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Clinical importance of HIV and depressive symptoms among veterans with HIV infection

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Abstract

OBJECTIVE: To compare the clinical importance (association with illness severity and survival) of depressive and HIV symptoms among veterans with HIV infection.

DESIGN: Cross-sectional study; survival analysis.

SETTING: Infectious Disease Clinics at 3 VA Medical Centers.

PARTICIPANTS: HIV-infected patients (N=881) and their health care providers from June 1999 through July 2000.

MEASUREMENTS AND MAIN RESULTS: Depressive symptoms were assessed using the 10-item Centers for Epidemiologic Studies Depression Scale (CES-D). Patient baseline survey included an HIV Symptom Index measuring the frequency and bother of 20 common symptoms. Providers were surveyed on patients’ illness severity, and survival data were obtained from VA death records. Of 881 patients, 46% had significant depressive symptoms (CES-D ≥10). Increasing depression symptom severity was associated with increasing HIV symptom frequency (P<.001) and bother (P<.001). Multiple regression results revealed that having moderate or severe depressive symptoms was not associated with provider-reported illness severity or survival. However, HIV symptoms were significantly associated with provider-reported illness severity (P<.01) and survival (P=.05), after adjusting for moderate and severe depressive symptoms, CD4 cell count/mm3, viral load, age, race, and antiretroviral use.

CONCLUSIONS: Depression, while common in this sample, was not associated with illness severity or mortality after adjusting for HIV symptoms. HIV symptoms are associated with severity of illness and survival regardless of patients’ severity of depressive symptoms. This suggests that equal medical consideration should be given to HIV symptoms presented by HIV-infected patients regardless of their depression status, rather than automatically attributing medical complaints to depression.

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Author information

Authors and Affiliations

  1. the VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, Pa

    Amy M. Kilbourne PhD, MPH, Amy C. Justice MD, PhD, Kathleen A. McGinnis MS & Susan Smola MBA

  2. School of Medicine, Division of General Internal Medicine, the University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pa

    Amy M. Kilbourne PhD, MPH, Amy C. Justice MD, PhD & Bruce L. Rollman MD, MPH

  3. the University of Pittsburgh Center for Social and Urban Research, Pittsburgh, Pa

    Richard Schultz PhD

  4. Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada

    Linda Rabeneck MD, MPH

  5. the Department of Medicine, Baylor College of Medicine, Houston, Tex

    Maria Rodriguez-Barradas MD

  6. the VA Medical Center, Houston, Tex

    Maria Rodriguez-Barradas MD

  7. the Hospital of Saint Raphael, New Haven, Conn

    Sharon Weissman MD

  8. the Department of Internal Medicine, Geriatric and General Medicine, Kansas University Medical Center, and Kansas City VA Medical Center, Kansas City, Kan.

    Jeff Whittle MD, MPH

Authors
  1. Amy M. Kilbourne PhD, MPH
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  2. Amy C. Justice MD, PhD
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  3. Bruce L. Rollman MD, MPH
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  4. Kathleen A. McGinnis MS
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  5. Linda Rabeneck MD, MPH
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  6. Sharon Weissman MD
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  7. Susan Smola MBA
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  8. Richard Schultz PhD
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  9. Jeff Whittle MD, MPH
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  10. Maria Rodriguez-Barradas MD
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Corresponding author

Correspondence to Amy M. Kilbourne PhD, MPH.

Additional information

The primary funding sources were from a National Institute of Aging (NIA) Career Development Award, a Robert Wood Johnson Faculty Scholar Award, and an Inter-agency Agreement between the NIA, National Institute of Mental Health, and the Department of Veterans Affairs (Dr. Justice, Pl). Dr. Rabeneck is the recipient of a VA Health Services Research and Development Advanced Research Career Development Award.

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Kilbourne, A.M., Justice, A.C., Rollman, B.L. et al. Clinical importance of HIV and depressive symptoms among veterans with HIV infection. J GEN INTERN MED 17, 512–520 (2002). https://doi.org/10.1046/j.1525-1497.2002.10803.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2002.10803.x

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