August 7, 2002
A new study published in the July issue of Journal of General and Internal Medicine (2002;17;7) suggests that physicians could be making a lethal mistake if they do not give the same credibility and treatment to depressed HIV patients that they give to non-depressed HIV patients. A research team found that HIV patients who experience more symptoms -- regardless of how depressed they may or may not be -- are more likely to die within the coming year. Physicians tempted to dismiss symptoms reported by a depressed patient with HIV, the study indicated, are missing the bigger picture.
Lead author Dr. Amy M. Kilbourne of the Veterans Administration Pittsburgh Center for Health Equity Research and Promotion explained that physicians have long been aware that depressed patients with HIV report more symptoms than non- depressed patients with HIV. "Yet clinicians are given little guidance as to what to do in response to symptoms reported by depressed patients," she noted. "Should clinicians first treat the depression and observe whether the symptom resolves, or should they also search for the medical causes of the symptom?"
Kilbourne and colleagues used data from a large-scale study of 881 HIV patients treated at Veterans Administration Medical Centers in Cleveland, Houston and Manhattan between June 1999 and July 2000. The investigators surveyed patients' medical records to determine the severity of their illness, the nature and number of their HIV symptoms, and how bothersome those symptoms were. The researchers simultaneously assessed each participant's level of depression. The team followed the patients' medical progress during the following year.
"In a prior survey of over 200 primary care providers... providers were less likely to believe that a patient with a prior psychiatric history who presented a new symptom had a potentially serious physical illness. This is perhaps due to the provider's perception that patients with depression exaggerate their physical symptoms," Kilbourne wrote. Although Kilbourne by no means advised ignoring psychological distress, she did warn against treating the medical symptoms of HIV any differently in depressed and non-depressed patients.
Pain & Central Nervous System Week