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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
Importance of Mental Health Assessment in HIV-Infected
Christine Zinkernagel; Patrick Taffe; Martin Rickenbach;
November 19, 2001
Journal of Acquired Immune Deficiency Syndromes (11.01.01) Vol

HIV infection, even when well controlled, is often associated with important mental health problems. This study sought to investigate anxiety, depression, and health-related quality of life using screening measurements in patients with HIV infection, and their relation to biosocial parameters linked to HIV.

Three hundred ninety-seven consecutive HIV-infected outpatients ages 16 years or older were enrolled in this study in clinics participating in the Swiss HIV Cohort study, Basel and St. Gallen. The patient populations in the Basel and St. Gallen centers were representative for the entire Swiss Cohort (e.g., regarding percentage of women or age distribution). The cohort has a continuing enrollment of HIV-infected individuals ages 16 years or older. Enrollment is independent of disease state or degree of immunodeficiency, and data are collected prospectively according to standardized criteria at registration and at six- month follow-up visits. At every follow-up a detailed history of HIV-associated diseases and of medications is obtained; CD4 counts are obtained and viral load is quantified.

For this study, the HIV RNA and CD4 counts were obtained at the closest date possible before the date of answering of four self-reported questionnaires. These were the Hospital Anxiety and Depression Scale (HADS), the State Trait Anxiety Inventory (STAI), a visual analog scale (VAS) and a quality of life measurement, the HIV Medical Outcome Study (HIV-MOS).

Almost all scores were significantly worse for intravenous drug users compared with other transmission groups. People who were employed, with a higher education or with higher CD4 count tended to score better, whereas those hospitalized within the last six months, infected for a long time, with higher viral load or loss of weight scored significantly worse.

According to the investigators, "The most important findings of this analysis were that 1) validated screening tests showed anxiety and depression to be relevant; 2) there was a significant association between social parameters such as employment status and a patient's psychometric scores; 3) higher viral load was negatively associated with all scores, whereas lower CD4 counts were not, and importantly; 4) longer duration of disease, independent of other factors, was associated with anxiety and depression." The presence or type of medication was not linked with anxiety, depression, or health-related quality of life. There were significant differences between men and women, with men more anxious and distressed about their health status.

HIV infection remains a serious psychologic burden, despite the dramatic reduction of morbidity and mortality in recent years. As the investigation indicates, patients are prone to anxiety and depression, and long-term care must address the social and mental health problems of these patients. The screening conducted in this study may enhance adherence to antiretroviral medication, as well as enable and support coping strategies. Discussions with patients on their mental well being has shown to be beneficial to patient care and warrants further study.