Marseille 2007
Marseille 2007
Abstract book
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Abstract #511  -  Do HIV-Positive Women Receive Depression Treatment Meeting Practice Guidelines?
Session:
  38.7: Counselling and Therapy (Parallel) on Tuesday @ 14.00-16.00 in CP Chaired by Barbara Hedge, Michael Blank
Authors:
  Presenting Author:   Mr Dennis Grey - University of Illinois at Chicago, United States
 
  Additional Authors:  Mr Dennis D. Grey, Prof Judith A. Cook, Ms Jane K. Burke-Miller,  
Aim:
Recent research has confirmed the high rate of depression among HIV-positive women and its association with more rapid disease progression, higher AIDS-related mortality, and lesser likelihood of using and adhering to highly active antiretroviral therapy (HAART). Such associations point to the importance of the quality of depression treatment received by these women and whether it meets practice guidelines established by the American Psychiatric Association and the Agency for Health Care Policy and Research. The purpose of the present study was to examine the psychopharmacologic and psychotherapeutic treatment received by a large cohort of depressed HIV+ women, and to determine whether it met established standards for adequate treatment as defined in the clinical literature.
 
Method / Issue:
The sample was composed of HIV-positive women enrolled in the Womens Interagency HIV Study, a multi-site cohort study conducted in six U.S. cities. Starting in April 1994, women were interviewed every six months through March 2006. Depression was measured using the Center for Epidemiologic Studies Depression Scale, with the standard cutoff of 16 indicating clinically significant depression (CSD), and the cutoff of 27 indicating Major Depressive Disorder (MDD). At the most recent visit, women were asked a series of questions about medications they were taking for depression, outpatient visits to physicians for medication management, and outpatient visits with professionals in the specialty mental health sector for psychotherapy. Following published practice guidelines, minimally adequate treatment for depression was defined as receiving either: (1) four or more outpatient visits with any type of doctor for pharmacotherapy that included use of any antidepressant or mood stabilizer; or (2), eight or more therapy sessions of at least thirty minutes with a mental health professional for psychotherapy.
 
Results / Comments:
A total of 1707 women responded to questions regarding depressive symptoms and depression treatment. At the study visit 12 months prior, over half (55.8%, n=925) met the CES-D cutoff for CSD, and 28.1% (n=467) met the cutoff for MDD. Of those with indicated CSD, only 15% (n=137) met the first treatment standard and 13% (n=120) the second, for a combined total of 21.4% (n=198) receiving adequate treatment for depression. Of those with indicated MDD, only 20% (n=93) met the first treatment standard and 16.1% (n=75) the second, for a combined total of 27.8% (n=130) receiving adequate treatment for depression. A multivariate logistic regression analysis found that those not receiving minimally adequate treatment were younger, more likely to be employed, Caucasian, and have low CD4; and less likely to see a consistent health care provider, and have experience with IV drug use prior to baseline.
 
Discussion:
The high rate of depression in this cohort, coupled with the absence of treatment meeting established guidelines, constitutes a call to action. Given that over two-thirds (67.4%) of the total population were receiving best-practice anti-retroviral therapy (HAART), the extremely low proportion receiving minimally adequate depression treatment is cause for concern. Hopefully, greater efforts can be made to screen HIV-positive women for depression, and offer effective and culturally sensitive psychotropic and psychotherapeutic therapies.
 
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