title: Simple and practical screening approach to identify HIV-infected individuals with depression or at risk of developing depression.
abstract: Studies have shown that depression and other mental illnesses are under-diagnosed among HIV-infected individuals. The aim of this study was to evaluate the use of mental health history and questionnaire-based screening instruments to identify HIV-infected individuals at risk of depression.
  
  
  
  The Beck Depression Inventory II (BDI-II) was used to assess the prevalence and severity of depressive symptoms among HIV-infected individuals attending two out-patient clinics in Denmark. HIV-infected individuals with a BDI-II score ≥ 20 were offered a clinical evaluation by a consultant psychiatrist. The BDI-II score was compared to the outcome of mental health history review, and to results obtained using the European AIDS Clinical Society (EACS) two-item depression screening tool.
  
  
  
  A total of 501 HIV-infected individuals were included in the study. Symptoms of moderate/major depression (BDI-II score ≥ 20) were observed in 111 patients (22%); 65 of these patients consulted a psychiatrist, of whom 71% were diagnosed with a co-existing disorder. The BDI-II score was compared to the outcome of a mental health history review, and to results obtained using the European AIDS Clinical Society (EACS) two-item depression screening tool. The two questions showed a sensitivity and specificity of 95% and 68%, respectively, for diagnosis of current depression or risk of depression. A previous psychiatric history and substance abuse were independently associated with an increased risk of depression.
  
  
  
  We suggest that the mental health of HIV-infected individuals should be reviewed and a "risk-flag" three-step approach should be used (1) to screen routinely with the two verbal questions suggested by the EACS, (2) to identify whether there is a risk of depression and then screen with the BDI-II, and (3) to identify whether there is still a risk and then perform a full evaluation and obtain an accurate psychiatric diagnosis by a psychiatrist.
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark. lottrodk@rm.dk.
authors.forename: L
authors.initials: L
authors.lastname: Rodkjaer
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Gabel
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Laursen
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Slot
authors.affiliation: Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Leutscher
authors.affiliation: The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: N
authors.initials: N
authors.lastname: Christensen
authors.affiliation: Department of Psychiatric Diseases, Odense University Hospital, Odense, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Holmskov
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Sodemann
mesh_terms: D000293:Adolescent; D000328:Adult; D003718:Denmark; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010045:Outpatients; D015995:Prevalence; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: HIV; depression; mental health; screening