Jon C Mills1, Brian W Pence2, Jonathan V Todd1, Angela M Bengtson2, Tiffany L Breger2, Andrew Edmonds2, Robert L Cook3, Adebola Adedimeji4, Rebecca M Schwartz5, Seble Kassaye6, Joel Milam7, Jennifer Cocohoba8, Mardge Cohen9, Elizabeth Golub10, Gretchen Neigh11, Margaret Fischl12, Mirjam-Colette Kempf13, Adaora A Adimora1. 1. Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill. 2. Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health. 3. Departments of Epidemiology and Medicine, University of Florida, Gainesville, New York. 4. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. 5. Department of Occupational Medicine, Epidemiology and Prevention, Hofstra Northwell School of Medicine, Great Neck, New York. 6. Department of Infectious Diseases, Georgetown University, Georgetown University Medical Center, Washington, D.C. 7. Institute for Health Promotion and Disease Prevention Research, University of Southern California, Keck School of Medicine, Los Angeles. 8. Department of Clinical Pharmacy, University of California San Francisco, School of Pharmacy. 9. Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois. 10. Department of Epidemiology, John Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland. 11. Department of Anatomy and Neurobiology, Virginia Commonwealth University, School of Medicine, Richmond. 12. Department of Medicine/Infectious Diseases, Miami Center for AIDS Research, University of Miami, Miller School of Medicine, Florida. 13. Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham.
Abstract
Background: Research linking depression to mortality among people living with human immunodeficiency virus (PLWH) has largely focused on binary "always vs never" characterizations of depression. However, depression is chronic and is likely to have cumulative effects on mortality over time. Quantifying depression as a cumulative exposure may provide a better indication of the clinical benefit of enhanced depression treatment protocols delivered in HIV care settings. Methods: Women living with HIV (WLWH), naive to antiretroviral therapy, from the Women's Interagency HIV Study were followed from their first visit in or after 1998 for up to 10 semiannual visits (5 years). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. An area-under-the-curve approach was used to translate CES-D scores into a time-updated measure of cumulative days with depression (CDWD). We estimated the effect of CDWD on all-cause mortality using marginal structural Cox proportional hazards models. Results: Overall, 818 women contributed 3292 woman-years over a median of 4.8 years of follow-up, during which the median (interquartile range) CDWD was 366 (97-853). Ninety-four women died during follow-up (2.9 deaths/100 woman-years). A dose-response relationship was observed between CDWD and mortality. Each additional 365 days spent with depression increased mortality risk by 72% (hazard ratio, 1.72; 95% confidence interval, 1.34-2.20). Conclusions: In this sample of WLWH, increased CDWD elevated mortality rates in a dose-response fashion. More frequent monitoring and enhanced depression treatment protocols designed to reduce CDWD may interrupt the accumulation of mortality risk among WLWH.
Background: Research linking depression to mortality among people living with human immunodeficiency virus (PLWH) has largely focused on binary "always vs never" characterizations of depression. However, depression is chronic and is likely to have cumulative effects on mortality over time. Quantifying depression as a cumulative exposure may provide a better indication of the clinical benefit of enhanced depression treatment protocols delivered in HIV care settings. Methods:Women living with HIV (WLWH), naive to antiretroviral therapy, from the Women's Interagency HIV Study were followed from their first visit in or after 1998 for up to 10 semiannual visits (5 years). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. An area-under-the-curve approach was used to translate CES-D scores into a time-updated measure of cumulative days with depression (CDWD). We estimated the effect of CDWD on all-cause mortality using marginal structural Cox proportional hazards models. Results: Overall, 818 women contributed 3292 woman-years over a median of 4.8 years of follow-up, during which the median (interquartile range) CDWD was 366 (97-853). Ninety-four women died during follow-up (2.9 deaths/100 woman-years). A dose-response relationship was observed between CDWD and mortality. Each additional 365 days spent with depression increased mortality risk by 72% (hazard ratio, 1.72; 95% confidence interval, 1.34-2.20). Conclusions: In this sample of WLWH, increased CDWD elevated mortality rates in a dose-response fashion. More frequent monitoring and enhanced depression treatment protocols designed to reduce CDWD may interrupt the accumulation of mortality risk among WLWH.
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