Depression and Survival in a 17-Year Longitudinal Study of People With HIV: Moderating Effects of Race and Education.
Depression and Survival in a 17-Year Longitudinal Study of People With HIV: Moderating Effects of Race and Education.
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DOI：
10.1097/psy.0000000000000488
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发表时间：
2017-09
影响因子：
3.3
通讯作者：
Stuetzle R
中科院分区：
文献类型：
--
作者：
Ironson G;Fitch C;Stuetzle R
艾滋病毒感染者（PLWH）的临床显著抑郁症状的患病率是普通人群的3倍。虽然研究表明，抑郁症预示着艾滋病毒的恶化过程，但很少有人研究其与死亡率的关系，而且没有一个人有17年的随访期，并且完全在蛋白酶抑制剂出现后的时间内进行。我们跟踪了一个不同的样本艾滋病毒阳性的人（n=177）在中等范围的疾病的压力和应对的研究。参与者每六个月（12年）通过抽血，问卷调查和访谈进行评估。使用贝克抑郁量表（BDI-I）测量抑郁。该研究于1997年3月开始，2014年4月评估了死亡率。在主要分析中，抑郁作为一个连续变量，显著预测全因死亡率（风险比（HR）= 1.038，95%CI = 1.008 - 1.068）。将BDI评分二分，HR为2.044（95%CI = 1.176 - 3.550）。此外，这一结果受到种族和教育程度的调节，因此抑郁症只预测非非洲裔美国人和受过大学或以上教育的人的生存率更低。在考虑了最初的疾病状态、抗逆转录病毒药物和年龄后，在一个17年的不同PLWH样本中，在第一年半测量的抑郁症预测了更差的生存率。需要更多的研究来确定非裔美国人和那些没有受过大学教育的人长期结果的心理风险因素。针对抑郁症的干预措施可能会改善艾滋病毒感染者的健康状况，并可能提高其长期生存率。
The prevalence of clinically significant depressive symptoms is 3 times higher in people living with HIV (PLWH) than in the general population. While studies have shown that depression predicts worse course with HIV, few have investigated its relationship with mortality, and none have had a 17-year follow-up period and been conducted entirely during the time since the advent of protease inhibitors. We followed a diverse sample of HIV positive people (n=177) in the mid-range of illness for a study on stress and coping. Participants were assessed every six months (for 12 years) via blood draw, questionnaires and interview. Depression was measured using the Beck Depression Inventory (BDI-I). The study began in March, 1997 and mortality was assessed in April, 2014. In the primary analysis depression, analyzed as a continuous variable, significantly predicted all-cause mortality (Hazard Ratio (HR) = 1.038, 95%CI = 1.008 – 1.068). With BDI scores dichotomized, the HR was 2.044 (95%CI = 1.176 - 3.550). Furthermore, this result was moderated by race and educational attainment such that depression only predicted worse survival for non-African Americans and those with a college education or above. Depression measured during the first year and a half predicted worse survival in a diverse sample of PLWH followed for 17 years after accounting for initial disease status, antiretroviral medications and age. More research is needed to identify psychological risk factors for long-term outcomes in African Americans and those who are not college educated. Interventions targeting depression may improve well-being and potentially also long-term survival in individuals with HIV.