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HIV and Depression

HIV and Depression. Learning Objectives. Define what is depression Describe the relationship between depression and HIV/AIDS List the symptoms of depression Explain how to identify potential depression in our patients Identify signs of substance abuse in our patients. Introduction.

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HIV and Depression

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  1. HIV and Depression

  2. Learning Objectives • Define what is depression • Describe the relationship between depression and HIV/AIDS • List the symptoms of depression • Explain how to identify potential depression in our patients • Identify signs of substance abuse in our patients

  3. Introduction • Many studies worldwide show evidence of increased psychological distress in people with HIV/AIDS • Increased rates of anxiety and depression: • Occurs at time of diagnosis/ disclosure to family members • Increased risk in those with painful physical symptoms of HIV/AIDS • HIV associated with stigma/ rejection by family members

  4. Gaps in MHS in PLWHIV • Mental health conditions for PLHIV are under diagnosed and under treated • In resource-limited countries: • High burden of HIV/AIDS • Limited capacity of mental health care delivery • Detection of depression poor in HIV • WHO recommend that psychosocial needs of HIV+ve/ AIDS population should be integral to HIV services

  5. What is Depression? • State of lowered mood, often accompanied by disturbances of sleep, energy, appetite, concentration, interest, and sexual drive

  6. Depression and HIV/AIDS • Evidence that there are higher rates of HIV infection in depressed population • Increased risk taking behaviour • Social exclusion • Substance misuse • Cognitive deficits/ Impaired judgment • Mentally ill less likely to attend for screening and to attend follow up. Also have poorer quality of life and increased mortality

  7. Depression and HIV/AIDS (contd.) • Emerging evidence that depression is an independent risk factor for poor prognosis for those initiated on ARVs • HIV-positive have nearly twice the rate of major depression as HIV-negative • HIV with depressive disorders compared with HIV alone • Greater delays in medical treatment • Worse adherence to medical treatment • For women, higher mortality

  8. Depression in PLWHIV • Increase in mortality rate among HIV-seropositive women and with disease progression in HIV-seropositive men. • Depression associated with more rapid disease progression independent of demographics, psychosocial and clinical factors. • Patients with likely mood, anxiety, or substance use disorders were 2x as likely to develop virologic failure and took 41% longer to achieve virologicsupression.

  9. Depressive Factors Asymptomatic Period: • “Slow Sentence” effect – unable to hope or plan, vigilant and fearful about self and others • Complex decision making (e.g.: who to inform?) • Lifestyle changes • Reconsidering life plans • Preparations for death • Worries about financial and health security • Pressures of medical regimen

  10. Depressive Factors (contd.) Symptomatic Period: • Reduced independence • Fears about the future • Death anxiety • Concerns over body image • Changes in self-concept • Social isolation/conflictive relationships • Prejudice from others • Bereavement

  11. Symptoms of depression For at least two weeks, the presence of at least two core symptoms: • Depressed mood (or irritable mood in children/adolescents) • Loss of interest or pleasure in activities (anhedonia) • Decreased energy or easily fatigued

  12. Symptoms of depression (contd.) During the last two weeks, at least three of the following: • Reduced concentration/attention • Reduced self esteem and self confidence • Ideas of guilt and unworthiness • Bleak and pessimistic view of the future • Ideas or acts of self harm or suicide • Disturbed sleep • Disturbed appetite

  13. Symptoms of depression (contd.) • The person has difficulties carrying out their usual work, school, social, or domestic activities • It does not occur secondary to a medical illness or a substance abuse problem

  14. Screening for depression • S leep • I nterest • G uilt • E nergy • C oncentration • A ppetite • P sychomotor agitation/retardation • S uicide

  15. Medication Side Effects • Steroids: mania or depression, paranoia • Efavirenz: decreased concentration, vivid dreams, may trigger onset of depression

  16. Protective Factors • Positive social support • Optimism • Adaptive coping • Acceptance, planning, and active coping vs. denial and avoidance

  17. The Flip Side • Fatalistic-pessimistic attitude is significant predictor of shorter survival time among men with AIDS • Use of extreme denial or extreme acceptance associated with accelerated disease course, while distraction is associated with slower course • People who remain socially isolated appear to show the fastest progression of disease

  18. Depression and Adherence • Depression decreases adherence by: • Negatively influencing expectations and benefits about the efficacy of treatment • Increasing withdrawal and social isolation • Decreasing cognitive functioning and memory • Influencing dietary regimes • Decreasing energy for self care

  19. What characterises ‘Super Survivors’? • Healthy self-care behaviors • Sense of connectedness • Sense of meaning and purpose • Maintaining perspective (cited in Antoni, 2000)

  20. Depression and HIVTreatment – Psychological benefits • Decrease high risk behaviors • Increase compliance • Enhance quality of life • Improve coping • Increase utilization of health care services • Lengthen survival time

  21. Psychosocial/Behavioral Treatments • Support • Psychoeducation • Psychosocial • Cognitive-Behavioral • Existential

  22. Supportive Therapy for Adherence to Antiretroviral Treatment (STAART) • Techniques to increase medication adherence and learn effective strategies to cope with stress and depression • Enhanced HIV treatment readiness • Reduced depressive symptoms in those who were depressed • (Balfour, Kowal, & Silverman, 2006)

  23. Alcohol Use • CAGE screening questionnaire: • Have you ever thought you should CUT down? • Have you ever been ANGRY if someone criticised your drinking? • Have you ever felt GUILTY about your drinking? • Have you ever needed an EYE OPENER early in the morning? • 2 or more should lead to further referral assessment and referral

  24. Key Messages • HIV positive people are at greater risk for depression • It’s important to screen our patients for symptoms of depression • Depression can affect a patient’s adherence to their treatment • Patient’s with depressive symptoms or substance abuse issues should be referred to the appropriate professionals

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