Préau M, Bonnet A, Bouhnik A-D, Fernandez L, Obadia Y, Spire B
Laboratoire de psychologie éducation, cognition développement, université de Nantes, chemin de la Censive-du-Tertre, BP 81227, 44312 Nantes cedex 3, France.
Encephale. 2008 Sep;34(4):385-93. doi: 10.1016/j.encep.2007.05.004. Epub 2007 Oct 24.
Anhedonia is defined as the loss of the capacity to feel pleasure and there is no consensus with its relationship with depressive symptomatology. Furthermore, no study has investigated the problematic of anhedonia in the context of HIV-infection, which concern a lot of patients with depressive symptoms. Depressive symptomatology presents a major challenge in the management of HIV-infection due to its central role in clinical progression.
This study aims to disentangle relationship between determinants of anhedonia, depression and anxiety in order to optimise mental management of HIV infection.
In 2003, a face-to-face survey (ANRS-EN12-VESPA) was conducted among patients selected in a random stratified sample of 102 French hospital departments delivering HIV care. Eligible respondents were HIV-infected outpatients, aged 18 or older living in France and diagnosed for at least six months. Among solicited patients, 2932 agreed to participate (response rate: 59%) and data about anhedonia, anxiety and depression are available for 1427 patients. The face-to-face gathered information on sociodemographic characteristics, such as education level, gender, partner, children, financial situation or housing and also psychosocial and sociobehavioural characteristics, such as drug use. Self-reported side effects of treatment were also available.
Anxiety and depression were assessed using the hospital anxiety and depression (HAD) scale. Physical anhedonia was assessed using the French version of the Chapman scale. Three regression models were used to identify factors associated with anhedonia, anxiety and depression among demographic, psychosocial and clinical characteristics.
Factors independently associated with anhedonia were older age (>50), lower education level, unemployment and men HIV contaminated by heterosexual relation or injecting drug use. Women, with lower education level, unemployment, without steady partner, with a detectable viral load and who reported side effect of HAART presented more frequently anxiety. Unemployment, uncomfortable housing, no social support from friends, self-reported side effect and lipodystrophy were independently associated with depression.
Our results underline the multiplicity of factors associated with mental disorders related to depression. These results can be explained by the fact that the anxiety and anhedonia are two cardinal symptoms of depression. Determinants of anhedonia and anxiety reported in this study may provide the key to a more exact delineation of depressive disorders in the context of HIV infection in order to optimize long-term psychological follow up of concerned patients.
快感缺失被定义为感受愉悦能力的丧失，其与抑郁症状之间的关系尚无定论。此外，尚无研究在HIV感染背景下调查快感缺失问题，而这涉及许多有抑郁症状的患者。抑郁症状在HIV感染管理中构成重大挑战，因为其在临床进展中起核心作用。
本研究旨在厘清快感缺失、抑郁和焦虑的决定因素之间的关系，以优化HIV感染的心理管理。
2003年，在提供HIV护理的102个法国医院科室的随机分层样本中选取患者进行面对面调查（ANRS-EN12-VESPA）。符合条件的受访者为年龄在18岁及以上、居住在法国且诊断至少六个月的HIV感染门诊患者。在被邀请的患者中，2932人同意参与（回复率：59%），1427名患者可获得有关快感缺失、焦虑和抑郁的数据。面对面收集了社会人口学特征信息，如教育水平、性别、伴侣、子女、经济状况或住房情况，以及心理社会和社会行为特征信息，如药物使用情况。还可获得自我报告的治疗副作用信息。
使用医院焦虑抑郁量表（HAD）评估焦虑和抑郁。使用查普曼量表的法语版本评估躯体性快感缺失。使用三个回归模型在人口统计学、心理社会和临床特征中识别与快感缺失、焦虑和抑郁相关的因素。
与快感缺失独立相关的因素包括年龄较大（>50岁）、教育水平较低、失业以及通过异性关系或注射吸毒感染HIV的男性。教育水平较低、失业、没有稳定伴侣且病毒载量可检测到以及报告有高效抗逆转录病毒治疗（HAART）副作用的女性更常出现焦虑。失业、住房条件差、没有朋友的社会支持、自我报告的副作用和脂肪代谢障碍与抑郁独立相关。
我们的结果强调了与抑郁相关的精神障碍相关因素的多样性。这些结果可以用焦虑和快感缺失是抑郁的两个主要症状这一事实来解释。本研究报告的快感缺失和焦虑的决定因素可能为在HIV感染背景下更准确地界定抑郁症提供关键，以便优化对相关患者的长期心理随访。
