Prevalence of Treated & Untreated
Depression in a Cohort of HIV+
Women: Impact on Antiretroviral
Therapy Utilization & HIV Disease
Outcomes
Judith A. Cook, PhD
University of Illinois at Chicago
Department of Psychiatry
Presented at APHA Annual Meeting & Expo
San Francisco, CA, October 30, 2012
Collaborators & Funders
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Mardge H. Cohen, Core Center, Chicago, IL
Rebecca Schwartz, Population Health, Hofstra University
Pamela Steigman, Psychiatry, UIC
Dennis Grey, Psychiatry, UIC
Nancy Hessol, Pharmacy, University of California, SF
Elizabeth T. Golub, Public Health, Johns Hopkins University
Kathryn Anastos, Albert Einstein College of Medicine
Daniel Merenstein, Family Medicine, Georgetown University
Joel Milam, Preventive Medicine, University of Southern CA
Estimates of Depression
Prevalence in Different U.S. Study
Populations
General
Population
20%a
a
b
c
d
e
HIV+
Men
21%b
20%c
15%d
Kessler et al., 1994, Arch Gen Psych
Lyketsos et al., 1993, JAMA
Hays et al., 1992, J Consult Clin Psych
Sambamoorthi et al., 2000, J Gen Int Med
Cook et al., 2003, JAIDS
HIV+
Women
51%e
Research Has Established a Link
Between Tx for Depression &
Positive HIV Outcomes
Depression treatment is associated with
lower medical costs, greater HAART use
and adherence, curtailed HIV disease
progression, and lower AIDS-related
mortality.
DEPRESSION
TREATMENT
POSITIVE HIV
OUTCOMES
Cook, Grey et al., 2006
AIDS Care
 Use
of antidepressants plus mental health
therapy, or use of mental health therapy
alone significantly increased the
probability of HAART utilization, compared
to receiving no depression treatment.
Turner, Laine et al., 2003
J Gen Intern Med
 Women
diagnosed with depression who
received psychiatric and antidepressant tx
had nearly a two-fold greater adjusted
odds of adherence to ART, compared to
women whose depression was untreated.
Cook, Grey et al., 2004
Am J Public Health
 While
depressed women were more than
twice as likely to experience AIDS-related
mortality as non-depressed (controlling for
HAART use & adherence), those receiving
MH tx were significantly less likely to die.
Sambamoorthi, Walkup et al., 2000
J Gen Int Med.
 Antidepressant
treatment for depressed
HIV-positive individuals was associated
with a 24% reduction in monthly total
healthcare costs even controlling for
socioeconomic and clinical characteristics.
Women’s Interagency
HIV Study (WIHS)
 Cohort
study of HIV-positive women
recruited in 6 cities: Chicago, Los
Angeles, San Francisco/Bay Area,
Bronx, Brooklyn, Washington, DC
 Data collection bi-annually beginning in
1994 (1st cohort) until present
 Bi-annual in-person interviews, physical
exam, blood work, gynecological exam
 Chart abstraction of medical records
World Mental Health (WMH)
Composite International Diagnostic
Interview (CIDI)

Allows researchers to assess & study the impact of
mental & substance use disorders
 Valid & reliable way for trained non-clinicians to
generate diagnoses using the DSM-IV framework.
 Measures prevalence
 Measures severity
 Determines risk factors
 Assesses service use
 Assesses use of medications
 Assesses who is treated, who isn’t, & barriers to
treatment
CIDI Participants (N=889)
Average Age: 48 years (min-max = 27-77)
Race/Ethnicity: 65% African American; 15% Hispanic/Latina;
17% White; 3% Other
Education: 34% < HS education; 33% HS/GED; 25% some
college; 8% college education/advanced degree
Marital Status: 29% never married; 28% married/ cohabiting;
12% divorced; 11% widowed; 6% separated; 14% other
Employment: 32% employed at time of interview
Income: 51% < $12,000 annually
Insurance Coverage: 96% insured
12-month Prevalence of Depressive
Disorder (DD): General U.S. Population
Compared to HIV+ Women
Major DD
Dysthymia
Minor DD
U.S.
Women
WIHS
Sample
8.6%a
1.9%a
1.0%b
17.9%
8.7%
1.6%
a Source: National Comorbidity Survey-Replication, Kessler et al., 2005
b Source: Klier et al., 2000
Logistic Regression: HAART Use Among
HIV+ Women with Depression Diagnosis
Variables
Depression tx
Age
High School Ed+
Income < $12,000
Minority
O.R.
3.23
1.08
0.00
0.05
0.00
Significance
p<.05
p<.05
ns
p<.01
ns
Logistic Regression: Unsuppressed Viral Load
(>1,000 copies/ml) Among HIV+ Women
Treated and Not Treated for Depression
Variables
Depression tx
Age
High School Grad+
Income < $12,000
Minority
On HAART
O.R.
0.37
0.96
0.78
1.73
1.58
0.18
Significance
p<.05
ns
ns
ns
ns
p<.001
% of Women Reporting Mental
Health Tx by Type of Professional*
Type
%
Psychiatrist
71
Social Worker
46
Medical Doctor
34
Counselor
31
Psychologist
29
Psychotherapist
23
Non-Medical Health Prof (RN, etc) 12
Spiritual Advisor
19
Does not add to 100% since women could report >1 type of professional
N
79
52
38
35
33
26
14
21
Helpfulness (“a lot” or “some”) of Mental
Health Tx by Type of Professional*
Type
Psychiatrist
Social Worker
Medical Doctor
Counselor
Psychologist
Psychotherapist
Non-Medical Hlth. Prof. (RN, etc)
Spiritual Advisor
%
89
83
84
80
76
85
86
86
N
70
43
32
28
25
22
12
18
Does not add to 100% since women could report >1 type of professional
Additional Features of Tx for
Depression
 71.4%
of all women reporting depression
tx said their tx helped “a lot”
 79.5% of women reporting depression tx
reported a prescription for psychiatric
medication
Conclusions
 Prevalence
of depression in this cohort of
HIV+ women was two- to four-fold greater
than in the general U.S. population of women
 Most depressed women reported receiving
tx from a professional; the large majority
reported that tx was helpful.
 Depressed women receiving MH tx were
significantly more likely to be on HAART, &
were less likely to have unsuppressed viral
loads.