262256 Prevalence of treated and untreated depression in a cohort of HIV+ women: Impact on antiretroviral therapy utilization and HIV disease outcomes

Tuesday, October 30, 2012 : 12:30 PM - 12:45 PM

Judith A. Cook, PhD , Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
Mardge H. Cohen, MD , Women's Equity in Access to Care and Treatment, Boston, MA
Rebecca Schwartz, PhD , SUNY Downstate, Brooklyn, NY
Pamela Steigman, MA , Psychiatry, University of Illinois at Chicago, Chicago, IL
Dennis Grey, BA , Psychiatry, University of Illinois at Chicago, Chicago, IL
Nancy Hessol, MSPH , Department of Clinical Pharmacy & Medicine, Univ of California, San Francisco, San Francisco, CA
Elizabeth T. Golub, PhD, MPH , Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Kathryn Anastos, MD , Medicine, Montefiore Medical Center, Bronx, NY
Dan Merenstein, MD , Department of Family Medicine, Georgetown University School of Medicine, Washington, DC
Joel Milam, PhD , University of Southern California Los Angeles, Los Angeles, CA
Background: The prevalence of depressive disorders (DD) was assessed in a multi-site cohort of Women's Interagency HIV Study (WIHS) HIV+ participants. We hypothesized that: 1) DD prevalence would be higher than among women in the general population; and 2) those with treated DD would be more likely than untreated women to be on highly active antiretroviral therapy (HAART), and have better HIV disease outcomes.

Methods: 889 women were assessed using the World Mental Health Composite International Diagnostic Interview. Prevalence and treatment of major depressive disorder (MDD), dysthymia, and minor depressive disorder (mDD) were calculated and matched to 12-month data regarding HAART utilization, plasma HIV-RNA (>1,000), and CD4 (<200 copies/ml). Logistic regression analysis controlled for age, race/ethnicity, income, and education.

Results: MDD 12-month prevalence was 18%, dysthymia 9% and mDD 2%; all were double the proportions found in the adult female population in the U.S. National Co-morbidity Survey-Replication. DD treatment prevalence was 73%. Those with treated DD were significantly more likely than those with untreated DD to be receiving HAART (O.R.=3.21, C.I.=1.29-8.00); there no relationship with adherence. Those with treated DD were significantly more likely than untreated counterparts to have controlled viral loads (O.R.=0.37, C.I.=0.17-0.82), despite controlling for use of HAART, age, race/ethnicity, education, and income. No relationship between treated DD and CD4 was observed.

Conclusions: Depression is highly prevalent among HIV+ women but many depressed women report receiving treatment. Treated women are more likely to be on HAART and to have controlled viral loads regardless of their use of HAART.

Learning Areas:
Chronic disease management and prevention
Other professions or practice related to public health
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
1. List three types of depressive disorders and describe their prevalence among HIV+ women. 2. Describe the relationship between untreated depressive disorders and the likelihood that HIV+ women are on HAART and adherent to HAART regimens. 3. Compare HIV disease outcomes for women with treated and untreated psychiatric disorders.

Keywords: Epidemiology, Mental Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal of multiple federally funded grants focusing on psychiatric epidemiology, HIV and co-occurring mental and drug use disorders, and randomized controlled trials of behavioral health interventions. Among my scientific interests has been the development of interventions for illness self-management among people with behavioral health disorders.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4223.0: HIV/AIDS and Mental Health