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Depression Linked to Death Risk Among Gay/Bisexual Men with HIV SAN FRANCISCO, Oct. 25, 1996 -- Depression increases the risk of death among HIV infected gay and bisexual men, according to a new UCSF study published in the current (Oct. 28) issue of The Archives of Internal Medicine. The UCSF study is the first to measure the effect of chronic depression throughout the course of HIV disease among gay and bisexual men. Other studies have measured depression only at the start of the study rather than examining depression during HIV disease progression, and have produced inconsistent results, says lead author Tracy Mayne, PhD, a researcher at the UCSF Center for AIDS Prevention Studies (CAPS). "In the past, depression has been linked to higher mortality in the general population and shorter survival in patients with chronic diseases," Mayne says. "This, however, is the first time that this relationship has been documented in people with HIV infection." The finding is important, Mayne says, because in addition to decreasing quality of life, depression may also be decreasing survival among those with AIDS. "Depression is treatable, even among those with advanced AIDS," Mayne says. For the study, CAPS researchers recruited 405 single men, aged 25 to 54 years, from an ongoing, prospective study called the San Francisco Men's Health Study. The first wave of data collection for the study took place in 1985, with followups at six-month intervals. Each visit included a self-administered questionnaire, interview, physical examination, and a blood draw. The UCSF study is based on 8 years of data collection. CAPS researchers omitted three men who died within one year of recruitment, in order to base depression scores on at least three waves of data, according to Mayne. The researchers assessed the participant's depression during each visit based on a subset of the Center for Epidemiological Studies Depression Scale, a 20-item, self-report inventory of depressive symptoms. Because some symptoms of depression, such as loss of appetite, sleep disorders and fatigue, can also be caused by HIV disease, the researchers used the subset, which includes only items having to do with the emotional components of depression, such as "feeling depressed," "sad" or "lonely." At each wave of data collection, the CAPS researchers assigned each study participant a "time-dependent" depression score -- the proportion of visits, up to and including the most recent, at which the participant met the criteria for depression. For example, each man's depression score at the 15th visit was based on his scores from recruitment through wave 15. The CAPS researchers found that the more frequently a man in the study received a higher depression score, the greater his risk of death. Depression was reported by 230 (58 percent) of the men at least once during the study. For a man who had an elevated depression score at every wave, the risk for mortality was 1.67 times greater than for men who had never had an elevated depression score. "The association between depression and mortality in this study is independent of physiological and clinical measures of HIV disease progression, such as CD-4 counts," Mayne says. "These results suggest that depression affects mortality in ways other than direct physiological channels." Other possible explanations for the relationship between depression and HIV disease progression are behaviors associated with depression, such as increased substance abuse and smoking, according to the study. "Depressed people are also known to be less adherent to medical regimes, which can increase risk of disease progression and death in people with HIV," Mayne says. In addition, depression has been associated with increased risky sexual practices among young gay men and gay men who have HIV. Not only does this increase the risk of reinfection, but it can increase exposure to other sexually transmitted diseases, according to the study. "Regardless of the mechanism, it is important to increase physicians' awareness of depression among those infected with HIV," Mayne says. Co-authors of the study are CAPS researchers Eric Vittinghoff, PhD, Margaret A. Chesney, PhD, Donald C. Barrett, PhD, and CAPS director Thomas J. Coates, PhD. E-mail this page to a friend or colleague! To print, use this version