Changes in depressive symptoms as AIDS develops. The Multicenter AIDS Cohort Study.
OBJECTIVE
The authors sought to determine whether rates of depressive symptoms change from early- to late-stage HIV-1 infection and to determine the predictors of depressive symptoms as AIDS develops.


METHODS
The data for this study were from 911 HIV-seropositive men-community volunteers from four U.S. cities-who entered the 10-year Multicenter AIDS Cohort Study without a diagnosis of AIDS and subsequently developed AIDS. The subjects underwent semiannual follow-ups during the study period. The outcome measures-overall depressive symptoms, nonsomatic depressive symptoms, syndromal depression, and severe depression-were assessed over the 5 years before and the 2 years after AIDS diagnosis from responses on the Center for Epidemiologic Studies Depression Scale (CES-D Scale).


RESULTS
Depressive symptoms were stable over time from month 60 to month 18 before AIDS developed. However, beginning 12-18 months before AIDS diagnosis, there was a significant rise in all measures of depression, which reached a plateau within 6 months before AIDS developed. At this plateau, there was a 45% increase in mean CES-D Scale scores above baseline. An elevated CES-D Scale score in the earlier stages of infection, a self-report of AIDS-related symptoms (such as rash and lymphadenopathy), concurrent unemployment, cigarette smoking, and limited social supports were consistent predictors of higher rates of depression as AIDS developed.


CONCLUSIONS
There is a dramatic, sustained rise in depressive symptoms as AIDS develops, beginning as early as 18 months before clinical AIDS is diagnosed. Prior depression, HIV-disease-related factors, and psychological stressors contribute to this rise. This robust phenomenon invites further characterization.
Lyketsos
C G
CG
Johns Hopkins University, Baltimore, MD 21287-5371, USA.
Hoover
D R
DR
Guccione
M
M
Dew
M A
MA
Wesch
J E
JE
Bing
E G
EG
Treisman
G J
GJ
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis; D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D018450:Disease Progression; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D010555:Personality Inventory; D011336:Probability; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index