Novel approaches to characterize depressive symptoms and cognitive outcomes

描述（由申请人提供）：在现代治疗时代，随着我们将hiv研究重点转向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、滥用药物和认知障碍的风险很高，而同性恋和艾滋病毒感染者经常承受的社会压力会加剧所有这些问题。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岁的中位数年龄。随着年龄和艾滋病毒相关因素导致抑郁症和认知障碍的流行，这些问题的重要性只会上升。我们建议采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。使用新的统计方法和来自多中心艾滋病队列研究的数据，这是一个描述良好的数据源，有许多未被充分利用的社会心理变量和超过25年的未被探索的抑郁症状和神经心理（NP）功能历史，我们将阐明从生命过程中的社会压力源到抑郁到NP下降的途径：1。hiv感染者抑郁症状与NP功能测试/自我知觉记忆的纵向关系研究。2. 研究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、CD4细胞计数）和种族之间的复杂相互关系。3. 开发方法来识别和描述艾滋病毒感染和未感染的男男性行为者（MSM）纵向抑郁症状和NP结果数据的独特模式，并描述治疗后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。打破长期模式

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.