The study included almost 6000 people being treated at eight American hospitals. The symptoms of depression were assessed every six months. The researchers then calculated the proportion of days a person had been depressed – for example, 50% of days in the last six months, or 75% of days in the last six months.
While a third of people in the study had no days with depression, the average was 14% of days with depression. Four per cent of people were depressed every day.
In the whole sample, around a fifth of scheduled appointments were missed. And for each 25% increase in the proportion of days with depression, there was an 8% increase in the risk of missing an appointment.
Around a fifth of viral load measurements were above the limit of detection, indicating treatment that was not fully effective, possibly because of difficulties with adherence. Again, people with depressive symptoms were a little more likely to have a detectable viral load – for each 25% increase in the proportion of days with depression, there was a 5% increase in the risk of this.
There were 158 deaths during the study. Each 25% increase in depression was linked with a 19% increased risk of death.
“Even modest increases in the proportion of time spent with depression led to clinically meaningful increases in negative outcomes,” sum up the researchers. They say that the implication of their study is that doctors should pay more attention to depression in their patients and offer treatment when people have it. This should mean people spend less time depressed and their HIV is better managed.
For more information, read ‘Depression’ in NAM’s booklet ‘HIV, mental health & emotional wellbeing’.