Optimal metrics for identifying long term patterns of depression in older HIV-infected and HIV-uninfected men who have sex with men

ABSTRACT

Objectives: Center of Epidemiologic Studies–Depression Scale (CES-D) provides a snapshot of symptom severity at a single point in time. However, the best way of using CES-D to classify long-term depression is unclear.

Method: To identify long-term depression among HIV-infected and HIV–uninfected 50+ year-old men who have sex with men (MSM) with at least 5 years of follow-up, we compared sensitivities and specificities of CES-D–based metrics (baseline CES-D; four consecutive CES-Ds; group-based trajectory models) thresholded at 16 and 20 to a clinician's evaluation of depression phenotype based on all available data including CES-D history, depression treatment history, drug use history, HIV disease factors, and demographic characteristics.

Results: A positive depressive phenotype prevalence was common among HIV-infected (prevalence = 33.1%) and HIV-uninfected MSM (prevalence = 23.2%). Compared to the depressive phenotype, trajectory models of CES-D≥20 provided highest specificities among HIV-infected (specificity = 99.9%, 95% Confidence Interval [CI]:99.4%–100.0%) and HIV-uninfected MSM (specificity = 99.0%, 95% CI:97.4%–99.7%). Highest sensitivities resulted from classifying baseline CES-D ≥ 16 among HIV-infected MSM (sensitivity = 75.0%, 95% CI:67.3%–81.7%) and four consecutive CES-Ds ≥ 16 among HIV-uninfected MSM (sensitivity = 81.0%, 95% CI:73.7%–87.0%).

Conclusion: Choice of method should vary, depending on importance of false positive or negative rate for long-term depression in HIV-infected and HIV-uninfected MSM.

KEYWORDS:

• Depression
• HIV infection
• sensitivity
• specificity
• validity

Acknowledgments

We would like to thank the participants of the Multicenter AIDS Cohort Study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by National Institutes of Health [grant number 1R03MH10396-01]. An additional source of support for MACS included the Center for AIDS Research, Johns Hopkins University [grant number 112547]. NMA was supported by fellowship from the Epidemiology and Biostatistics of Aging Training Grant [grant number 5T32AG000247]. Data in this manuscript were collected by the Multicenter AIDS Cohort Study (MACS). MACS (Principal Investigators): Johns Hopkins University Bloomberg School of Public Health (Joseph Margolick) [grant number U01-AI35042]; Northwestern University (Steven Wolinsky) [grant number U01-AI35039]; University of California, Los Angeles (Roger Detels) [grant number U01-AI35040]; University of Pittsburgh (Charles Rinaldo) [grant number U01-AI35041]; the Center for Analysis and Management of MACS, Johns Hopkins University Bloomberg School of Public Health (Lisa Jacobson) [grant number UM1-AI35043]. The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH). Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute on Deafness and Communication Disorders (NIDCD). MACS data collection is also supported by UL1-TR001079 (JHU ICTR) from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH), Johns Hopkins ICTR, or NCATS.  The MACS website is located at http://aidscohortstudy.org/.