Depressed mood and care preferences in patients with AIDS.
Eight hundred ninety-seven patients with AIDS seen in ambulatory settings were questioned about whether they would accept a nursing home or a respirator if necessary to prolong their lives. Two hundred ninety-one (32.9%) said they would accept a nursing home; 102 (11.5%) said they would accept a respirator. Acceptability of these life-sustaining interventions was significantly lower in those patients who showed evidence of clinical depression on a structural screening instrument (nursing home: 29.4% vs 39.5%, p = 0.002; respirator: 9.4% vs 14.3%, p = 0.032). Depression remained significant in multivariate models of care preferences that controlled for demographics and symptom severity. Based upon follow-up interviews conducted an average of 11 months later, subjects who were initially depressed and found nursing home care unacceptable were significantly more likely to have changed their minds at follow-up if their depression was no longer present (45.7% vs 28.4%; p = 0.0005). Findings for respirator preferences were similar, but did not attain significance. We conclude that assessment for depression is essential when advance directives for care are elicited from patients with AIDS.
Fogel
B S
BS
Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island 02912.
Mor
V
V
D000163:Acquired Immunodeficiency Syndrome / Q000523:psychology*; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001293:Attitude to Death; D003863:Depression / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010342:Patient Acceptance of Health Care; D012803:Sick Role; D013727:Terminal Care / Q000523:psychology; D012122:Ventilators, Mechanical