美国接受医疗护理的艾滋病毒感染者中抑郁症的额外负担：来自医疗监测项目和行为危险因素监测系统的数据。
Excess burden of depression among HIV-infected persons receiving medical care in the united states: data from the medical monitoring project and the behavioral risk factor surveillance system.
作者信息
Do Ann N, Rosenberg Eli S, Sullivan Patrick S, Beer Linda, Strine Tara W, Schulden Jeffrey D, Fagan Jennifer L, Freedman Mark S, Skarbinski Jacek
机构信息
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.
出版信息
PLoS One. 2014 Mar 24;9(3):e92842. doi: 10.1371/journal.pone.0092842. eCollection 2014.
BACKGROUND
With increased life expectancy for HIV-infected persons, there is concern regarding comorbid depression because of its common occurrence and association with behaviors that may facilitate HIV transmission. Our objectives were to estimate the prevalence of current depression among HIV-infected persons receiving care and assess the burden of major depression, relative to that in the general population.
METHODS AND FINDINGS
We used data from the Medical Monitoring Project (MMP) and the Behavioral Risk Factors Surveillance System (BRFSS). The eight-item Patient Health Questionnaire was used to identify depression. To assess the burden of major depression among HIV-infected persons receiving care, we compared the prevalence of current major depression between the MMP and BRFSS populations using stratified analyses that simultaneously controlled for gender and, in turn, each of the potentially confounding demographic factors of age, race/ethnicity, education, and income. Each unadjusted comparison was summarized as a prevalence ratio (PR), and each of the adjusted comparisons was summarized as a standardized prevalence ratio (SPR). Among HIV-infected persons receiving care, the prevalence of a current episode of major depression and other depression, respectively, was 12.4% (95% CI: 11.2, 13.7) and 13.2% (95% CI: 12.0%, 14.4%). Overall, the PR comparing the prevalence of current major depression between HIV-infected persons receiving care and the general population was 3.1. When controlling for gender and each of the factors age, race/ethnicity, and education, the SPR (3.3, 3.0, and 2.9, respectively) was similar to the PR. However, when controlling for gender and annual household income, the SPR decreased to 1.5.
CONCLUSIONS
Depression remains a common comorbidity among HIV-infected persons. The overall excess burden among HIV-infected persons receiving care is about three-times that among the general population and is associated with differences in annual household income between the two populations. Relevant efforts are needed to reduce this burden.
背景
随着艾滋病毒感染者预期寿命的延长，由于合并抑郁症的普遍存在及其与可能促进艾滋病毒传播的行为之间的关联，人们对此表示担忧。我们的目标是估计接受治疗的艾滋病毒感染者中当前抑郁症的患病率，并评估重度抑郁症相对于普通人群的负担。
方法与结果
我们使用了医疗监测项目（MMP）和行为危险因素监测系统（BRFSS）的数据。采用八项患者健康问卷来识别抑郁症。为了评估接受治疗的艾滋病毒感染者中重度抑郁症的负担，我们使用分层分析比较了MMP人群和BRFSS人群中当前重度抑郁症的患病率，该分析同时控制了性别，并依次控制了年龄、种族/族裔、教育程度和收入等每个潜在的混杂人口统计学因素。每个未调整的比较总结为患病率比（PR），每个调整后的比较总结为标准化患病率比（SPR）。在接受治疗的艾滋病毒感染者中，当前重度抑郁发作和其他抑郁症的患病率分别为12.4%（95%CI：11.2，13.7）和13.2%（95%CI：12.0%，14.4%）。总体而言，比较接受治疗的艾滋病毒感染者与普通人群中当前重度抑郁症患病率的PR为3.1。在控制性别以及年龄、种族/族裔和教育程度等每个因素时，SPR（分别为3.3、3.0和2.9）与PR相似。然而，在控制性别和家庭年收入时，SPR降至1.5。
结论
抑郁症仍然是艾滋病毒感染者中常见的合并症。接受治疗的艾滋病毒感染者的总体额外负担约为普通人群的三倍，并且与这两个人群家庭年收入的差异有关。需要做出相关努力来减轻这一负担。
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