Predictors of depression recovery in HIV-infected individuals managed through measurement-based care in infectious disease clinics

J Affect Disord. 2016 Mar 1;192:153-61. doi: 10.1016/j.jad.2015.12.031. Epub 2015 Dec 22.

Abstract

Background: Treatment of comorbid chronic disease, such as depression, in people living with HIV/AIDS (PLWHA) increasingly falls to HIV treatment providers. Guidance in who will best respond to depression treatment and which patient-centered symptoms are best to target is limited.

Methods: Bivariable analyses were used to calculate hazard ratios for associations between baseline demographic, mental health-related, and HIV-related factors on time to first depression remission among PLWHA enrolled in a randomized trial of measurement-based antidepressant management. Time-updated factors also were analyzed at time of antidepressant (AD) initiation/adjustment and 8 weeks post AD initiation/adjustment.

Results: Baseline comorbid depression and anxiety; comorbid depression, anxiety and substance abuse; and generalized anxiety disorder predicted a slower time to first remission. Being on ART but non-adherent, having panic disorder, having a history of a major depressive episode, or having been in HIV care for >10 years prior to study initiation predicted a faster time to first remission. Sleep difficulty or fatigue at the time of AD initiation/adjustment predicted a slower time to remission. In non-remitters at 8 weeks post AD initiation/adjustment, sleep difficulty, anxiety, and fatigue each predicted a slower time to remission.

Limitations: Remission was determined by PHQ-9 scores, not diagnostic criteria. The results may apply only to depression recovery in this particular model of treatment. We conducted only exploratory analyses to determine magnitude of effects.

Conclusions: Baseline comorbid anxiety with or without substance abuse predicts slower time to depression remission among PLWHA treated in HIV clinics. Targeting anxiety or fatigue at the time of AD initiation/adjustment or sleep difficulty, anxiety, and fatigue at 8 weeks post AD initiation/adjustment could shorten time to depression remission in this model.

Keywords: Depression; Depression treatment; HIV; Measurement-based care; Remission predictors.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Antidepressive Agents / therapeutic use*
  • Antiviral Agents / therapeutic use
  • Anxiety / psychology
  • Anxiety / virology
  • Anxiety Disorders / virology
  • Comorbidity
  • Depression / drug therapy*
  • Depression / virology
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / virology
  • Fatigue / psychology
  • Fatigue / virology
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / psychology*
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Proportional Hazards Models
  • Remission Induction
  • Sleep Initiation and Maintenance Disorders / psychology
  • Sleep Initiation and Maintenance Disorders / virology
  • Substance-Related Disorders / drug therapy
  • Substance-Related Disorders / virology
  • Time Factors
  • Treatment Outcome
  • United States

Substances

  • Antidepressive Agents
  • Antiviral Agents