Two-year prospective study of major depressive disorder in HIV-infected men.
OBJECTIVE
The risks and factors contributing to major depressive episodes in HIV infection remain unclear. This 2-year prospective study compared cumulative rates and predictors of a major depressive episode in HIV-infected (HIV+) men (N=297) and uninfected (HIV-) risk-group controls (N=90).


METHODS
By design participants at entry were without current major depression, substance dependence or major anxiety disorder. Standardized neuromedical, neuropsychological, neuroimaging, life events, and psychiatric assessments (Structured Clinical Interview for DSM III-R) were conducted semi-annually for those with AIDS, and annually for all others.


RESULTS
Lifetime prevalence of major depression or other psychiatric disorder did not differ at baseline between HIV+ men and controls. On a two-year follow-up those with symptomatic HIV disease were significantly more likely to experience a major depressive episode than were asymptomatic HIV+ individuals and HIV-controls (p<0.05). Episodes were as likely to be first onset as recurrent depression. After baseline disease stage and medical variables associated with HIV infection were controlled, a lifetime history of major depression, or of lifetime psychiatric comorbidity (two or more psychiatric disorders), predicted subsequent major depressive episode (p<0.05). Neither HIV disease progression during follow-up, nor the baseline presence of neurocognitive impairment, clinical brain imaging abnormality, or marked life adversity predicted a later major depressive episode.


CONCLUSIONS
Research cohort of men examined before era of widespread use of advanced anti-HIV therapies.


CONCLUSIONS
Symptomatic HIV disease, but not HIV infection itself, increases intermediate-term risk of major depression. Prior psychiatric history most strongly predicted future vulnerability.
Atkinson
J Hampton
JH
Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, California 92093, USA. jhatkinson@ucsd.edu
Heaton
Robert K
RK
Patterson
Thomas L
TL
Wolfson
Tanya
T
Deutsch
Reena
R
Brown
Stephen J
SJ
Summers
J
J
Sciolla
A
A
Gutierrez
R
R
Ellis
Ronald J
RJ
Abramson
Ian
I
Hesselink
John R
JR
McCutchan
J Allen
JA
Grant
Igor
I
D000328:Adult; D001921:Brain / Q000033:anatomy & histology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D008016:Life Change Events; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors