This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Constantine G. Lyketsos, MD; Donald R. Hoover, PhD; Marcella Guccione, MS; Walton Senterfitt, MPH; Mary Amanda Dew, PhD; Jerry Wesch, PhD; Mark J. VanRaden, MA; Glenn J. Treisman, MD, PhD; Hal Morgenstern, PhD; the Multicenter AIDS Cohort Study; A. J. Saah; J. Palenicek; H. Armenian; H. Farzadegan; N. Graham; J. Margolick; J. McArthur; J. P. Phair; J. S. Chmiel; B. Cohen; M. O'Gorman; D. Variakojis; J. Wesch; S. M. Wolinsky; R. Detels; B. R. Visscher; I. S. Y. Chen; J. Dudley; J. L. Fahey; J. V. Giorgi; M. Lee; O. Martinez-Mara; E. N. Miller; P. Nishanian; J. Taylor; J. Zack; C. R. Rinaldor, Jr; L. Kingsley; J. T. Becker; P. Gupta; M. Ho; A. Muñoz; L. P. Jacobson; T. Beaty; N. Galai; L. Epstein; M. Guccione; D. R. Hoover; C. Meinert; K. Nelson; S. Piantadosi; S. Su; L. Schrager; S. H. Vermund; R. A. Kaslow; M. J. VanRaden; D. Seminara

JAMA. 1993;270(21):2563-2567.

Abstract
Objective.
—To ascertain whether depressive symptoms as determined by the Center for Epidemiologic Studies—Depression scale (CES-D) predict accelerated mortality and worse medical outcomes in patients infected with human immunodeficiency virus (HIV).

Design.
—Eight-year cohort study with semiannual follow-up.

Setting.
—Community volunteers.

Participants.
—A total of 1809 HIV-seropositive homosexual men without the acquired immunodeficiency syndrome (AIDS) who entered the Multicenter AIDS Cohort Study in 1984 or 1985. Eight-year follow-up data were available on 75% of eligible participants.

Outcome Measures.
—Times to AIDS, death, and prophylactic treatment, and slopes describing the decline in CD4 count for each individual participant.

Results.
—Using a conventional definition of depression (CES-D 16 at the first study visit), 21.3% of participants were classified as depressed. Depressed participants had lower CD4 counts and reported more AIDS-related symptoms. There were no significant differences between depressed and nondepressed participants on any of the outcome measures (P>.05 in all cases). In contrast, men reporting AIDS-related symptoms had shorter times to AIDS and to death even after adjusting for CD4 counts (P<.01). The analyses were repeated, with similar results, using different definitions of depression based on the CES-D.

Conclusions.
—We find no evidence that depressive symptoms independently prognosticate worse outcomes in HIV infection. Because of associations of depression with symptom reports, CD4 counts, and indicators of socioeconomic status, future studies of the relationship between depression and HIV outcome should consider these variables as confounders.

(JAMA. 1993;270:2563-2567)

Author Affiliations
Baltimore, Md.—The Johns Hopkins School of Hygiene and Public Health; Chicago, Ill.—Howard Brown Memorial Clinic—Northwestern University Medical School; Los Angeles, Calif.— UCLA Schools of Public Health and Medicine; Pittsburgh, Pa.—University of Pittsburgh Graduate School of Public Health; Data Coordinating Center.—The Johns Hopkins School of Hygiene and Public Health; National Institutes of Health, Bethesda, Md.—National Institute of Allergy and Infectious Diseases; National Cancer Institute

From the Departments of Psychiatry and Behavioral Sciences (Drs Lyketsos and Treisman), Mental Hygiene (Drs Lyketsos and Treisman), and Epidemiology (Dr Hoover and Ms Guccione), Schools of Medicine and Public Health, The Johns Hopkins University, Baltimore, Md; Department of Epidemiology (Mr Senterfitt and Dr Morgenstern), UCLA School of Public Health, Los Angeles, Calif; Department of Psychiatry, School of Medicine, and Department of Epidemiology, School of Public Health, University of Pittsburgh (Pa) (Dr Dew); The Howard Brown Memorial Clinic, Northwestern University, Chicago, III (Dr Wesch); and National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (Mr VanRaden).

Footnotes
A complete list of the participants in this study appears at the end of this article.

Reprint requests to Osler 320, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287 (Dr Lyketsos).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Impact of depression on HIV outcomes in the HAART era
Hartzell et al.
J Antimicrob Chemother 2008;62:246-255.
ABSTRACT | FULL TEXT  

Promoting Health and Well-being in Lives of People Living with HIV and AIDS
Biswas
Psychology Developing Societies 2007;19:215-247.
ABSTRACT  

Patient-related Factors Predicting HIV Medication Adherence among Men and Women with Alcohol Problems
Parsons et al.
J Health Psychol 2007;12:357-370.
ABSTRACT  

Psychosocial Factors Predict CD4 and Viral Load Change in Men and Women With Human Immunodeficiency Virus in the Era of Highly Active Antiretroviral Treatment
Ironson et al.
Psychosom. Med. 2005;67:1013-1021.
ABSTRACT | FULL TEXT  

Depressive Symptoms and AIDS-Related Mortality Among a Multisite Cohort of HIV-Positive Women
Cook et al.
AJPH 2004;94:1133-1140.
ABSTRACT | FULL TEXT  

Positive Affect Predicts Lower Risk of AIDS Mortality
Moskowitz
Psychosom. Med. 2003;65:620-626.
ABSTRACT | FULL TEXT  

Psychological Distress is Associated With Decreased Memory Helper T-cell and B-cell Counts in Pre-AIDS HIV Seropositive Men and Women but Only in Those With Low Viral Load
Motivala et al.
Psychosom. Med. 2003;65:627-635.
ABSTRACT | FULL TEXT  

A Prospective Trial of Sustained-Release Bupropion for Depression in HIV-Seropositive and AIDS Patients
Currier et al.
Psychosomatics 2003;44:120-125.
ABSTRACT | FULL TEXT  

Depressive Symptoms and Severity of Illness in Multiple Sclerosis: Epidemiologic Study of a Large Community Sample
Chwastiak et al.
Am. J. Psychiatry 2002;159:1862-1868.
ABSTRACT | FULL TEXT  

Resolved: Psychosocial Interventions Can Improve Clinical Outcomes in Organic Disease--Moderator Introduction
Markovitz
Psychosom. Med. 2002;64:549-551.
FULL TEXT  

Response to Symptoms among a U.S. National Probability Sample of Adults Infected with Human Immunodeficiency Virus
Kilbourne et al.
Med Care Res Rev 2002;59:36-58.
ABSTRACT  

Mortality, CD4 Cell Count Decline, and Depressive Symptoms Among HIV-Seropositive Women: Longitudinal Analysis From the HIV Epidemiology Research Study
Ickovics et al.
JAMA 2001;285:1466-1474.
ABSTRACT | FULL TEXT  

Brief Communication: Detecting Depression: Providing High Quality Primary Care for HIV-Infected Patients
Fairfield et al.
American Journal of Medical Quality 2001;16:71-74.
ABSTRACT  

Psychiatric Diagnoses in Adolescents Seropositive for the Human Immunodeficiency Virus
Pao et al.
Arch Pediatr Adolesc Med 2000;154:240-244.
ABSTRACT | FULL TEXT  

Stress-Induced Immunomodulation: Implications for Infectious Diseases?
Glaser et al.
JAMA 1999;281:2268-2270.
FULL TEXT  

Progression to AIDS: The Effects of Stress, Depressive Symptoms, and Social Support
Leserman et al.
Psychosom. Med. 1999;61:397-406.
ABSTRACT | FULL TEXT  

A Bereavement Support Group Intervention Is Longitudinally Associated with Salutary Effects on the CD4 Cell Count and Number of Physician Visits
Goodkin et al.
CVI 1998;5:382-391.
ABSTRACT | FULL TEXT  

Psychological Distress, Coping, and Disease Progression in HIV-positive Homosexual Men
Vassend and Eskild
J Health Psychol 1998;3:243-257.
ABSTRACT  

Severe Stress, Depressive Symptoms, and Changes in Lymphocyte Subsets in Human Immunodeficiency Virus--Infected Men: A 2-Year Follow-up Study
Leserman et al.
Arch Gen Psychiatry 1997;54:279-285.
ABSTRACT  

Depressive Affect and Survival Among Gay and Bisexual Men Infected With HIV
Mayne et al.
Arch Intern Med 1996;156:2233-2238.
ABSTRACT  

Depression and Survival Among HIV-Infected Persons
Lyketsos et al.
JAMA 1996;275:35-36.
ABSTRACT  

'Now and Again It Really Hits Me': The Impact of an HIV-positive Diagnosis upon Psychosocial Well- being
Green et al.
J Health Psychol 1996;1:125-141.
ABSTRACT  

Depression and CD4 Decline
Barrett et al.
JAMA 1994;271:1743-1743.
ABSTRACT  

Depression and CD4 Decline-Reply
Perry and Fishman
JAMA 1994;271:1744-1744.
ABSTRACT  

DEPRESSION APPEARS NOT TO AFFECT OUTCOME IN HIV INFECTION
JWatch General 1993;1993:5-5.
FULL TEXT  

Depression and HIV How Does One Affect the Other?
Perry and Fishman
JAMA 1993;270:2609-2610.
ABSTRACT