02/17/10

DENMARK:  Depression in Patients with HIV Is Under-Diagnosed: A Cross-Sectional Study in Denmark

According to international studies, 20-37 percent of HIV-positive patients have diagnosable depression; however, this may be an underestimate. In the setting of an outpatient clinic in Denmark, investigators in the current study set out to determine the prevalence of depression among patients with HIV and to identify important factors for the development of depression.

In 2005, 205 HIV-positive patients were included in the questionnaire-based study. Prevalence and severity of depressive symptoms were assessed using the Beck Depression Inventory II (BDI-II). Persons scoring 20 or higher on the inventory were offered a clinical evaluation by a consultant psychiatrist.

The researchers observed symptoms of depression (BDI greater than 14) in 77 patients (38 percent), while 53 (26 percent) showed symptoms of major depression (BDI of 20 or greater). Subsequently, 18 patients began treatment with antidepressants. A reduced logistic regression model showed "self-reported stress, loneliness, constant thoughts about HIV, and being in a difficult financial situation were associated with risk of depression."

In addition, those patients at risk of major depression were almost six times more likely to have missed at least one dose of highly active antiretroviral therapy (HAART) in the four days preceding the assessment (odds ratio 5.7, 95 percent confidence interval 1.7-18.6). The authors noted a dose-response trend in relation to unsafe sex (P=0.03).

"The study found that depression was under-diagnosed among HIV-positive patients and was associated with stress, loneliness, a difficult financial situation, low adherence, and unsafe sex," the authors concluded. "Screening for depression should be conducted regularly to provide full evaluation and relevant psychiatric treatment. This is particularly important at the time of diagnosis and before initiating HAART."

Source: HIV Medicine Vol. 11; No. 1: P. 46-53 (01..10):: L. Rodkjaer; T. Laursen; N. Balle; M. Sodemann; Courtesy of the CDC National Center for HIV, STD, and TB Prevention