Morrison Mary F, Petitto John M, Ten Have Thomas, Gettes David R, Chiappini Margaret S, Weber Anita L, Brinker-Spence Priscilla, Bauer Russell M, Douglas Steven D, Evans Dwight L
Center for Clinical Epidemiolgy and Biostatistics and Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, 19104-6021, USA.
Am J Psychiatry. 2002 May;159(5):789-96. doi: 10.1176/appi.ajp.159.5.789.
This study examined whether there were differences in the rate of depressive and anxiety disorders between HIV-infected women (N=93) and a comparison group of uninfected women (N=62). Secondary objectives were to examine correlates of depression in HIV-infected women-including HIV disease stage and protease inhibitor use-and the associations between symptoms of depression or anxiety and other potential predictor variables.
Subjects underwent extensive semiannual clinical, psychiatric, neuropsychological, and immunological evaluations. Depressive and anxiety disorder diagnoses were assessed by using the Structured Clinical Interview for DSM-IV. Symptoms of depression and anxiety were evaluated with the Hamilton Depression Rating Scale (the 17-item version and a modified 11-item version) and the Hamilton Anxiety Rating Scale, respectively.
The rate of current major depressive disorder was four times higher in HIV-seropositive women (19.4%) than in HIV-seronegative women (4.8%). Mean depressive symptom scores on the 17-item Hamilton depression scale also were significantly higher, overall, in the HIV-infected women (mean=8.7, SD=8.0) relative to comparison subjects (mean=3.3, SD=5.8). There was no significant between-group difference in the rate of anxiety disorders. However, HIV-seropositive women had significantly higher anxiety symptom scores (mean=8.8, SD=8.9) than did HIV-seronegative women (mean=3.6, SD=5.5). Both groups had similar substance abuse/dependence histories, but adjusting for this factor had little impact on the relationship of HIV status to current major depressive disorder.
HIV-seropositive women without current substance abuse exhibited a significantly higher rate of major depressive disorder and more symptoms of depression and anxiety than did a group of HIV-seronegative women with similar demographic characteristics. These controlled, clinical findings extend recent epidemiologic findings and underscore the importance of adequate assessment and treatment of depression and anxiety in HIV-infected women.
本研究调查了感染人类免疫缺陷病毒（HIV）的女性（n = 93）与未感染的女性对照组（n = 62）之间抑郁和焦虑症发病率是否存在差异。次要目的是研究感染HIV女性抑郁的相关因素，包括HIV疾病阶段和蛋白酶抑制剂的使用情况，以及抑郁或焦虑症状与其他潜在预测变量之间的关联。
受试者每半年接受一次全面的临床、精神、神经心理和免疫学评估。使用《精神疾病诊断与统计手册》第四版（DSM-IV）的结构化临床访谈来评估抑郁和焦虑症诊断。分别使用汉密尔顿抑郁量表（17项版本和修订的11项版本）和汉密尔顿焦虑量表评估抑郁和焦虑症状。
HIV血清阳性女性当前重度抑郁症的发病率（19.4%）是HIV血清阴性女性（4.8%）的四倍。总体而言，在17项汉密尔顿抑郁量表上，感染HIV的女性平均抑郁症状评分（均值 = 8.7，标准差 = 8.0）也显著高于对照组受试者（均值 = 3.3，标准差 = 5.8）。焦虑症发病率在组间无显著差异。然而，HIV血清阳性女性的焦虑症状评分（均值 = 8.8，标准差 = 8.9）显著高于HIV血清阴性女性（均值 = 3.6，标准差 = 5.5）。两组有相似的药物滥用/依赖史，但校正该因素对HIV状态与当前重度抑郁症之间的关系影响不大。
与一组具有相似人口统计学特征的HIV血清阴性女性相比，目前无药物滥用的HIV血清阳性女性重度抑郁症发病率显著更高，且有更多的抑郁和焦虑症状。这些对照临床研究结果扩展了近期的流行病学研究结果，并强调了对感染HIV女性的抑郁和焦虑进行充分评估和治疗的重要性。
