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Brief Communication: Detecting Depression: Providing High Quality Primary Care for HIV-Infected Patients

Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, Boston, Mass

Howard Libman, MD

Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, Boston, Mass

Roger B. Davis, ScD

Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, Boston, Mass

David M. Eisenberg, MD

Division of General Medicine and Primary Care and the Center for Alternative Medicine Research, Department of Medicine, BIDMC and Harvard Medical School, Boston, Mass

Alexandra Beckett, MD

Department of Psychiatry, BIDMC and Harvard Medical School, Boston, Mass

Russell S. Phillips, MD

Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, Boston, Mass

Depression is common among HIV-infected patients, but little is known about risk factors for depression in this population. Several studies before protease inhibitors became available have reported inconsistent associations between depression and disease severity. Delivering high quality HIV care includes adequate detection and treatment of depression. The objective of this study was to describe the prevalence and correlates of depression among a contemporary group of HIV-infected patients. The setting and design for the study was a chart abstraction for HIV-infected patients in a primary care practice in Boston, Mass, in June 1997. Among 275 HIV-infected patients, depression was documented in 147 patient charts (53%), half of whom (n = 73, 27%) also received antidepressant medications. We used multivariable logistic regression to identify risk factors for depression among patients with both a chart diagnosis of depression and current antide-pressant medication use. We observed increased risk of depression among patients with a history of substance use (odds ratio 2.7, 95% confidence interval 1.5-4.7), recent medical hospitalization (2.6, 1.4-5.0), and homosexual risk behavior (2.1, 1.14.2). Depression remains a common problem for HIV-infected patients, particularly among those with history of substance abuse, medical hospitalization, or homosexual risk behavior. Routine screening for depression in this population with special attention to those at higher risk may offer opportunities for earlier diagnosis and treatment.

Key Words: Depression • HIV • substance abuse

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