Boston University School of Medicine, Boston, MA, USA.
Indiana University School of Medicine, Indianapolis (IUPUI), Indianapolis, IN, USA.
HIV Med. 2019 May;20(5):317-329. doi: 10.1111/hiv.12726. Epub 2019 Mar 29.
The contribution of depression to mortality in adults with and without HIV infection is unclear. We hypothesized that depression increases mortality risk and that this association is stronger among those with HIV infection.
Veterans Aging Cohort Study (VACS) data were analysed from the first clinic visit on or after 1 April 2003 (baseline) to 30 September 2015. Depression definitions were: (1) major depressive disorder defined using International Classification of Diseases, Ninth Revision (ICD-9) codes; (2) depressive symptoms defined as Patient Health Questionnaire (PHQ)-9 scores ≥ 10. The outcome was all-cause mortality. Covariates were demographics, comorbid conditions and health behaviours.
Among 129 140 eligible participants, 30% had HIV infection, 16% had a major depressive disorder diagnosis, and 24% died over a median follow-up time of 11 years. The death rate was 25.3 [95% confidence interval (CI) 25.0-25.6] deaths per 1000 person-years. Major depressive disorder was associated with mortality [hazard ratio (HR) 1.04; 95% CI 1.01, 1.07]. This association was modified by HIV status (interaction P-value = 0.02). In HIV-stratified analyses, depression was significantly associated with mortality among HIV-uninfected veterans but not among those with HIV infection. Among those with PHQ-9 data (n = 7372), 50% had HIV infection, 22% had PHQ-9 scores ≥ 10, and 28% died over a median follow-up time of 12 years. The death rate was 27.3 (95% CI 26.1-28.5) per 1000 person-years. Depressive symptoms were associated with mortality (HR 1.16; 95% CI 1.04, 1.28). This association was modified by HIV status (interaction P-value = 0.05). In HIV-stratified analyses, depressive symptoms were significantly associated with mortality among veterans with HIV infection but not among those without HIV infection.
Depression was associated with all-cause mortality. This association was modified by HIV status and method of depression ascertainment.
目前尚不清楚抑郁在感染和未感染 HIV 的成年人中的死亡贡献。我们假设抑郁会增加死亡风险，且这种关联在感染 HIV 的人群中更强。
对退伍军人老龄化队列研究（VACS）的数据进行分析，该研究的数据来自于 2003 年 4 月 1 日或之后的第一次就诊（基线）至 2015 年 9 月 30 日。抑郁的定义如下：（1）使用国际疾病分类，第 9 版（ICD-9）代码定义的重度抑郁症；（2）用患者健康问卷（PHQ-9）得分≥10 定义的抑郁症状。结局为全因死亡率。协变量包括人口统计学特征、合并症和健康行为。
在 129140 名合格参与者中，30%有 HIV 感染，16%有重度抑郁症诊断，中位随访 11 年后有 24%死亡。死亡率为 25.3 [95%置信区间（CI）25.0-25.6]每 1000 人年死亡 25.3 人。重度抑郁症与死亡率相关[风险比（HR）1.04；95%CI 1.01，1.07]。这种关联受 HIV 状态的影响（交互 P 值=0.02）。在 HIV 分层分析中，抑郁与 HIV 阴性退伍军人的死亡率显著相关，但与 HIV 感染的退伍军人无关。在有 PHQ-9 数据（n=7372）的人群中，50%有 HIV 感染，22%有 PHQ-9 评分≥10，中位随访 12 年后有 28%死亡。死亡率为每 1000 人年 27.3（95%CI 26.1-28.5）。抑郁症状与死亡率相关（HR 1.16；95%CI 1.04，1.28）。这种关联受 HIV 状态的影响（交互 P 值=0.05）。在 HIV 分层分析中，抑郁症状与 HIV 感染的退伍军人死亡率显著相关，但与未感染 HIV 的退伍军人无关。
抑郁与全因死亡率相关。这种关联受 HIV 状态和抑郁评估方法的影响。
