Gaynes Bradley N, O'Donnell Julie, Nelson Elise, Heine Amy, Zinski Anne, Edwards Malaika, McGuinness Teena, Riddhi Modi A, Montgomery Charita, Pence Brian W
Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC.
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Gen Hosp Psychiatry. 2015 Jul-Aug;37(4):277-82. doi: 10.1016/j.genhosppsych.2015.03.021. Epub 2015 Apr 7.
To report on the prevalence of psychiatric comorbidity and its association with illness severity in depressed HIV patients.
As part of a multi-site randomized controlled trial of depression treatment for HIV patients, 304 participants meeting criteria for current Major Depressive Disorder (MDD) were assessed for other mood, anxiety and substance use disorders with the Mini-International Neuropsychiatric Interview, a structured psychiatric diagnostic interview. We also assessed baseline adherence, risk, and health measures.
Complicated depressive illness was common. Only 18% of participants experienced MDD with no comorbid psychiatric diagnoses; 49% had comorbid dysthymia, 62% had ≥1 comorbid anxiety disorder, and 28% had a comorbid substance use disorder. Self-reported antiretroviral adherence did not differ by the presence of psychiatric comorbidity. However, psychiatric comorbidity was associated with worse physical health and functioning: compared to those with MDD alone, individuals with ≥1 comorbidity reported more HIV symptoms (5.1 vs. 4.1, P=.01), and worse mental health-related quality of life on the SF-12 (29 vs. 35, P<.01).
For HIV patients with MDD, chronic depression and psychiatric comorbidity are strikingly common, and this complexity is associated with greater HIV disease severity and worse quality of life. Appreciating this comorbidity can help clinicians better target those at risk of harder-to-treat HIV disease, and underscores the challenge of treating depression in this population.
报告抑郁的HIV患者中精神疾病共病的患病率及其与疾病严重程度的关联。
作为一项针对HIV患者抑郁症治疗的多中心随机对照试验的一部分，使用结构化精神科诊断访谈工具——迷你国际神经精神访谈，对304名符合当前重度抑郁症（MDD）标准的参与者进行了其他情绪、焦虑和物质使用障碍的评估。我们还评估了基线依从性、风险和健康指标。
复杂的抑郁性疾病很常见。只有18%的参与者患有MDD且无共病精神疾病诊断；49%患有共病恶劣心境，62%患有≥1种共病焦虑症，28%患有共病物质使用障碍。自我报告的抗逆转录病毒治疗依从性在有无精神疾病共病方面无差异。然而，精神疾病共病与更差的身体健康和功能相关：与仅患有MDD的患者相比，患有≥1种共病的个体报告有更多的HIV症状（5.1比4.1，P = 0.01），且在SF - 12量表上与心理健康相关的生活质量更差（29比35，P < 0.01）。
对于患有MDD的HIV患者，慢性抑郁症和精神疾病共病极为常见，这种复杂性与更高的HIV疾病严重程度和更差的生活质量相关。认识到这种共病情况有助于临床医生更好地针对那些有更难治疗的HIV疾病风险的患者，并凸显了在这一人群中治疗抑郁症的挑战。
