Cumulative Burden of Depression and All-Cause Mortality in Women Living With Human Immunodeficiency Virus

Jon C. Mills, Brian W. Pence, Jonathan V. Todd, Angela M. Bengtson, Tiffany L. Breger, Andrew Edmonds, Robert L. Cook, Adebola A. Adedimeji, Rebecca M. Schwartz, Seble Kassaye, Joel Milam, Jennifer Cocohoba, Mardge Cohen, Elizabeth Golub, Gretchen Neigh, Margaret Fischl, Mirjam Colette Kempf, Adaora A. Adimora

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Research linking depression to mortality among people living with human immunodeficiency virus (PLWH) has largely focused on binary "always vs never" characterizations of depression. However, depression is chronic and is likely to have cumulative effects on mortality over time. Quantifying depression as a cumulative exposure may provide a better indication of the clinical benefit of enhanced depression treatment protocols delivered in HIV care settings.

Methods: Women living with HIV (WLWH), naive to antiretroviral therapy, from the Women's Interagency HIV Study were followed from their first visit in or after 1998 for up to 10 semiannual visits (5 years). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. An area-under-the-curve approach was used to translate CES-D scores into a time-updated measure of cumulative days with depression (CDWD). We estimated the effect of CDWD on all-cause mortality using marginal structural Cox proportional hazards models.

Results: Overall, 818 women contributed 3292 woman-years over a median of 4.8 years of follow-up, during which the median (interquartile range) CDWD was 366 (97-853). Ninety-four women died during follow-up (2.9 deaths/100 woman-years). A dose-response relationship was observed between CDWD and mortality. Each additional 365 days spent with depression increased mortality risk by 72% (hazard ratio, 1.72; 95% confidence interval, 1.34-2.20).

Conclusions: In this sample of WLWH, increased CDWD elevated mortality rates in a dose-response fashion. More frequent monitoring and enhanced depression treatment protocols designed to reduce CDWD may interrupt the accumulation of mortality risk among WLWH.

Original languageEnglish (US)
Pages (from-to)1575-1581
Number of pages7
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume67
Issue number10
DOIs
StatePublished - Oct 30 2018

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HIV
Depression
Mortality
Clinical Protocols
Epidemiologic Studies
Proportional Hazards Models
Area Under Curve
Confidence Intervals

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Cumulative Burden of Depression and All-Cause Mortality in Women Living With Human Immunodeficiency Virus. / Mills, Jon C.; Pence, Brian W.; Todd, Jonathan V.; Bengtson, Angela M.; Breger, Tiffany L.; Edmonds, Andrew; Cook, Robert L.; Adedimeji, Adebola A.; Schwartz, Rebecca M.; Kassaye, Seble; Milam, Joel; Cocohoba, Jennifer; Cohen, Mardge; Golub, Elizabeth; Neigh, Gretchen; Fischl, Margaret; Kempf, Mirjam Colette; Adimora, Adaora A.

In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol. 67, No. 10, 30.10.2018, p. 1575-1581.

Research output: Contribution to journalArticle

Mills, JC, Pence, BW, Todd, JV, Bengtson, AM, Breger, TL, Edmonds, A, Cook, RL, Adedimeji, AA, Schwartz, RM, Kassaye, S, Milam, J, Cocohoba, J, Cohen, M, Golub, E, Neigh, G, Fischl, M, Kempf, MC & Adimora, AA 2018, 'Cumulative Burden of Depression and All-Cause Mortality in Women Living With Human Immunodeficiency Virus', Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol. 67, no. 10, pp. 1575-1581. https://doi.org/10.1093/cid/ciy264
Mills, Jon C. ; Pence, Brian W. ; Todd, Jonathan V. ; Bengtson, Angela M. ; Breger, Tiffany L. ; Edmonds, Andrew ; Cook, Robert L. ; Adedimeji, Adebola A. ; Schwartz, Rebecca M. ; Kassaye, Seble ; Milam, Joel ; Cocohoba, Jennifer ; Cohen, Mardge ; Golub, Elizabeth ; Neigh, Gretchen ; Fischl, Margaret ; Kempf, Mirjam Colette ; Adimora, Adaora A. / Cumulative Burden of Depression and All-Cause Mortality in Women Living With Human Immunodeficiency Virus. In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2018 ; Vol. 67, No. 10. pp. 1575-1581.
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abstract = "Background: Research linking depression to mortality among people living with human immunodeficiency virus (PLWH) has largely focused on binary {"}always vs never{"} characterizations of depression. However, depression is chronic and is likely to have cumulative effects on mortality over time. Quantifying depression as a cumulative exposure may provide a better indication of the clinical benefit of enhanced depression treatment protocols delivered in HIV care settings.Methods: Women living with HIV (WLWH), naive to antiretroviral therapy, from the Women's Interagency HIV Study were followed from their first visit in or after 1998 for up to 10 semiannual visits (5 years). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. An area-under-the-curve approach was used to translate CES-D scores into a time-updated measure of cumulative days with depression (CDWD). We estimated the effect of CDWD on all-cause mortality using marginal structural Cox proportional hazards models.Results: Overall, 818 women contributed 3292 woman-years over a median of 4.8 years of follow-up, during which the median (interquartile range) CDWD was 366 (97-853). Ninety-four women died during follow-up (2.9 deaths/100 woman-years). A dose-response relationship was observed between CDWD and mortality. Each additional 365 days spent with depression increased mortality risk by 72{\%} (hazard ratio, 1.72; 95{\%} confidence interval, 1.34-2.20).Conclusions: In this sample of WLWH, increased CDWD elevated mortality rates in a dose-response fashion. More frequent monitoring and enhanced depression treatment protocols designed to reduce CDWD may interrupt the accumulation of mortality risk among WLWH.",
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T1 - Cumulative Burden of Depression and All-Cause Mortality in Women Living With Human Immunodeficiency Virus

AU - Mills, Jon C.

AU - Pence, Brian W.

AU - Todd, Jonathan V.

AU - Bengtson, Angela M.

AU - Breger, Tiffany L.

AU - Edmonds, Andrew

AU - Cook, Robert L.

AU - Adedimeji, Adebola A.

AU - Schwartz, Rebecca M.

AU - Kassaye, Seble

AU - Milam, Joel

AU - Cocohoba, Jennifer

AU - Cohen, Mardge

AU - Golub, Elizabeth

AU - Neigh, Gretchen

AU - Fischl, Margaret

AU - Kempf, Mirjam Colette

AU - Adimora, Adaora A.

PY - 2018/10/30

Y1 - 2018/10/30

N2 - Background: Research linking depression to mortality among people living with human immunodeficiency virus (PLWH) has largely focused on binary "always vs never" characterizations of depression. However, depression is chronic and is likely to have cumulative effects on mortality over time. Quantifying depression as a cumulative exposure may provide a better indication of the clinical benefit of enhanced depression treatment protocols delivered in HIV care settings.Methods: Women living with HIV (WLWH), naive to antiretroviral therapy, from the Women's Interagency HIV Study were followed from their first visit in or after 1998 for up to 10 semiannual visits (5 years). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. An area-under-the-curve approach was used to translate CES-D scores into a time-updated measure of cumulative days with depression (CDWD). We estimated the effect of CDWD on all-cause mortality using marginal structural Cox proportional hazards models.Results: Overall, 818 women contributed 3292 woman-years over a median of 4.8 years of follow-up, during which the median (interquartile range) CDWD was 366 (97-853). Ninety-four women died during follow-up (2.9 deaths/100 woman-years). A dose-response relationship was observed between CDWD and mortality. Each additional 365 days spent with depression increased mortality risk by 72% (hazard ratio, 1.72; 95% confidence interval, 1.34-2.20).Conclusions: In this sample of WLWH, increased CDWD elevated mortality rates in a dose-response fashion. More frequent monitoring and enhanced depression treatment protocols designed to reduce CDWD may interrupt the accumulation of mortality risk among WLWH.

AB - Background: Research linking depression to mortality among people living with human immunodeficiency virus (PLWH) has largely focused on binary "always vs never" characterizations of depression. However, depression is chronic and is likely to have cumulative effects on mortality over time. Quantifying depression as a cumulative exposure may provide a better indication of the clinical benefit of enhanced depression treatment protocols delivered in HIV care settings.Methods: Women living with HIV (WLWH), naive to antiretroviral therapy, from the Women's Interagency HIV Study were followed from their first visit in or after 1998 for up to 10 semiannual visits (5 years). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. An area-under-the-curve approach was used to translate CES-D scores into a time-updated measure of cumulative days with depression (CDWD). We estimated the effect of CDWD on all-cause mortality using marginal structural Cox proportional hazards models.Results: Overall, 818 women contributed 3292 woman-years over a median of 4.8 years of follow-up, during which the median (interquartile range) CDWD was 366 (97-853). Ninety-four women died during follow-up (2.9 deaths/100 woman-years). A dose-response relationship was observed between CDWD and mortality. Each additional 365 days spent with depression increased mortality risk by 72% (hazard ratio, 1.72; 95% confidence interval, 1.34-2.20).Conclusions: In this sample of WLWH, increased CDWD elevated mortality rates in a dose-response fashion. More frequent monitoring and enhanced depression treatment protocols designed to reduce CDWD may interrupt the accumulation of mortality risk among WLWH.

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