Discrepancies between physician's perception of depression in HIV patients and self-reported CES-D-20 assessment: the DHIVA study

ABSTRACT

Depression in HIV/AIDS patients affects adherence and disease progression and often goes unnoticed. DHIVA is a cross-sectional epidemiologic survey, investigating the prevalence of depression in people living with HIV through use of a validated self-administered scale (CES-D-20), as well and the degree of concordance between the physician's perception and patients' reports. A total of 690 HIV-infected patients attending 24 centers across Italy were enrolled. Concordance was calculated by K statistics. Association between depression and subject characteristics were evaluated through univariate and multivariate logistic models (OR and 95%CI). The prevalence of depressive symptoms was 48.8% from patient's questionnaires and 49.5% from physicians' reports, with a low/fair concordance (K = .38, p < .001). CES-D-20 found severe depression in 22.5% of the patients vs 4% identified by physicians. 135/155 (87%) of the severely depressed patients (according to CES-D-20) were considered as non or mildly/moderately depressed by physicians. Risk of severe depression was associated with unemployment (p < .001), previous depression (p < .001), treatment failure (p = .001), and former smoking status (p = .018). Depression is frequent in HIV-infected patients in the HAART era, with significant discrepancy between physician perception and the self-reported CES-D-20 results. Screening should be mandatory in all HIV patients.

KEYWORDS:

• Depression
• HIV
• CES-D-20 scale
• psychological evaluation

Acknowledgements

The authors wish to thank all patients and all Clinical Centers involved in the DHIVA Study. They also wish to thank Pencil and Papers (Italy) for the editorial assistance in preparing this manuscript.

Disclosures statement

The study was entirely sponsored by AbbVie. The design and study conduct support for this study was provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the publication. F.M, G.G, A.M.C and U.d.L.P. are employees of AbbVie and may own AbbVie stocks or options. M.G. is a member of the Panel for the “Italian Guidelines for the Use of Antiretroviral Agents and the Diagnostic-clinical Management of HIV-1 infected Persons”. He has served on the Advisory Boards for Abbvie srl, BMS, Gilead, GSK, Janssen-Cilag, MSD, ViiV. A.A. has received honoraria for consultancy from Abbvie srl, Bristol-Myers Squibb, Gilead Sciences, Merck, Janssen-Clilag, ViiV Healthcare, and has received research founding from Bristol-Myers Squibb, Gilead Sciences, and ViiV Healthcare. A. A. is a member of the Panel for the “Italian Guidelines for the Use of Antiretroviral Agents and the Diagnostic-clinical Management of HIV-1 infected Persons”. She has served on the Advisory Boards for Abbvie, Merck, Janssen, and Gilead.

DHIVA Study Group

Figoni M., Divisione Malattie Infettive ad Alta Complessità 2, Azienda Ospedaliera D. Cotugno, Napoli;

Andreoni M., Maffongelli G., UOC di Malattie Infettive e Day Hospital Fondazione Policlinico Tor Vergata, Roma;

Mercuri A., Clinica Malattie Infettive Ospedale S. Maria della Misericordia, Perugia;

Carosi G., Motta D., Istituto Malattie Infettive e Tropicali Azienda Ospedaliera Spedali Civili di Brescia;

Cattelan A.M., Sasset L., SOC di Malattie Infettive Ospedale “Santa Maria della Misericordia”, Rovigo;

Cauda R., Ciccarelli N., Istituto di Clinica Malattie Infettive Università Cattolica, Roma;

Chirianni A., Sangiovanni V., III Divisione Malattie Infettive Azienda Ospedaliera D. Cotugno Napoli;

Colangeli V., Magistrelli E., U.O. di Malattie Infettive Azienda Ospedaliera Universitaria Policlinico S. Orsola Malpighi, Bologna;

Di Perri G., Trentini, L., Clinica Universitaria di Malattie Infettive Ospedale Amedeo di Savoia, Torino;

D'Arminio Monforte A., Comi L., Clinica Malattie Infettive Azienda Ospedaliera San Paolo, Milano;

Manzillo E., VIII Malattie Infettive Azienda Ospedaliera D. Cotugno, Napoli;

Lazzarin A., Fondazione San Raffaele del Monte Tabor di Milano;

Leoncini F., Martinelli C.V., SOD Malattie Infettive Azienda Ospedaliera Careggi, Firenze;

Blè C., Ospedale S. Maria Annunziata, Firenze;

Uglietti A., Clinica Malattie Infettive IRCCS Policlinico San Matteo, Pavia;

Montella F., Di Sora F., Dip.to delle Scienze Mediche U.O.C. Medicina 5 ad Indirizzo Immunologico, Roma;

Mughini M.T., Istituto Malattie Infettive ARNAS, A.O. Garibaldi di Nesima, Catania

Clinica Malattie Infettive Azienda Ospedaliera Universitaria di Sassari;

Narciso P., Bellagamba, IV Divisione Malattie Infettive IRCCS, Roma;

Parruti G., Vadini F., U.O Malattie Infettive e Tropicali, Pescara;

Rizzardini G., Capetti A., I°Divisione Malattie Infettive Ospedale L. Sacco di Milano;

Sighinolfi L., Segala D., U.O. Malattie Infettive Azienda Ospedaliero Universitaria di Ferrara