The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area-Piedmont Health Survey

The association between depression and two-year mortality risk was assessed in 1,606 elderly community participants in the 1982-83 Epidemiologic Catchment Area-Piedmont Health Survey. Two depression measures were formed from the Diagnostic Interview Schedule (DIS) depressive symptom items. Neither measure was associated with mortality in univariate or multiple logistic regression analyses. The adjusted relative risk of mortality comparing the lowest to highest levels of a three-level depression variable was 0.9 (95% confidence interval = 0.5-1.4). Similar results were obtained with other versions of the depression variables, with each depressive symptom category, and within sex, chronic disease, widowhood status, and age groups. These results indicate that depression does not increase mortality in elderly adults, but the short follow-up, sample characteristics, and operationalization of depression may have affected this association.     

The association between hepatitis C infection and prevalent cardiovascular disease among HIV-infected individuals

OBJECTIVE: To examine the association between hepatitis C and prevalent cardiovascular disease (CVD) among HIV-infected individuals. DESIGN: A cross-sectional analysis of data from the HIV-Longitudinal Interrelationships of Viruses and Ethanol (HIV-LIVE) cohort, a prospective cohort of HIV-infected individuals with current or past alcohol problems. METHODS: We analysed health questionnaire and laboratory data from 395 HIV-infected individuals (50.1% co-infected with hepatitis C) using logistic regression to estimate the odds ratio (OR) for the prevalence of CVD among those co-infected with hepatitis C and HIV compared with those infected with HIV alone. RESULTS: The prevalence of CVD was higher among those co-infected with hepatitis C compared with those with HIV alone (11.1 versus 2.5%, respectively). After adjusting for age, the OR for the prevalence of CVD was significantly higher among those with hepatitis C co-infection (adjusted OR 4.65, 95% confidence interval 1.70-12.71). The relationship between hepatitis C and CVD persisted when adjusting for age and other sociodemographic characteristics, substance use, and cardiovascular risk factors in separate regression models. CONCLUSION: Co-infection with hepatitis C among a cohort of HIV-infected individuals was associated with a higher age-adjusted odds for the prevalence of CVD. These data suggest that hepatitis C infection may be associated with an increased risk of CVD among those co-infected with HIV.     

Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: a systematic review and meta-analysis

Depressed mood is highly prevalent among HIV-infected individuals. Some but not all studies have found group psychotherapy to be efficacious in this population. We performed a systematic review and meta-analysis of double-blinded, randomized controlled trials to examine efficacy of group psychotherapy treatment among HIV infected with depressive symptoms. We used PubMed, the Cochrane database, and a search of bibliographies to find controlled clinical trials with random assignment to group psychotherapy or control condition among HIV infected patients with depressive symptoms. The principal measure of effect size was the standard difference between means on validated depression inventories. We identified 8 studies that included 665 subjects: 5 used cognitive behavioral therapy (CBT), 2 used supportive therapy, and 1 used coping effectiveness training. Three of the 8 studies reported significant effects. The pooled effect size from the random effects model was 0.38 (95% confidence interval [CI]: 0.23-0.53) representing a moderate effect. Heterogeneity of effect was not found to be significant (p = 0.69; I(2) = 0%). Studies reporting use of group CBT had a pooled effect size from the random effects model of 0.37 (95% CI: 0.18-0.56) and was significant. Studies reporting the use of group supportive psychotherapy had a pooled effect size from the random effects model 0.58 (95% CI: -0.05-1.22) and was nonsignificant. The results of this study suggest that group psychotherapy is efficacious in reducing depressive symptoms among, HIV-infected individuals. Of note, women were nearly absent from all studies. Future studies should be directed at addressing this disparity.     

Reduced morbidity and mortality in the first year after initiating highly active anti-retroviral therapy (HAART) among Ugandan adults

Objective  To evaluate the effect of highly active anti-retroviral therapy (HAART) and cotrimoxazole prophylaxis on morbidity after HAART eligibility.
Methods  Between 1999 and 2006, we collected morbidity data from a community-based cohort of HAART-eligible patients, comparing patients initiating HAART and those non-HAART. Patients aged 15 years or older visited the clinic every 6 months and when ill. Baseline data on patients' characteristics, WHO stage, haemoglobin and CD4+ T-cell counts, along with follow-up data on morbidity (new, recurrent and drug-related), were collected for the first year after initiating HAART or becoming HAART-eligible. We estimated the overall effect of HAART on morbidity; adjusted for the effect of cotrimoxazole prophylaxis by Mantel–Haenszel methods. A negative binomial regression model was used to assess rate ratios (RR) after adjustment for other confounders, including cotrimoxazole.
Results  A total of 219 HAART patients (median age 37 years; 73% women; 82% using cotrimoxazole prophylaxis, median haemoglobin 11.7 g/dl and median CD4+ 131 cells/μl) experienced 94 events in 127 person-years. 616 non-HAART patients (median age 33 years; 70% women; 26% using cotrimoxazole prophylaxis, median haemoglobin 11.2 g/dl and median CD4+ 130 cells/μl) experienced 862 events in 474 person-years. The overall morbidity during the first year of HAART was 80% lower than among non-HAART patients (adjusted RR = 0.20, 95% CI: 0.12–0.34). Cotrimoxazole prophylaxis also reduced morbidity (adjusted RR = 0.65, 95% CI: 0.45–0.94).
Conclusion  These results confirm the reduction in morbidity due to HAART, and the additional protection of cotrimoxazole prophylaxis.     

MOS-HIV量表简体中文版的翻译修订及信度的效度评价

目的 翻译、修订形成简体中文版MOS-HIV量表,并评价其效度和信度.方法 将美语版MOS-HIV量表通过系统的翻译、回译、预测等程序,修订为简体中文版.根据对758例艾滋病患者的测量结果,分析量表的可行性、效度和信度.结果 简体中文版MOS-HIV量表各条目所对应的最大因子负荷的分类结果,与量表的设计基本吻合;不同CD4细胞水平的人群其各领域得分有显著差异;重测信度各领域Pearson's相关系数范围为0.46～0.92,内部一致性各领域Cronbach's a系数范围为0.69～0.87.结论 修订的简体中文版MOS-HIV量表有良好的效度和信度,适合中国艾滋病病毒感染人群生活质量评估,为进一步开展国内艾滋病相关生活质量的研究提供了基础和依据.     

The association of depressive symptoms and urinary incontinence among older adults

OBJECTIVES: To examine the relationship of urinary incontinence (UI) and depressive symptoms (DS) in older adults. DESIGN: A randomized, controlled trial to determine the effects of clinical practice guideline implementation on provider attitudes and behavior, and patients' UI, health status, quality of life, and satisfaction with care. Baseline and endpoint data were collected from patients via computer-assisted telephone interviewing. SETTING: Forty-one nonacademic primary care practices (PCP) in North Carolina. PARTICIPANTS: A total of 668 community-dwelling adults (age > 60) who had visited the one of the selected PCPs. INTERVENTION: PCPs in the intervention group were given instruction in the detection and management of UI, educational materials for providers and patients, office system supports, and academic detailing. MEASUREMENTS: The dependent measure was assessed using an eight-item screener for DS. UI (status, frequency, amount), health (physical, mental), and demographic (age, gender, marital status) and self-report information about bladder control served as predictors. RESULTS: Wilcoxon rank sum tests showed that UI status was associated with moderate to severe DS (43% vs 30%, P = .05). Multivariate analyses showed that UI status, physical and mental health, and gender were significant predictors of DS. Among UI adults (n = 230), physical and mental health, life satisfaction, and the perception that UI interfered with daily life were significant predictors of DS. CONCLUSIONS: This study provides clear evidence that UI is related to DS in older adults.     

Effect of smoking and sedentary behavior on the association between depressive symptoms and mortality from coronary heart disease

It has been suggested that one of the mechanisms linking depression with elevated mortality risk is the association between depressive symptoms and other established coronary artery disease (CAD) risk factors, such as smoking and failure to exercise. The present study examined this hypothesis using repeated assessments of smoking and exercise from patients with CAD in whom depressive symptoms had been shown to predict decreased survival. Initially, associations between depressive symptoms and the risk factors of smoking and sedentary behavior were assessed. Next, patterns of smoking and sedentary behavior were examined as mediators and/or moderators of the association between depressive symptoms and mortality. Depressive symptoms were positively related to smoking (p <0.01) and sedentary behavior (p <0.01). Depressive symptoms, smoking, and sedentary behavior were independent predictors of mortality. Results indicated that smoking and/or sedentary behavior may partially mediate the relation between depressive symptoms and mortality. No evidence for moderation was found.     

The effect of a multidisciplinary program on HAART adherence

Although emerging evidence suggests differing interventions may improve antiretroviral adherence, there has not been a formal evaluation to identify the impact of a clinic-based multidisciplinary program designed to provide education and identify and correct potential adherence barriers prior to the initiation of highly active antiretroviral therapy (HAART). A retrospective cohort study utilizing a historical control group was conducted to compare duration on antiretrovirals, clinical indicators, and adherence rates, as captured by pharmacy refill records. Two hundred sixty-one patients met criteria for inclusion (109 subjects, 152 controls). Time to stopping antiretrovirals, as evidenced by Kaplan-Meier plot, was significantly higher in Protocol group than Controls (log-rank p = 0.023): the median duration on HAART for the intervention group was greater than 360 days but only 210 days for the control group. Thus, more subjects in the protocol group continued on therapy for the full year: 60 (55%) versus 65 (43%) for the control group. The mean reduction in log10 viral loads between HAART initiation and 12 months was greatest for the intervention group with viral load at HAART initiation 100,000 copies per milliliter or more, -3.57 versus -1.78 for controls with viral load less than 100,000 copies per milliliter (p < 0.001). For the intervention group, the mean number of adherence barriers identified per person was 4% and 72% were found to have three or more barriers. Patients at high risk for poor adherence benefit from multidisciplinary education and proactive identification of adherence barriers by exhibiting prolonged duration on therapy and greater reduction in log10 viral loads.     

Church attendance mediates the association between depressive symptoms and cognitive functioning among older Mexican Americans

BACKGROUND: The objective of this study was to examine how the effect of depressive symptoms on cognitive function is modified by church attendance. METHODS: We used a sample of 2759 older Mexican Americans. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) at baseline, 2, 5, 7, and 11 years of follow-up. Church attendance was dichotomized as frequent attendance (e.g., going to church at least once a month) versus infrequent attendance (e.g., never or several times a year). Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D; score >or=16 vs <16). General linear mixed models with time-dependent covariates were used to explore cognitive change at follow-up. RESULTS: In unadjusted models, infrequent church attendees had a greater decline in MMSE scores (drop of 0.151 points more each year, standard error [SE] = 0.02, p <.001) compared to frequent church attendees; participants having CES-D scores >or=16 also had greater declines in MMSE scores (drop of 0.132 points more each year, SE = 0.03, p <.001) compared to participants with CES-D score <16 at follow-up. In fully adjusted models, a significant Church attendance x CES-D x Time interaction (p =.001) indicated that, among participants with CES-D scores >or=16, infrequent church attendees had greater decline in MMSE scores (drop of 0.236 points more each year, SE = 0.05, p <.001) compared to frequent church attendees at follow-up. CONCLUSION: Church attendance appears to be beneficial for maintaining cognitive function of older persons. Church attendance moderates the impact of clinically relevant depressive symptoms on subsequent cognitive function.     

High prevalence of food insecurity among HIV-infected individuals receiving HAART in a resource-rich setting

This study aimed to assess the prevalence and correlates of food insecurity in a cohort of HIV-infected individuals on highly active antiretroviral therapy (HAART) in British Columbia (BC), Canada. Adults receiving HAART voluntarily enrolled into the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) cohort. Individual food insecurity was measured using a modified version of the Radimer/Cornell Questionnaire. We performed bivariate analyses to determine differences between explanatory variables for individuals who were food secure and food insecure. We performed logistic regression to determine independent predictors of food insecurity. Of the 457 individuals enrolled in the LISA cohort, 324 (71.0%) were found to be food insecure. Multivariate analysis indicated that individuals who had an annual incomes less than $15,000 (odds ratio [OR] 3.15, 95% confidence interval [CI] 1.83, 5.44), used illicit drugs (OR 1.85, 95% CI 1.03, 3.33), smoked tobacco (OR 2.30, 95% CI 1.30, 4.07), had depressive symptoms (OR 2.34, 95% CI 1.38, 3.96), and were younger (OR 0.95, 95% CI, 0.92, 0.98) were more likely to be food insecure. Our results demonstrated a high (71%) prevalence of food insecurity among HIV-infected individuals receiving HAART in this resource-rich setting, and that food insecurity is associated with a compendium of environmental and behavioral factors. More research is needed to understand the biological and social pathways linking food insecurity to these variables in order to identify program strategies that can effectively improve food security among HIV-infected populations.     

Impact of short-term adherence on virological and immunological success of HAART: a case study among French HIV-infected IDUs

To evaluate the impact of injection drug users (IDUs) adherence on effectiveness of highly active antiretroviral therapy (HAART), repeated measures of plasma viral load and CD4+ counts before HAART initiation and at last visit in the cohort were studied. Data were collected by means of patient's face-to-face and self-administered questionnaires about adherence to HAART during the week prior to the last visit. Of a total of 119 patients treated with HAART, undetectable viral load was obtained for 55 patients (46.2%) (G3); 34 patients (28.6%) (G2) had a viral load decline > 0.5 log copies/ml but still detectable viral load at last visit in the cohort, while 30 patients (25.2%) (G1) had no decline or decline 相似文献   

The interplay between life stressors and depressive symptoms among older adults

This study examined mutual predictive associations between life stressors and depressive symptoms in later life. A sample of late-middle-aged and older adults (N = 1,291) was surveyed at baseline and 1 year, 4 years, and 10 years later. At each contact point, participants completed an inventory that assessed chronic and acute life stressors and depressive symptoms. Over the 10-year interval, there was evidence of both social causation and social selection processes: More life stressors were associated with subsequent increases in depressive symptoms (social causation), and more depressive symptoms were associated with subsequent increases in stressors (social selection or stress generation). These findings reflect a mutual influence process in which life stressors and depressive symptoms can alter each other.     

Association between depressive symptoms and cerebrovascular lesions on MRI in community-dwelling elderly individuals

AIM: We conducted a community-based study to verify relationships between cerebrovascular lesions (CVL) on magnetic resonance imaging and depressive symptoms (DS) in elderly individuals, and the validity of Krishnan's MRI-defined vascular depression (MRI-VD). METHODS: MRI was performed in 196 community-dwelling elderly individuals (mean age, 72.3 +/- 1.7 years; range, 70-75 years) with a Mini Mental State (MMS) score of 22 or more who participated in the comprehensive geriatric assessment. The DS (+) group consisted of 41 subjects with Geriatric Depression Scale (GDS) score of 15 or more. The DS (-) group consisted of 141 subjects with a GDS score of 9 or less. Hyperintensities of deep white matter and subcortical gray matter were scored according to the modified Fazekas criteria. The CVL score was defined as the higher of the two scores, and 3 grades were defined as scores of 0, 1, or 2 or more. According to Krishnan's MRI-VD, a CVL score of 2 or more was defined as CVL (+). Logistic regression analyses were used to test associations between CVL and DS, and univariate analyses were used to examine differences in clinical features between CVL (+) and CVL (-) within the DS (+) group; RESULTS: Logistic regression analysis adjusting for age, sex, cognitive function, educational level, instrumental activities of daily life (IADL) and subjective healthiness, CVL scores of 1 and 2 or more displayed significant associations with DS compared with a score of 0. However, no significant differences in DS were found between CVL (+) and CVL (-). Within the DS (+) group, no significant differences were noted between CVL (+) and CVL (-) in MMS, IADL, subjective healthiness, sleeping symptoms, alcohol-related problem or suicidal ideation. CONCLUSION: CVL was associated with DS independent of various confounders. However, clarification of clinical profiles is required to define MRI-VD as an independent clinical entity.