title: Disparities in Depressive Symptoms and Antidepressant Treatment by Gender and Race/Ethnicity among People Living with HIV in the United States.
abstract: OBJECTIVE
  To describe disparities along the depression treatment cascade, from indication for antidepressant treatment to effective treatment, in HIV-infected individuals by gender and race/ethnicity.
  
  
  METHODS
  The Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) cohort includes 31,000 HIV-infected adults in routine clinical care at 8 sites. Individuals were included in the analysis if they had a depressive symptoms measure within one month of establishing HIV care at a CNICS site. Depressive symptoms were measured using the validated Patient Health Questionnaire-9 (PHQ-9). Indication for antidepressant treatment was defined as PHQ-9 ≥ 10 or a current antidepressant prescription. Antidepressant treatment was defined as a current antidepressant prescription. Evidence-based antidepressant treatment was considered treatment changes based on a person's most recent PHQ-9, in accordance with clinical guidelines. We calculated the cumulative probability of moving through the depression treatment cascade within 24 months of entering CNICS HIV care. We used multivariable Cox proportional hazards models to estimate associations between gender, race/ethnicity, and a range of depression outcomes.
  
  
  RESULTS
  In our cohort of HIV-infected adults in routine care, 47% had an indication for antidepressant treatment. Significant drop-offs along the depression treatment cascade were seen for the entire study sample. However, important disparities existed. Women were more likely to have an indication for antidepressant treatment (HR 1.54; 95% CI 1.34, 1.78), receive antidepressant treatment (HR 2.03; 95% CI 1.53, 2.69) and receive evidence-based antidepressant treatment (HR 1.67; 95% CI 1.03, 2.74), even after accounting for race/ethnicity. Black non-Hispanics (HR 0.47, 95% CI 0.35, 0.65), Hispanics (HR 0.63, 95% CI 0.44, 0.89) and other race/ethnicities (HR 0.35, 95% CI 0.17, 0.73) were less likely to initiate antidepressant treatment, compared to white non-Hispanics.
  
  
  CONCLUSIONS
  In our cohort of HIV-infected adults depressive symptoms were common. Important disparities in the prevalence of depressive symptoms and receipt of antidepressant treatment existed by gender and race/ethnicity.
authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors: Angela M
authors: AM
authors: Bengtson
authors: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors: Brian W
authors: BW
authors: Pence
authors: Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America.
authors: Heidi M
authors: HM
authors: Crane
authors: HIV/AIDS Division, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America.
authors: Katerina
authors: K
authors: Christopoulos
authors: Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America.
authors: Rob J
authors: RJ
authors: Fredericksen
authors: Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors: Bradley N
authors: BN
authors: Gaynes
authors: Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors: Amy
authors: A
authors: Heine
authors: Department of Medicine, School of Medicine, University of California San Diego, San Diego, California, United States of America.
authors: W Christopher
authors: WC
authors: Mathews
authors: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors: Richard
authors: R
authors: Moore
authors: Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors: Sonia
authors: S
authors: Napravnik
authors: Department of Psychology, University of Miami, Miami, Florida, United States of America.
authors: Steven
authors: S
authors: Safren
authors: Department of Medicine and UAB Center for AIDS Research, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors: Michael J
authors: MJ
authors: Mugavero
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D015497:HIV-1 / Q000187:drug effects; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D044469:Racial Groups; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000928:Antidepressive Agents