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. 2016 Aug 11;11(8):e0160738.
doi: 10.1371/journal.pone.0160738. eCollection 2016.

Disparities in Depressive Symptoms and Antidepressant Treatment by Gender and Race/Ethnicity Among People Living With HIV in the United States

Free PMC article

Disparities in Depressive Symptoms and Antidepressant Treatment by Gender and Race/Ethnicity Among People Living With HIV in the United States

Angela M Bengtson et al. PLoS One. .
Free PMC article


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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.


Fig 1
Fig 1. The depression treatment cascade for HIV-infected adults.
Fig 2
Fig 2
The cumulative probability of moving through the depression treatment cascade, by (A) gender and (B) race/ethnicity. The cumulative probability of experiencing each depression-related event is defined as the probability of experiencing an event, multiplied by the probability of experiencing each previous event on the depression treatment cascade.
Fig 3
Fig 3
Antidepressant (AD) use and depressive severity, stratified by person-time and (A) gender and (B) race/ethnicity.

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