Novel approaches to characterize depressive symptoms and cognitive outcomes

描述(由申请人提供)：随着我们将艾滋病毒研究的重点转向现代治疗时代的继发性并发症和老龄化，心理、行为和认知健康是研究的关键领域。艾滋病毒感染者患抑郁症、滥用药物和认知障碍的风险很高，所有这些都可能因同性恋和艾滋病毒感染者经常承受的社会压力而加剧。其中许多问题也是老龄化问题，美国艾滋病毒感染人口正迅速接近50岁的中值年龄。随着年龄和艾滋病毒相关因素推高抑郁症和认知障碍的患病率，这些问题只会变得更加重要。我们建议使用一种综合的方法来理解心理社会因素与抑郁症和认知功能的长期趋势之间的复杂关系。利用新的统计方法和来自多中心艾滋病队列研究的数据，我们将通过：1.阐明HIV感染者抑郁症状和神经心理(NP)功能下降的纵向关系；多中心艾滋病队列研究是一个被描述的数据源，具有许多未被充分利用的心理社会变量和超过25年的抑郁症状和神经心理(NP)功能史。2.审查NP功能测试/自我感知记忆、抑郁症状、药物滥用、社会压力(内在化的同性恋恐惧症、同性恋受害者)、社会支持和联系、艾滋病毒疾病指标(病毒载量、CD4细胞计数)和种族之间的复杂相互关系。3.开发方法来确定和表征感染艾滋病毒的和未感染的男男性接触者(MSM)的纵向抑郁症状和NP结果数据的不同模式，并描述经治疗的艾滋病毒感染如何影响这些轨迹。抑郁症是一种可以治疗的疾病。打破一种长期模式 对慢性或周期性抑郁症的干预可能提供的不仅仅是改善生活质量；这种干预还可能防止、阻止甚至逆转认知功能下降。了解HIV感染者的抑郁史与其NP功能轨迹之间的关系和无数途径的性质，是设计有效的筛查和干预计划的重要第一步。

DESCRIPTION (provided by applicant): As we shift HIV-research focus towards secondary complications and aging in the modern therapy era, mental, behavior and cognitive health are critical domains for study. HIV-infected individuals are at high risk for depression, substance abuse and cognitive impairments, all of which can be exacerbated by the social stresses that gay and HIV-infected populations often endure. Many of these problems are also problems of aging and the U.S. HIV-infected population is rapidly approaching a median age of 50 years. These issues can only rise in importance as age and HIV-related factors drive up the prevalence of depression and cognitive impairment. We propose to use a comprehensive approach to understand the complex relationships between psychosocial factors and long term trends in depression and cognitive function. Using novel statistical approaches and data from the Multicenter AIDS Cohort Study, a well-described data source with many under- utilized psychosocial variables and over 25 years of under-explored depressive symptom and neuropsychological (NP) function history, we will elucidate the pathways leading from life-course social stressors through depression to NP decline by: 1. Elucidating the longitudinal relationship between depressive symptoms and NP function tests/self- perceived memory among HIV-infected men. 2. Examining complex interrelations between NP function tests/self-perceived memory, depressive symptoms, substance abuse, social stressors (internalized homophobia, gay victimization), social support and connectedness, HIV disease indicators (viral load, CD4 cell count) and race. 3. Developing methods for identifying and characterizing distinctive patterns of longitudinal depressive symptom and NP outcome data in HIV-infected and -uninfected men who have sex with men (MSM) and describe how treated HIV infection influences these trajectories. Depression is a treatable condition. Disrupting a long-term pattern of chronic or cyclic depression may provide more than just improved quality of life; such an intervention may also prevent, halt or even reverse cognitive function decline. Understanding the nature of the relationship and the myriad pathways between an HIV-infected person's history of depression and their NP functional trajectory is an important first step towards devising an effective screening and intervention program.