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HIV Med. 2016 Nov;17(10):749-757. doi: 10.1111/hiv.12381.

Simple and practical screening approach to identify HIV-infected individuals with depression or at risk of developing depression.

Author information

1
Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark. lottrodk@rm.dk.
2
Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
3
Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
4
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
5
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
6
Department of Psychiatric Diseases, Odense University Hospital, Odense, Denmark.

Abstract

OBJECTIVES:

Studies have shown that depression and other mental illnesses are under-diagnosed among HIV-infected individuals. The aim of this study was to evaluate the use of mental health history and questionnaire-based screening instruments to identify HIV-infected individuals at risk of depression.

METHODS:

The Beck Depression Inventory II (BDI-II) was used to assess the prevalence and severity of depressive symptoms among HIV-infected individuals attending two out-patient clinics in Denmark. HIV-infected individuals with a BDI-II score ≥ 20 were offered a clinical evaluation by a consultant psychiatrist. The BDI-II score was compared to the outcome of mental health history review, and to results obtained using the European AIDS Clinical Society (EACS) two-item depression screening tool.

RESULTS:

A total of 501 HIV-infected individuals were included in the study. Symptoms of moderate/major depression (BDI-II score ≥ 20) were observed in 111 patients (22%); 65 of these patients consulted a psychiatrist, of whom 71% were diagnosed with a co-existing disorder. The BDI-II score was compared to the outcome of a mental health history review, and to results obtained using the European AIDS Clinical Society (EACS) two-item depression screening tool. The two questions showed a sensitivity and specificity of 95% and 68%, respectively, for diagnosis of current depression or risk of depression. A previous psychiatric history and substance abuse were independently associated with an increased risk of depression.

CONCLUSIONS:

We suggest that the mental health of HIV-infected individuals should be reviewed and a "risk-flag" three-step approach should be used (1) to screen routinely with the two verbal questions suggested by the EACS, (2) to identify whether there is a risk of depression and then screen with the BDI-II, and (3) to identify whether there is still a risk and then perform a full evaluation and obtain an accurate psychiatric diagnosis by a psychiatrist.

KEYWORDS:

HIV; depression; mental health; screening

PMID:
27186956
DOI:
10.1111/hiv.12381
[Indexed for MEDLINE]
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