Background: Mental health has been highlighted as a current priority area in HIV care, but there have been few large studies of mental health issues among UK HIV patients.
Methods: We used a validated diagnostic questionnaire to assess the prevalence of depression, and its association with virological status, in ASTRA (Antiretrovirals, Sexual Transmission Risk and Attitudes), a multicentre UK study of over 3000 HIV outpatients in 2011/12. The ‘PHQ-9’ symptom questions classiﬁed participants according to (i)presence/absence of ‘depres- sive disorder’ and (ii)’depression symptom score’ (none; minimal; mild; moderate; severe). Participants also reported any current (medical or other) treatment for depression. ART non-adherence was deﬁned as ‡1 missed dose in the past 2 weeks. Latest viral load (VL) at questionnaire completion was recorded from clinic databases. Associations were assessed using Chi-squared tests and logistic regression.
Results: Data are presented for the ﬁrst 1227 participants [18% women; 73% MSM; 9% heterosexual men]. Mean age was 45.3 years. Ethnic classiﬁcation was:70% white; 17% Black African; 13% other ethnicity. 925 patients (75.4%) were currently on ART for ‡3 months, of whom 9.5% had latest VL>50c/mL. Overall, the prevalence of depressive disorder was 22.2% (273/ 1227) and did not vary by risk group, age, ethnicity, or ART use(p>0.2). Among the 925 patients on ART, the prevalence of VL>50c/mL was much higher among those with depressive disorder compared to those without [16.3% (34/ 209) vs 7.5% (54/716), p<0.001]. Prevalence of VL>50c/mL rose with increasing depression symptom score [5.7%; 6.0%; 11.7%; 12.0%; 21.7% for 5 categories from none to severe, p<0.001 for trend]. The association of depressive disorder with VL>50c/mL persisted after adjustment for non- adherence [odds ratios(95% CI):2.4(1.5, 3.8) and 2.3(1.4, 3.6) for unadjusted and adjusted respectively]. Of all 273 patients with depressive disorder, 120 (44.0%) were receiving treatment for depression. A further 140 patients were being treated for depression with no depressive disorder symptoms [total treated or symptoms:413/1227 (33.7%)].
Conclusions: One in three UK HIV outpatients were either receiving treatment for depression or had symptoms of depressive disorder. Among ART-treated patients, depressive symptoms were strongly and consistently associated with non-suppression of VL, emphasising the importance of identiﬁcation and management of depression in HIV clinical care
|Number of pages||1|
|Publication status||Published - 20 Apr 2012|