title: Psychiatric comorbidity in depressed HIV-infected individuals: common and clinically consequential.
abstract: OBJECTIVE
  To report on the prevalence of psychiatric comorbidity and its association with illness severity in depressed HIV patients.
  
  
  METHODS
  As part of a multi-site randomized controlled trial of depression treatment for HIV patients, 304 participants meeting criteria for current Major Depressive Disorder (MDD) were assessed for other mood, anxiety and substance use disorders with the Mini-International Neuropsychiatric Interview, a structured psychiatric diagnostic interview. We also assessed baseline adherence, risk, and health measures.
  
  
  RESULTS
  Complicated depressive illness was common. Only 18% of participants experienced MDD with no comorbid psychiatric diagnoses; 49% had comorbid dysthymia, 62% had ≥1 comorbid anxiety disorder, and 28% had a comorbid substance use disorder. Self-reported antiretroviral adherence did not differ by the presence of psychiatric comorbidity. However, psychiatric comorbidity was associated with worse physical health and functioning: compared to those with MDD alone, individuals with ≥1 comorbidity reported more HIV symptoms (5.1 vs. 4.1, P=.01), and worse mental health-related quality of life on the SF-12 (29 vs. 35, P<.01).
  
  
  CONCLUSIONS
  For HIV patients with MDD, chronic depression and psychiatric comorbidity are strikingly common, and this complexity is associated with greater HIV disease severity and worse quality of life. Appreciating this comorbidity can help clinicians better target those at risk of harder-to-treat HIV disease, and underscores the challenge of treating depression in this population.
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Electronic address: bgaynes@med.unc.edu.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: jkodonne@email.unc.edu.
authors.forename: Julie
authors.initials: J
authors.lastname: O'Donnell
authors.affiliation: Center for Health Policy and Inequalities Research, Duke University, Durham, NC. Electronic address: elise.nelson@duke.edu.
authors.forename: Elise
authors.initials: E
authors.lastname: Nelson
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: amy_heine@med.unc.edu.
authors.forename: Amy
authors.initials: A
authors.lastname: Heine
authors.affiliation: Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL. Electronic address: azinski@uab.edu.
authors.forename: Anne
authors.initials: A
authors.lastname: Zinski
authors.affiliation: Infectious Diseases Clinic, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: malaika_edwards@med.unc.edu.
authors.forename: Malaika
authors.initials: M
authors.lastname: Edwards
authors.affiliation: School of Nursing, University of Alabama at Birmingham, Birmingham, AL. Electronic address: tmcg@uab.edu.
authors.forename: Teena
authors.initials: T
authors.lastname: McGuinness
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL. Electronic address: rmodi@uab.edu.
authors.forename: Modi A
authors.initials: MA
authors.lastname: Riddhi
authors.affiliation: Infectious Diseases Clinic, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: charita_montgomery@med.unc.edu.
authors.forename: Charita
authors.initials: C
authors.lastname: Montgomery
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: bpence@unc.edu.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D019263:Dysthymic Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents
keywords: Depression; HIV; Psychiatric comorbidity; Quality of life