Department of Infection and Population Health, University College London, London, UK.
Psychol Health Med. 2011 Oct;16(5):493-527. doi: 10.1080/13548506.2011.579990. Epub 2011 Aug 2.
HIV-positive individuals are more likely to be diagnosed with major depressive disorder than HIV-negative individuals. Depression can precede diagnosis and be associated with risk factors for infection. The experience of illness can also exacerbate depressive episodes and depression can be a side effect to treatment. A systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review aims to provide a comprehensive understanding of evaluated interventions related to HIV and depression and provide some insight on questions of prevalence and measurement. Standard systematic research methods were used to gather quality published papers on HIV and depression. From the search, 1015 articles were generated and hand searched resulting in 90 studies meeting adequacy inclusion criteria for analysis. Of these, 67 (74.4%) were implemented in North America (the US and Canada) and 14 (15.5%) in Europe, with little representation from Africa, Asia and South America. Sixty-five (65.5%) studies recruited only men or mostly men, of which 31 (35%) recruited gay or bisexual men. Prevalence rates of depression ranged from 0 to 80%; measures were diverse and rarely adopted the same cut-off points. Twenty-one standardized instruments were used to measure depression. Ninety-nine interventions were investigated. The interventions were diverse and could broadly be categorized into psychological, psychotropic, psychosocial, physical, HIV-specific health psychology interventions and HIV treatment-related interventions. Psychological interventions were particularly effective and in particular interventions that incorporated a cognitive-behavioural component. Psychotropic and HIV-specific health psychology interventions were generally effective. Evidence is not clear-cut regarding the effectiveness of physical therapies and psychosocial interventions were generally ineffective. Interventions that investigated the effects of treatments for HIV and HIV-associated conditions on depression generally found that these treatments did not increase but often decreased depression. Interventions are both effective and available, although further research into enhancing efficacy would be valuable. Depression needs to be routinely logged in those with HIV infection during the course of their disease. Specific data on women, young people, heterosexual men, drug users and those indiverse geographic areas are needed. Measurement of depression needs to be harmonized and management into care protocols incorporated.
HIV 阳性个体比 HIV 阴性个体更有可能被诊断出患有重度抑郁症。抑郁症可能先于诊断出现，并与感染的危险因素有关。疾病的经历也会使抑郁发作恶化，而抑郁可能是治疗的副作用。需要系统地了解哪些干预措施已经在 HIV 血清阳性个体中进行了测试，并对其有效性进行了评估。本综述旨在全面了解与 HIV 和抑郁症相关的评估干预措施，并就流行率和测量问题提供一些见解。采用标准系统研究方法收集了有关 HIV 和抑郁症的高质量已发表论文。通过检索，共生成 1015 篇文章，并进行了手工检索，最终有 90 项研究符合纳入分析的充分标准。其中，67 项（74.4%）在北美（美国和加拿大）实施，14 项（15.5%）在欧洲实施，非洲、亚洲和南美洲的代表性很小。65 项（65.5%）研究仅招募男性或主要是男性，其中 31 项（35%）招募男同性恋或双性恋男性。抑郁症的患病率从 0 到 80%不等；测量方法多种多样，很少采用相同的临界点。21 种标准化工具用于测量抑郁。共调查了 99 项干预措施。干预措施多种多样，大致可分为心理、精神药理学、心理社会、身体、HIV 特定健康心理学干预和 HIV 治疗相关干预。心理干预特别有效，特别是包含认知行为成分的干预。精神药理学和 HIV 特定健康心理学干预通常有效。关于身体疗法有效性的证据并不明确，心理社会干预通常无效。调查 HIV 治疗和与 HIV 相关疾病对抑郁症影响的干预措施一般发现，这些治疗并没有增加，反而经常减少了抑郁症。干预措施既有效又可用，尽管进一步研究增强疗效将是有价值的。在 HIV 感染者的疾病过程中，需要常规记录抑郁症。需要有特定的数据来了解女性、年轻人、异性恋男性、吸毒者和来自不同地理区域的人。需要对抑郁进行标准化测量，并将管理纳入护理方案。
