Prevalence, Recurrence, and Incidence of Current Depressive Symptoms among People Living with HIV in Ontario, Canada: Results from the Ontario HIV Treatment Network Cohort Study.
BACKGROUND
Current studies of depression among people living with HIV focus on describing its point prevalence. Given the fluctuating nature of depression and its profound impacts on clinical and quality-of-life outcomes, this study aimed to examine the prevalence, recurrence and incidence of current depressive symptoms and its underlying catalysts longitudinally and systematically among these individuals.


METHODS
We conducted a prospective cohort study between October 1, 2007 and December 31, 2012 using longitudinal linked data sources. Current depressive symptoms was identified using the Centre for Epidemiologic Studies Depression Scale or the Kessler Psychological Distress Scale, first at baseline and again during follow-up interviews. Multivariable regressions were used to characterize the three outcomes.


RESULTS
Of the 3,816 HIV-positive participants, the point prevalence of depressive symptoms was estimated at 28%. Of the 957 participants who were identified with depressive symptoms at baseline and who had at least two years of follow-up, 43% had a recurrent episode. The cumulative incidence among 1,745 previously depressive symptoms free participants (at or prior to baseline) was 14%. During the five-year follow-up, our multivariable models showed that participants with greater risk of recurrent cases were more likely to feel worried about their housing situation. Participants at risk of developing incident cases were also likely to be younger, gay or bisexual, and unable to afford housing-related expenses.


CONCLUSIONS
Depressive symptoms are prevalent and likely to recur among people living with HIV. Our results support the direction of Ontario's HIV/AIDS Strategy to 2026, which addresses medical concerns associated with HIV (such as depression) and the social drivers of health in order to enhance the overall well-being of people living with or at risk of HIV. Our findings reinforce the importance of providing effective mental health care and demonstrate the need for long-term support and routine management of depression, particularly for individuals at high risk.
The Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|Ontario HIV Treatment Network, Toronto, Ontario, Canada.
Stephanie K Y
SK
Choi
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Eleanor
E
Boyle
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.|Infant and Child Health Lab, McMaster University, Hamilton, Ontario, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.|CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.|Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada.|Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada.|Centre for Addiction and Mental Health, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.
John
J
Cairney
Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.|University Health Network, Toronto, Ontario, Canada.
Evan J
EJ
Collins
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Sandra
S
Gardner
Ontario HIV Treatment Network, Toronto, Ontario, Canada.
Jean
J
Bacon
Ontario HIV Treatment Network, Toronto, Ontario, Canada.|Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|St. Michael's Hospital, Toronto, Ontario, Canada.
Sean B
SB
Rourke
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D012307:Risk Factors; D055815:Young Adult