School of Medicine, University of California San Diego, La Jolla, CA, USA.
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA; HIV Neurobehavioral Research Program, University of California San Diego, San Diego, CA, USA.
J Affect Disord. 2019 Nov 1;258:163-171. doi: 10.1016/j.jad.2019.07.081. Epub 2019 Jul 30.
Chronicity of depression among people living with HIV (PLWH) is associated with poorer viral suppression and mortality risk. The extent to which suicidal ideation (SI) and other baseline characteristics predict a prolonged duration of depressive illness among PLWH is not known but could help identify PLWH most at risk.
Data were drawn from a sample of 1002 depressed PLWH engaged in primary care at a metropolitan HIV clinic from 2007-2018, representing 2,569 person-years. Depression characteristics were derived from the Patient Health Questionnaire 9 (PHQ-9), administered during routine screening. Other characteristics were derived from clinic data. Unadjusted and covariate-adjusted survival analyses compared the time to depression remission between depressed participants with and without SI at their initial screening.
At baseline, 38.4% of depressed PLWH endorsed SI. Depressed PLWH with SI took significantly longer to achieve remission from depression than those without SI. The association appeared to be mediated by depression symptom severity. When adjusted for age, depression diagnosis, any recent drug use, and depression symptom severity, baseline SI no longer predicted remission hazard.
Participants were assessed for depression with variable frequency. The analysis assumed all patients received comparable treatment for their depression. Some variables were based on clinic measurements that may be subject to misclassification bias.
These data suggest that depressed PLWH with SI are at risk for greater chronicity of depression because their depression is more severe. Accordingly, PLWH should be urgently engaged in psychiatric care in the event of SI or severe depressive symptoms.
艾滋病毒感染者（PLWH）的抑郁慢性化与病毒抑制不良和死亡风险增加有关。自杀意念（SI）和其他基线特征在多大程度上预测 PLWH 抑郁持续时间延长尚不清楚，但可能有助于确定风险最高的 PLWH。
数据来自于 2007 年至 2018 年间在一家大都市 HIV 诊所接受初级保健的 1002 名抑郁 PLWH 的样本，代表 2569 人年。抑郁特征来自于患者健康问卷 9（PHQ-9），在常规筛查期间进行。其他特征来自于诊所数据。未调整和调整协变量的生存分析比较了初始筛查时存在和不存在 SI 的抑郁参与者之间达到抑郁缓解的时间。
基线时，38.4%的抑郁 PLWH 有 SI。有 SI 的抑郁 PLWH 从抑郁中缓解的时间明显长于没有 SI 的患者。这种关联似乎是由抑郁症状严重程度介导的。在调整年龄、抑郁诊断、近期任何药物使用和抑郁症状严重程度后，基线 SI 不再预测缓解风险。
参与者接受抑郁评估的频率不同。分析假设所有患者都接受了相当的抑郁治疗。一些变量基于可能存在分类偏倚的诊所测量。
这些数据表明，有 SI 的抑郁 PLWH 患抑郁慢性化的风险更高，因为他们的抑郁更严重。因此，如果出现 SI 或严重抑郁症状，PLWH 应紧急接受精神科护理。
