mental health AIDS

Winter 2006 Newsletter / Volume 7, Issue 2

HIV Assessment News

Psychiatric Assessment

Uphold, Rane, Reid, and Tomar (2005) interviewed 226 men engaged in medical care and living with HIV in northern Florida or southern Georgia. Using two different methods to define and categorize area of residency – the U.S. Census Bureau classification and the Office of Rural Health Policy’s Rural Urban Commuting Area Codes (RUCAs) – these investigators found that

[r]ural and urban men of various age groups did not differ in socioeconomic factors, travel distance to clinics, use of medications, satisfaction with care, types of severe stressors, and confidentiality concerns. ... [These investigators also] found that rural men as compared to urban men had similar levels of total stress, AIDS-related stress, social support, active coping and avoidance coping, but higher rates of risk for depression[, even after controlling for demographic, clinical, and health-related factors]. Rural men had higher levels of non-AIDS-related stress only when the US Census Bureau’s categorization was used. (p. 355)

More specifically, Uphold and colleagues "found a high rate of risk for major depression (i.e., 38%) in the total sample and an even higher rate (47%) in the rural subgroup, which markedly contrast … with national estimates that 14% of primary care patients are at risk for major depression. ... The high rate ... supports the [recommendation] ... that HIV-infected patients, particularly those living in rural areas, need to be carefully screened for depression and treated if depression is detected" (p. 371).

To explore factors underlying the depression experienced by people living with HIV/AIDS, Australian investigators (Judd et al., 2005) used self-report symptom measures, a short battery of neuropsychological (NP) tests, and a structured clinical interview to evaluate 129 adults receiving HIV medical care. The investigators noted a high rate of depression among study participants, with 34.8% scoring above the cutoff score for depression on the Beck Depression Inventory (BDI) and 27% meeting DSM-IV diagnostic criteria for a current mood disorder. Importantly, Judd and colleagues did not discern depression secondary to, or associated with, the progression of HIV disease in this cohort. "As with medically well cohorts, [the investigators] found depression was associated with higher levels of neuroticism, a past history of psychiatric disorder and aspects of the current psychosocial situation. Family history and illicit drug use were also linked with the presence of depression. Specifically,... [there was] no significant evidence for a distinct subtype of 'organic' [or secondary] depression when [the investigators] tested for correlates between BDI scores and cognitive measures" (p. 830).

Judd and colleagues conclude that "at least for [medically] 'well' people living with HIV/AIDS, there is no distinct subtype of depression and early treatment approaches can be modelled on those used for ... non-HIV groups" (p. 826).

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