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BACKGROUND: Depression is a common condition and is particularly concerning in the HIV-infected population as it may have adverse impacts on behavioral risk factors and treatment adherence. The Medical Monitoring Project (MMP) is a surveillance project designed to ascertain the experiences and needs of HIV-infected adults receiving HIV care. The project includes a patient interview and medical record abstraction. The purpose of this analysis is to estimate the prevalence of depression among HIV-infected persons receiving care in Washington State (WA), compare prevalence of depression to the WA general adult population, and compare behavioral risk factors and viral suppression between HIV-infected adults in care with and without depression.
METHODS: Data sources included WA State combined 2009 and 2010 MMP patient interviews and medical record abstractions, and combined 2009 and 2010 Behavioral Risk Factor Surveillance System (BRFSS), a population-based telephone survey of WA State residents 18 years and older. Depression status was defined using the Patient Health Questionnaire (PHQ-8) Depression Scale. Major depression was defined as presence of five or more symptoms during the same 2-week period with at least one being depressed mood or loss of interest or pleasure. Any depression was defined as presence of two or more symptoms during the same 2-week period with one including depressed mood or loss or interest of pleasure. Prevalence ratios (PR) were used to compare differences in prevalence among the two populations. Statistical significance was calculated using two-proportion z tests.
RESULTS: An estimated 13.4% (95% CI: 9.8-17.0%) indicated major depression and 26.6% (95% CI: 21.4-31.9%) indicated any depression. Prevalence of any depression was significantly higher among participants below poverty level compared to participants at or above poverty level (41.0% [30.3-51.7] versus 18.4% [12.8-23.9]). Unadjusted prevalence of any depression was 3.5 times higher among HIV-infected persons compared to WA general population (p<0.01). This disparity was particularly high in those aged 34-44 (PR: 5.5; p< 0.01) and those with a bachelor’s degree or higher (PR: 5.6; p< 0.01). HIV-infected adults with depression were equally as likely to have a suppressed viral load, but 1.8 times more likely to report injection drug use (p=0.02) compared to those without depression.
CONCLUSIONS: While depression does not appear to negatively impact treatment adherence, it is a significant issue among HIV-infected adults in WA. Providers and social service staff should integrate depression services into routine care and service provision. Providers should consider discussing drug use with patients with depression and provide appropriate drug treatment referrals.