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衰老，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、药物滥用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。许多这些问题也是老龄化的问题，美国艾滋病毒感染人口的中位年龄正在迅速接近50岁。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，这些问题的重要性只会上升。 我们建议使用一种全面的方法来了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。使用新的统计方法和来自多中心艾滋病队列研究的数据，一个描述良好的数据来源，具有许多未充分利用的心理社会变量和超过25年的未充分探索的抑郁症状和神经心理（NP）功能史，我们将通过以下方式阐明从生命过程社会压力源通过抑郁到NP下降的途径：1. HIV感染者抑郁症状与NP功能测试/自我感知记忆之间的纵向关系2.检查NP功能测试/自我感知记忆，抑郁症状，药物滥用，社会压力源（内化同性恋恐惧症，同性恋受害），社会支持和连通性，艾滋病毒疾病指标（病毒载量，CD 4细胞计数）和种族之间复杂的相互关系。3.开发方法识别和表征艾滋病毒感染和未感染的男性同性恋者（MSM）的纵向抑郁症状和NP结果数据的独特模式，并描述治疗艾滋病毒感染如何影响这些轨迹。 抑郁症是可以治疗的。打破长期模式 对慢性或周期性抑郁症的干预不仅可以改善生活质量，还可以预防、停止甚至逆转认知功能下降。了解HIV感染者的抑郁史和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的第一步。

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.