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Gen Hosp Psychiatry. 2015 Jul-Aug;37(4):277-82. doi: 10.1016/j.genhosppsych.2015.03.021. Epub 2015 Apr 7.

Psychiatric comorbidity in depressed HIV-infected individuals: common and clinically consequential.

Author information

1
Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Electronic address: bgaynes@med.unc.edu.
2
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: jkodonne@email.unc.edu.
3
Center for Health Policy and Inequalities Research, Duke University, Durham, NC. Electronic address: elise.nelson@duke.edu.
4
Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: amy_heine@med.unc.edu.
5
Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL. Electronic address: azinski@uab.edu.
6
Infectious Diseases Clinic, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: malaika_edwards@med.unc.edu.
7
School of Nursing, University of Alabama at Birmingham, Birmingham, AL. Electronic address: tmcg@uab.edu.
8
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL. Electronic address: rmodi@uab.edu.
9
Infectious Diseases Clinic, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: charita_montgomery@med.unc.edu.
10
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: bpence@unc.edu.

Abstract

OBJECTIVE:

To report on the prevalence of psychiatric comorbidity and its association with illness severity in depressed HIV patients.

METHODS:

As part of a multi-site randomized controlled trial of depression treatment for HIV patients, 304 participants meeting criteria for current Major Depressive Disorder (MDD) were assessed for other mood, anxiety and substance use disorders with the Mini-International Neuropsychiatric Interview, a structured psychiatric diagnostic interview. We also assessed baseline adherence, risk, and health measures.

RESULTS:

Complicated depressive illness was common. Only 18% of participants experienced MDD with no comorbid psychiatric diagnoses; 49% had comorbid dysthymia, 62% had ≥1 comorbid anxiety disorder, and 28% had a comorbid substance use disorder. Self-reported antiretroviral adherence did not differ by the presence of psychiatric comorbidity. However, psychiatric comorbidity was associated with worse physical health and functioning: compared to those with MDD alone, individuals with ≥1 comorbidity reported more HIV symptoms (5.1 vs. 4.1, P=.01), and worse mental health-related quality of life on the SF-12 (29 vs. 35, P<.01).

CONCLUSION:

For HIV patients with MDD, chronic depression and psychiatric comorbidity are strikingly common, and this complexity is associated with greater HIV disease severity and worse quality of life. Appreciating this comorbidity can help clinicians better target those at risk of harder-to-treat HIV disease, and underscores the challenge of treating depression in this population.

KEYWORDS:

Depression; HIV; Psychiatric comorbidity; Quality of life

[Indexed for MEDLINE]
Free PMC Article

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