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Am J Psychiatry 1996; 153:1430-1437
Copyright © 1996 by American Psychiatric Association
Changes in depressive symptoms as AIDS develops. The Multicenter AIDS Cohort Study
CG Lyketsos, DR Hoover, M Guccione, MA Dew, JE Wesch, EG Bing and GJ Treisman
Johns Hopkins University, Baltimore, MD 21287-5371, USA.
OBJECTIVE: The authors sought to determine whether rates of depressive
symptoms change from early- to late-stage HIV-1 infection and to determine
the predictors of depressive symptoms as AIDS develops. METHOD: The data
for this study were from 911 HIV-seropositive men- community volunteers
from four U.S. cities-who entered the 10-year Multicenter AIDS Cohort Study
without a diagnosis of AIDS and subsequently developed AIDS. The subjects
underwent semiannual follow- ups during the study period. The outcome
measures-overall depressive symptoms, nonsomatic depressive symptoms,
syndromal depression, and severe depression-were assessed over the 5 years
before and the 2 years after AIDS diagnosis from responses on the Center
for Epidemiologic Studies Depression Scale (CES-D Scale). RESULTS:
Depressive symptoms were stable over time from month 60 to month 18 before
AIDS developed. However, beginning 12-18 months before AIDS diagnosis,
there was a significant rise in all measures of depression, which reached a
plateau within 6 months before AIDS developed. At this plateau, there was a
45% increase in mean CES-D Scale scores above baseline. An elevated CES-D
Scale score in the earlier stages of infection, a self-report of AIDS-
related symptoms (such as rash and lymphadenopathy), concurrent
unemployment, cigarette smoking, and limited social supports were
consistent predictors of higher rates of depression as AIDS developed.
CONCLUSIONS: There is a dramatic, sustained rise in depressive symptoms as
AIDS develops, beginning as early as 18 months before clinical AIDS is
diagnosed. Prior depression, HIV-disease-related factors, and psychological
stressors contribute to this rise. This robust phenomenon invites further
characterization.
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