Depression and All-Cause Mortality in an HIV Treatment Cohort in Rural Uganda!
Mocello, A. Rain
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To determine the extent to which depression is associated with mortality among persons living with HIV (PLHIV) initiating antiretroviral therapy (ART).! 694 treatment-naïve PLHIV in rural Uganda were followed from initiation of ART. Each participant provided quarterly data through blood draws and structured interviews. Baseline depression symptom severity and mental health status were measured using locally adapted versions of the Hopkins Symptom Checklist and MOS-HIV mental health summary. Vital status was ascertained through participant tracing after missed study visits. We fit Cox proportional hazards regression models, adjusting our estimates for baseline age, sex, marital status, educational attainment, household asset wealth, CD4+ T-lymphocyte cell count, body mass index, and MOS-HIV physical health summary.! Over 4.3 median years of follow-up, only 48 participants (7%) were lost to follow-up and there were 44 deaths. After multivariable adjustment, probable depression was associated with increased mortality (AHR=2.24; 95% CI, 1.08-4.62), while mental health-related quality of life was not (AHR=0.98; 95% CI, 0.94-1.03).! Conclusions: Depressed mood is associated with increased mortality among HIV+ persons initiating ART. Screening for depression may be a relatively low-cost method of identifying HIV+ persons at high risk for mortality. Whether pre-ART depression reflects underlying immune activation or poor overall health status should be addressed in future studies.!
- Medical and Health Sciences