Psychosomatic medicine 2017 05 12() doi 10.1097/PSY.0000000000000488
The prevalence of clinically significant depressive symptoms is 3 times higher in people living with HIV (PLWH) than in the general population. While studies have shown that depression predicts worse course with HIV, few have investigated its relationship with mortality, and none have had a 17-year follow-up period and been conducted entirely during the time since the advent of protease inhibitors.
We followed a diverse sample of HIV positive people (n=177) in the mid-range of illness for a study on stress and coping. Participants were assessed every six months (for 12 years) via blood draw, questionnaires and interview. Depression was measured using the Beck Depression Inventory (BDI-I). The study began in March, 1997 and mortality was assessed in April, 2014.
In the primary analysis depression, analyzed as a continuous variable, significantly predicted all-cause mortality (Hazard Ratio (HR) = 1.038, 95%CI = 1.008 – 1.068). With BDI scores dichotomized, the HR was 2.044 (95%CI = 1.176 – 3.550). Furthermore, this result was moderated by race and educational attainment such that depression only predicted worse survival for non-African Americans and those with a college education or above.
Depression measured during the first year and a half predicted worse survival in a diverse sample of PLWH followed for 17 years after accounting for initial disease status, antiretroviral medications and age. More research is needed to identify psychological risk factors for long-term outcomes in African Americans and those who are not college educated. Interventions targeting depression may improve well-being and potentially also long-term survival in individuals with HIV.