The purpose of this study was to assess the prevalence of distress, anxiety, and depression in persons with human immunodeficiency virus (HIV) infection and determine the feasibility of screening in an urban HIV primary care setting. A convenience sample of 101 patients in the waiting room of an acquired immunodeficiency syndrome clinic completed two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer. The patient's demographic, medical, and psychiatric histories were obtained through chart review. The results of the Distress Thermometer revealed that 72.3% had a score of 5 or greater, demonstrating high distress. The results of the HADS revealed that 70.3% had high anxiety, with a score of 7 or greater. On the HADS depression questions, 45.5% had a score of 7 or greater, indicating depression. Analysis of the total HADS scores, including anxiety and depression, revealed that 53.5% had a score of greater than 15 and were experiencing significant distress. Patients with high viral loads were more likely to be distressed (P < 0.0005). Patients with high viral loads were also more likely to have higher anxiety or depression scores on the HADS. Patients who had CD4 counts higher than 500/mm3 were less likely to be depressed. This study demonstrates a high prevalence of distress, anxiety, and depression among persons with HIV. The HADS and the Distress Thermometer showed a good correlation with each other (P < 0.0005), and these questionnaires can provide a simple and efficient method for rapid screening in an HIV clinic setting.
Persons infected with human immunodeficiency virus (HIV) are living longer and healthier lives as a result of better medical care, major advances in antiretroviral therapy, and prophylaxis of some of the initially fatal complications.1 However, many continue to experience distress from symptoms such as pain, fatigue, insomnia, anxiety, and depression. Some people with HIV are also at increased risk for comorbid psychiatric disorders because of the high prevalence of drug dependence.2 Patients with advanced acquired immunodeficiency syndrome (AIDS) are especially vulnerable to dementia and suicide.3 In addition to these special vulnerabilities, persons with HIV and AIDS are also subject to family crises, financial stressors, losses, and a multiplicity of medical illnesses. Anxiety and depression may be factors in both quality of life and adherence to the complex regimen for HIV treatment.4
As AIDS continues to be the leading cause of death among Americans aged 25–44 years old, heterosexual transmission of HIV, especially from men to women, is increasing.5 Recognition and treatment of distress, anxiety, depression, and other psychiatric symptoms in HIV-positive persons can improve care, increase adherence, and decrease the transmission of HIV.6., 7. and 8.
A study by Lyketsos et al.9 at an HIV primary care clinic found a high prevalence of distress in HIV-infected persons. The authors identified 52% of their participants as having significant depression by using the General Health Questionnaire and the Beck Depression Inventory and found that 65.6% had a history of a substance use disorder.9 Community samples had identified only 4%–15% of participants as having a current major depressive disorder and 20%–35% as having substance abuse.10., 11. and 12.
Patients with psychiatric morbidity are at greater risk for poor adherence to antiretroviral therapy and higher risk for treatment failure. A study by Gordillo et al.7 found that patients who were depressed had poorer compliance with antiretroviral treatment. Adherence to antiretroviral medications is an important factor in illness outcome because most antiretroviral therapies require adherence 95% of the time for optimal effectiveness.8 Patient compliance has become more important because advances in antiretroviral therapy have led to a shift from inpatient care to the outpatient setting. With the shift to ambulatory care and the pressure to see more patients in shorter periods of time, clinicians may have more difficulty recognizing, diagnosing, and treating distress and related psychiatric problems. To screen a large number of patients in an efficient, timely manner, many clinics have relied on assessment questionnaires. This study examines the prevalence of distress, anxiety, and depression among persons with HIV and the feasibility of using screening questionnaires in the setting of a crowded waiting room in an HIV primary care clinic.
