Over a 2-year period (on average), Cysique et al. (2007) monitored 227 gay or bisexual men living with HIV who did not meet criteria for the diagnosis of a current major depressive episode (MDE) at baseline.
Participants received repeated NP [neuropsychological] assessments, as well as structured psychiatric interviews[,] to ascertain presence or absence of both lifetime MDD [major depressive disorder] and current MDE. Ninety-eight participants had a lifetime history of MDD, and 23 participants met criteria for incident MDE at one of their follow-up evaluations. Groups with and without lifetime MDD and/or incident MDE had comparable demographics, HIV disease status and treatment histories at baseline, and numbers of intervening assessments between baseline and the final follow-up. Lifetime MDD was associated with greater complaints of cognitive difficulties in everyday life, and such complaints were increased at the times of incident MDE. However, detailed group comparisons revealed no NP performance differences in association with either lifetime or incident major depression. Finally, NP data from consistently nondepressed participants were used to develop "norms for change[,]" and these findings failed to show any increased rates of NP worsening among individuals with incident MDE. (p. 1)
According to Cysique and colleagues, these longitudinal findings
are generally consistent with previously reported cross-sectional evidence that (1) MDD is not responsible for the substantially increased rates of NP impairment that are seen in HIV-infected populations and (2) MDD is not usually a significant confound[ing factor] in interpreting NP results of individual patients with HIV infection. ... Although MDD does not appear to significantly impair NP performance of HIV-infected persons, the current longitudinal findings support prior cross-sectional evidence that depressed mood often is associated with increased rates of cognitive complaints. This finding is important because self-reports of difficulties with cognition in everyday functioning may be used to help diagnose HIV-associated neurocognitive disorders[.] ... [These] findings strongly suggest that self-reports of impaired functioning should not be accepted uncritically in HIV-infected persons with significantly depressed mood. Although such reports by depressed patients may have some validity ..., they should be confirmed by independent informants and/or objective tests of instrumental activities of daily living ..., as well as by formal NP testing. (p. 8)3
Over a 2-year period, van Gorp et al. (2007) monitored 118 adults living with HIV to identify barriers and facilitators to the process of returning to work. During that time, 52% of study participants were able to obtain employment. Among the many measures utilized in this study, the investigators found that the California Verbal Learning Test (CVLT)
stood out as a robust predictor of finding employment. In fact, this study found that the likelihood of finding employment doubled from the lowest to the highest score on the CVLT obtained at baseline, with those attaining the highest score on the CVLT having a greater than 70% chance of finding work. Thus effortful learning and memory ability seems a key variable in predicting success in returning to work – even over IQ, health measures and other variables including entitlements, perhaps because the CVLT involves many components[,] including it being an effortful task, utilizing clustering as an effective strategy, and utilizing working memory as well. The unique combination of cognitive processes embodied in the CVLT seems to tap a construct that seems uniquely tied to success in returning to work, at least in this cohort. Motor speed was also a significant, but less consistent, predictor of those who found work during the study period. These variables, therefore, are obviously key to examine in any formal assessment of HIV+ persons.
Barriers to work include (not surprisingly) being older, having an AIDS diagnosis ..., and duration of unemployment. [Alt]hough clinicians cannot do much to alter the first two variables, they can perhaps encourage those who stop work in the context of illness to seek to return as soon as it is feasible to reduce as much as possible this duration of unemployment. The longer the individual is out of work, the lower the odds he or she will successfully find employment later.
In addition, ... providers may be too quick to recommend going on disability when their patients express concerns about working. They need to be aware that workplace re-entry after a period of unemployment is not easily accomplished. Seeking workplace accommodations for health reasons while maintaining some level of employment may be one option with fewer long-term costs.
People who do return to work report less depression following their employment. Although some depressive symptoms do not seem to pose a significant barrier to returning to work (at least in the absence of significant clinical depression), success in finding work does appear to significantly improve mood. Not surprisingly, HIV+ individuals who do return to work report improved mood and quality of life. (p. 87)
Overall, van Gorp and colleagues conclude that "[t]argeted efforts to lessen duration of unemployment, and other approaches (e.g., cognitive rehabilitation) to improve learning and motor function may optimize chances of successful re-entry to the workforce for those seeking to return to work in the context of HIV infection" (p. 88).
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Spring 2007 Newsletter / Volume 8, Issue 3
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