads, reduced opportunistic infections, increased CD4+ T cell count, and greater life expectancy. Although life expectancy is increased, patients often develop neurological disturbances that may persist for long periods, seriously jeopardizing quality of life and adherence to the medication protocols of HAART. For these reasons, HIV-associated neurological disorders have gained importance in both clinical and basic investigations of HIV infection. Depression is the most prevalent neuropsychiatric disorder among people living with HIV. In this review, we discuss how HIV can predispose infected individuals to depression by several interrelated mechanisms. These include inducing chronic elevation of cytokines through activation of microglia and astrocytes; decreasing monoaminergic function; inducing neurotoxicity, especially in dopaminergic neurons; and reducing brain-derived neurotrophic factor. These viral pathways interact with psychosocial factors to create the depressive state. HIV depression has a great impact on quality of life and implementation of antiretroviral therapy, and thus, recognition of these modes of action is significant for understanding HIV neuropathology and for selecting modalities for pharmacologic treatment.

Differential cognitive impairment in HCV coinfected men with controlled HIV compared to HCV monoinfection

BACKGROUND

Individuals infected with both HIV and hepatitis C virus (HCV) have shown impaired performance on different neuropsychological (NP) tests; however, whether coinfected individuals with controlled HIV and minimal liver damage in the era of antiretroviral therapy have impairment is understudied.

METHODS

Nineteen HCV monoinfected, 17 HIV/HCV coinfected, and 17 control male participants were evaluated for depression, attention, executive function, information processing, fine motor speed, and verbal/visual learning/memory. Eleven controls and 14 HIV monoinfected participants with controlled viral load from a previous study were also included for comparison. At time of testing, participants were not using drugs or alcohol and did not have cirrhosis. A global deficit score (GDS) was calculated from 7 domains of NP tests and alterations in specific domains were determined.

RESULTS

HIV/HCV subjects had a higher depression score (11.1 ± 7.5) than controls (5.4 ± 4.1, P = 0.010) and a higher GDS score (0.77 ± 0.47) than HCV (0.46 ± 0.34, P = 0.036), HIV (0.45 ± 0.36, P = 0.008), and controls (0.30 ± 0.29, P = 0.001). Coinfection was associated with worse scores in attention working memory (P =0.007), executive function (P = 0.01), fine motor function (P = 0.011), verbal learning/memory (P < 0.001), and visual learning/memory (P < 0.001) compared to controls. Within the HCV group, viral load was associated with lower attention, executive function, and information processing speed and positively with GDS.

CONCLUSIONS

Coinfection significantly increased the risk of cognitive impairment in subjects with controlled HIV viral loads. In HCV monoinfected but not coinfected subjects, HCV viral load correlated with worsening GDS, suggesting different pathways for NP impairment.

[Increased prevalence of depression in hepatitis C infection patients]

The prevalence of depression is increased in patients with chronic hepatitis C virus (HCV) infection. Several aetiological mechanisms are thought to be involved, e.g. premorbid psychiatric disease, genetic disposition to affective disorders, socio-economic factors, stigmatization and possibly HCV neuroinfection. Evidence to support that former intravenous drug abuse increases the risk of depression is lacking. It is particularly important to diagnose and treat depression in HCV patients as it constitutes a relative contraindication to antiviral treatment and may jeopardize therapeutic outcome.

[Impaired cognitive function in hepatitis C virus infection]

Impaired cognitive function is commonly seen in patients with hepatitis C-virus (HCV). This might be due to a toxic effect of the virus itself or to neuroinflammatory processes with a direct damaging cerebral effect. The symptoms appear in the pre-cirrhotic stage and impair the patient's level of functioning. Therefore, doctors in contact with HCV patients should be up to date on the existing knowledge in the field to be able to inform patients about their cognitive deficits and take them into consideration. It is unknown if the cognitive deficits decline when the virus is eradicated.

Imaging serotonergic transmission with [11C]DASB-PET in depressed and non-depressed patients infected with HIV

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.

Cytomegalovirus is associated with depression and anxiety in older adults

Infection with cytomegalovirus (CMV), a beta-herpesvirus, is common within the population. Although asymptomatic, infection is associated with increased serum concentrations of cytokines such as TNFalpha and IL-6, which are also related to mood and wellbeing. The present study examined whether infection with CMV was associated with mood in a community-based sample of older adults. Blood samples and scores on the General Health Questionnaire were available for 137 participants. Serum was analysed for the presence of CMV-specific IgG and the antibody titre was used as an indirect measure of viral load. The majority of the participants (66%) were CMV-seropositive and seropositive status was not associated with psychological morbidity. However, within the CMV-positive group, individuals with higher CMV-specific antibody titres were more likely to be depressed, anxious, and suffer more overall psychological morbidity. This association could be mediated by the impact of affect-moderating cytokines secreted through the CMV-specific immune response.

Multivitamin supplementation in HIV-positive pregnant women: impact on depression and quality of life in a resource-poor setting

OBJECTIVES

The primary objective of this study was to examine the effect of vitamin supplementation on health-related quality of life and the risk of elevated depressive symptoms comparable to major depressive disorder (MDD) in HIV-positive pregnant women in Dar es Salaam, Tanzania.

METHODS

From April 1995 to July 1997, 1078 HIV-positive pregnant women were enrolled in a randomized controlled trial. We examined the effects of vitamin supplementation on quality of life and the risk of elevated depressive symptoms, assessed longitudinally every 6-12 months.

RESULTS

A substantial prevalence of elevated depressive symptoms (42%) was observed in HIV-positive pregnant women. Multivitamin supplementation (B-complex, C and E) demonstrated a protective effect on depression [relative risk (RR)=0.78; P=0.005] and quality of life [RR=0.72 for social functioning (P=0.001) and vitality (P=0.0001); RR=0.70 for role-physical (P=0.002)]; however, vitamin A showed no effect on these outcomes.

CONCLUSIONS

Multivitamin supplementation (B-complex, C and E) resulted in a reduction in risk of elevated depressive symptoms comparable to MDD and improvement in quality of life in HIV-positive pregnant women in Tanzania.

Neuropsychological function in Greek patients with chronic hepatitis C

BACKGROUND

Research has shown that hepatitis C virus (HCV) infection is associated with subclinical neuropsychological deficits in the absence of hepatic encephalopathy.

METHODS

The current study assessed 32 Greek HCV patients without hepatic encephalopathy using standardized neuropsychological measures and compared them with 20 healthy controls and 29 hepatitis B virus (HBV)-infected patients. Patients and controls did not differ on age, educational level, depression or fatigue severity. Moreover, strict criteria were used to exclude any risk factor for cognitive impairment.

RESULTS

Chronic HCV patients performed significantly worse than healthy controls on verbal learning and memory (P=0.029). However, hepatitis C and hepatitis B patients were similarly impaired in cognitive function, suggesting that the observed abnormalities are not HCV specific. HCV patients' cognitive capacity was further associated with liver disease severity as indicated by fibrosis stage (r=-0.602, P=0.011). In contrast, cognitive decline did not correlate with patients' psychological distress, indicating that biological mechanisms might be implicated in its pathogenesis. Finally, after controlling for age and educational level, cirrhotic and non-cirrhotic patients appeared to be equally impaired.

CONCLUSIONS

In conclusion, this study confirmed previous findings and added further to the existing literature concerning the negative influence of HCV infection on cognition.

Tobacco addiction and HIV infection: toward the implementation of cessation programs. ANRS CO3 Aquitaine Cohort

In treated HIV-infected patients, mortality is now dominated by non-AIDS-related causes in which tobacco smoking is a predominant risk factor. The implementation of tobacco smoking cessation programs is therefore warranted to increase survival but should consider the specificities of this population to be successful. All outpatients consulting in May to June 2004 within the ANRS CO3 Aquitaine Cohort of HIV-infected patients were asked to complete a self-administered questionnaire including questions about tobacco and other drugs consumption, the Fagerström Test for Nicotine Dependence (FTND), a visual scale to estimate motivation to stop smoking and the Center for Epidemiologic Studies Depression (CESD) scale. Among 509 patients included, mean age was 44 years, 74% were men, 19% were infected through injection drug use, and 257 (51%) were regular smokers (at least one cigarette per day). Among them, 60% had a medium or strong nicotine dependence (FTND = 5), 40% were motivated to quit smoking and 70% had already tried at least once. An FTND of 5 or more was more frequently reported in the 146 smokers (62%) with depressive symptoms compared to other smokers (70% versus 48%). Fifty-five regular smokers (23%) were codependent on cannabis and 31 (12%) to alcohol. Overall, only 35 (14%) regular smokers were motivated, non-codependent, without depressive symptoms, and could be proposed a standard tobacco cessation program. Depressive symptoms were highly prevalent in this representative population of HIV-infected patients. To be successful, smoking cessation interventions should be specifically built to take into account depression and codependencies in addition to nicotine dependence and motivation.

Central nervous system as a possible site of HCV replication

There is mounting evidence of HCV neuroinvasion on the clinical and molecular level. It seems that microglia cells, representing a resident CNS macrophages population, are the main target for the virus. It can be also speculated that the macrophages carry HCV to CNS compartment. Nonspecific inflammation and changes in the metabolic pathway of infected cells can play a role in pathogenesis of neurological symptoms which are observed in HCV infected patients.

Methamphetamine Use and HIV Symptom Self-Management

This study describes HIV-related symptoms in a methamphetamine-using sample of 20 men living in southern California. Data were obtained in 2004 and 2005 using a cross-sectional design. Participants were administered the Revised Sign and Symptom Check-List for Persons With HIV Disease and the Addiction Severity Index and were engaged in a semistructured interview. Participants reported using methamphetamine to treat HIV-related depression, fatigue, and neuropathic pain. HIV-related diarrhea seemed to diminish with methamphetamine use, although this was not a motivation for use. These results, although preliminary, suggest that further study of the interplay between methamphetamine use and HIV symptom management is warranted.

Gender differences in use of prayer as a self-care strategy for managing symptoms in African Americans living with HIV/AIDS

The objective of this study was to explore the association of gender to use of prayer as a self-care strategy for managing the HIV-related symptoms of fatigue, nausea, depression, and anxiety among African American men and women who are HIV-seropositive. To accomplish this, data were determined using convenience sampling from a sample of 448 African American men and women from the United States who were participants in a national study on self-care symptom management of HIV/AIDS. Chi-square analyses were used to examine the potential relationships between gender and the use of prayer for managing the four symptoms. The mean age of the sample was 42.69 +/- 7.93 years (range, 20-66). Results showed the following gender differences in the use of prayer as a self-care strategy: fatigue-men 46% (n = 62), women 54% (n = 74); nausea-men 52% (n = 33), women 48% (n = 30); depression-men 55% (n = 90), women 45% (n = 73); and anxiety-men 77% (n = 83), women 87% (n = 73). Chi-square analyses determined that significant differences exist between African American men and women in the frequency of the use of prayer for managing HIV-related fatigue (chi(2) = 14.81, 1 df, p = .000), nausea (chi(2) = 4.10, 1 df, p =.043), and depression (chi(2) = 5.21, 1 df, p = .022). There was no gender difference in the use of prayer to manage anxiety. Prayer was reported as a self-care strategy by over 50% of the respondents for three of the four symptoms and was rated highly efficacious. The authors conclude that the African American men and women differed in their selection of prayer as a self-care strategy for managing HIV-related depression, fatigue, and nausea. A higher proportion of women than men used prayer to manage fatigue, and more men than women reported using prayer to manage nausea and depression.

Barriers to antiretroviral adherence: the importance of depression, abuse, and other traumatic events

Among HIV-infected persons, high-level adherence to antiretroviral medications (>90%-95%) is associated with improved immunologic, virologic, and clinical outcomes, and is necessary to prevent the emergence of viral resistance. This study examines whether lifetime traumatic events including physical and sexual abuse, are associated with antiretroviral nonadherence. We present a cross-sectional analysis of the Coping with HIV/AIDS in the Southeast (CHASE) Study, analyzing data from the enrollment interview and medical records of study subjects. The CHASE Study is a prospective cohort study of consecutively sampled HIV-infected subjects from infectious diseases clinics in five southern states; Alabama, Georgia, Louisiana, North Carolina, and South Carolina. Four hundred seventy-four (78%) of the 611 CHASE study subjects reported being treated with antiretroviral medications at enrollment and are included in this analysis. Nonadherence was defined as the patient's self-report of missing any doses of their antiretroviral medications over the previous 7 days. Among study subjects, 54% reported a history of physical and/or sexual abuse, 91% reported at least one lifetime traumatic event, and 24% reported nonadherence with their antiretrovirals. In multivariable logistic regression analysis, the number of categories of lifetime traumatic events (p = 0.03), the Addiction Severity Index (ASI) alcohol score (p = 0.02), and being uninsured (p = 0.04) were associated with antiretroviral nonadherence. The finding that lifetime traumatic events are associated with antiretroviral nonadherence, particularly among those who have been traumatized in multiple ways, highlights the complex and often persisting manifestations of such trauma and calls for further investigation.

Salivary Cortisol Values in HIV-Positive People

Fatigue is one of the most prevalent and troubling symptoms suffered by people with HIV infection. As part of a pilot study to examine physiological and psychosocial correlates of fatigue, the authors report results from a sample of 40 HIV-positive men and women who collected three saliva samples each over the course of a day. Few in the sample exhibited the normal salivary cortisol slope (a peak in the morning and falling throughout the day). There were four groups (N = 36) based on salivary cortisol plots: a normal downward trend (n = 7), an afternoon peak (n = 15), an afternoon drop (n = 9), and an upward trend (n = 5). The data in each of these groups were then analyzed on the key variables of sex, age, depression, state/trait anxiety, fatigue severity, CD4 count, and HIV viral load; the group that had an upward trend in cortisol values had a tendency toward more depression, more state and trait anxiety, higher fatigue severity, and higher HIV viral load. However, they also trended toward higher CD4 counts than the other three groups. The need to compare additional variables over a period of time is discussed.

Patterns of risk of depressive symptoms among HIV-positive women in the southeastern United States

Depressive symptoms are a common response to HIV disease, and women appear to be at particularly high risk. The authors report results from a cross-sectional analysis of data collected from 280 rural women with HIV/AIDS in the Southeastern United States aimed at identifying risk factors of depressive symptoms. Stress theory provided a framework for identification of potential risk factors. Descriptive statistics, measures of association, and regression analyses were used to systematically identify patterns of risk. The final regression model included 22 factors that accounted for 69% of the variance in depressive symptoms. The majority of variance in depressive symptoms was accounted for by only six variables: the frequency of HIV symptoms, recent experiences of sadness/hopelessness, the availability of social support, and the use of three coping strategies: living positively with HIV, isolation/withdrawal, and denial/avoidance. The results suggest a number of intervention strategies for use with rural women with HIV/AIDS.