May 8, 2003
Neuropsychiatric aspects of HIV are also strongly associated with overall QOL, with depression being the most common. Apathy -- a reduction in goal-directed behavior that is manifested by decreased behavioral, cognitive, or psychological activity -- has recently been identified as a potentially important neuropsychiatric symptom associated with HIV. In the current study, the authors examine the contribution of apathy and depression on QOL among individuals infected with HIV.
A total of 45 HIV-positive patients (16 males, 29 females) were recruited from an academic HIV care program, with the majority being infected with HIV through IV drug use. Those excluded from the study include patients with a history of bipolar disease or schizophrenia, neurologic disorder, learning disability, or developmental disability. Average age for the patient was 42.7 (5.7) and 95.5 (63.7) months since diagnosis. All patients were taking HAART and all but two were asymptomatic. The median CD4 cell count was 310. The study included 22 control subjects who were recruited from the community and met the same exclusion criteria. The control group averaged 38.6 (10.7) years of age.
In a single testing session, participants completed demographic questionnaires and self-report measures of apathy, mood and QOL. All measures were administered and scored according to standard procedures.
The second major clinical implication is that the impact of apathy on health-related QOL is far less than the impact of depression. Despite the higher rates of both apathy and depression in this sample, only depression is strongly associated with ratings of health-related QOL and should remain the primary mental health concern for practitioners who provide treatment for HIV-infected individuals.
Demographic factors associated with an increased risk of depression include comorbid substance abuse, an increased number of severe life events, greater physical disease, and low social support. In addition, women, homosexual men, and those with a history of psychiatric illness prior to seroconversion are more likely to experience significant depression following seroconversion.
Depression increases with greater HIV disease severity and increased sense of hopelessness regarding one's physical health. In addition to the effectiveness of pharmacotherapy and psychotherapeutic interventions for HIV-positive individuals, there is preliminary evidence that successful treatment of HIV with HAART is associated with reductions in depression severity. Depression is associated with reduced QOL and poor adherence to HIV treatment regimes. Furthermore, there is some evidence that depression compromises the immune system, and in turn hastens progression of the disease. The authors concluded that "effective treatment of depression has the potential to significantly influence the mental and physical health of a population living with a chronic condition that continuously presents physical, social, and psychological challenges."
AIDS Patient Care and STDs
03.03; Vol. 17; No. 3: P. 115-120; David Tate, B.S.; Robert H. Paul, Ph.D.; Timothy P. Flanigan, M.D.; Karen Tashima, M.D.; Justin Nash, Ph.D.; Christine Adair, B.S.; Robert Boland, M.D.; Ronald A. Cohen, Ph.D.
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