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Aging Ment Health. 2018 Feb 9:1-8. doi: 10.1080/13607863.2017.1423037. [Epub ahead of print]

Optimal metrics for identifying long term patterns of depression in older HIV-infected and HIV-uninfected men who have sex with men.

Author information

1
a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
2
b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
3
c Departments of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
4
d Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
5
e Cousins Center For Psychoneuroimmunology, UCLA Semel Institute For Neuroscience and Department of Psychiatry and Biobehavioral Sciences , UCLA David Geffen School of Medicine , Los Angeles , CA , USA.
6
f Departments of Psychiatry and Behavioral Sciences and Medicine: Infectious Diseases , Feinberg School of Medicine , Chicago , IL , USA.
7
g Department of Behavioral and Community Health , University of Pittsburgh Medical Center , Pittsburgh , PA , USA.
8
h Department of Ophthalmology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.

Abstract

OBJECTIVES:

Center of Epidemiologic Studies-Depression Scale (CES-D) provides a snapshot of symptom severity at a single point in time. However, the best way of using CES-D to classify long-term depression is unclear.

METHOD:

To identify long-term depression among HIV-infected and HIV-uninfected 50+ year-old men who have sex with men (MSM) with at least 5 years of follow-up, we compared sensitivities and specificities of CES-D-based metrics (baseline CES-D; four consecutive CES-Ds; group-based trajectory models) thresholded at 16 and 20 to a clinician's evaluation of depression phenotype based on all available data including CES-D history, depression treatment history, drug use history, HIV disease factors, and demographic characteristics.

RESULTS:

A positive depressive phenotype prevalence was common among HIV-infected (prevalence = 33.1%) and HIV-uninfected MSM (prevalence = 23.2%). Compared to the depressive phenotype, trajectory models of CES-D≥20 provided highest specificities among HIV-infected (specificity = 99.9%, 95% Confidence Interval [CI]:99.4%-100.0%) and HIV-uninfected MSM (specificity = 99.0%, 95% CI:97.4%-99.7%). Highest sensitivities resulted from classifying baseline CES-D ≥ 16 among HIV-infected MSM (sensitivity = 75.0%, 95% CI:67.3%-81.7%) and four consecutive CES-Ds ≥ 16 among HIV-uninfected MSM (sensitivity = 81.0%, 95% CI:73.7%-87.0%).

CONCLUSION:

Choice of method should vary, depending on importance of false positive or negative rate for long-term depression in HIV-infected and HIV-uninfected MSM.

KEYWORDS:

Depression; HIV infection; sensitivity; specificity; validity

PMID:
29424569
PMCID:
PMC6085148
[Available on 2019-08-09]
DOI:
10.1080/13607863.2017.1423037

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