Preliminary communicationDepression and suicidality in HIV/AIDS in China
Introduction
Persons with HIV infection and AIDS are at risk for neuropsychiatric comorbidity, particularly depression and neurocognitive disorders (Grant and Atkinson, 2000, Leserman et al., 2000, Lyketsos et al., 1996). Most data, however, derive from western industrialized contexts, and their generalizability to Asian or African settings, where the HIV epidemic is centered, is not known. This is especially true for China, where the magnitude of the HIV problem has been recognized only relatively recently. In this paper, we present, to our best knowledge, the first data on depression and suicidal ideation related to HIV infection in a Chinese cohort.
The context of HIV infection in China differs from that in the West and is important to understand, as it may affect neuropsychiatric outcome. The China Center for Disease Control (China-CDC) currently estimates the cumulative numbers of persons with HIV infection and AIDS in China have reached 840,000 and 80,000, respectively (China-CDC, 2003). Unlike the US, where the HIV epidemic started within the homosexual population, HIV infection in China concentrated in three high-risk populations: injection drug users (IDUs); commercial plasma donors; and sex workers (China-CDC, 2003). However, in recent years, the HIV epidemic has started to spread from these high-risk groups to the general population (China-CDC, 2003).
Prior research in the US and Europe has noted elevated rates of mood and substance use disorders in HIV populations compared to the general population (Atkinson et al., 1988, Bing et al., 2001, Dew et al., 1997, Lipsitz et al., 1994, Maj, 1996, Perkins et al., 1994, Rabkin et al., 1997, Rosenberger et al., 1993, Williams et al., 1991). Lifetime rates of major depression in HIV-infected homosexual men and IDUs approach 40% (Atkinson et al., 1988, Bing et al., 2001, Maj, 1996, Perkins et al., 1994, Rosenberger et al., 1993, Lipsitz et al., 1994, Rabkin, 1996). Rates of current major depression are about 10% (Perkins et al., 1994, Rabkin et al., 1997, Williams et al., 1991), slightly higher than those in HIV-negative primary care populations (Katon and Schulberg, 1992). Although marked distress and suicidality may be evident after news of testing HIV-positive, US studies suggest that both dysphoria and suicidal ideation remit within weeks or months (Jacobsen et al., 1990, Perry, 1994).
Since it is unclear whether findings in western countries pertain to China, the NeuroAIDS teams at the HIV Neurobehavioral Research Center (HNRC) at the University of California, San Diego (UCSD), and the China-CDC and the Mental Health Institute at Peking University conducted a neurocognitive feasibility study in China in early 2004. This article reports our findings on depression, suicidality and their association with daily functioning change in HIV-infected patients and HIV-negative controls. We postulated that (1) the rate of major depression and suicidality in HIV-positive participants would be significantly higher than that in HIV-negatives; (2) in the HIV-positive group, the severity of depression would be significantly associated with more impaired daily functioning, independent of HIV stage and demographic factors.
Section snippets
HIV neurocognitive feasibility study in China
The China HIV Neurocognitive Feasibility Study was launched after more than 1 year of preparatory work that included selection and construction of research instruments, translation and back-translation of selected English language instruments, revision and modification of culturally inappropriate items, and the training of examiners in China. This research study was approved by the Institution Review Boards (IRBs) from both China-CDC and UCSD. Written informed consent was obtained from all
Depression
Almost 79% (22/28) of the HIV+ compared to 4% (1/23) of HIV− group met criteria for lifetime major depression (p < .001, Fisher's Exact Test). HIV+ individuals also reported more depressive symptoms currently (HIV+ BDI = 22.4 vs. HIV− BDI = 6.6, p < .001). When “somatic” items (items 14–21) were removed from scoring, HIV+ individuals still had significantly more depressive symptoms than the uninfected individuals (HIV+ non-somatic = 14.6 vs. HIV− non-somatic = 4.1, p < .001) (Table 1).
In Western countries,
Discussion
The lifetime rate of major depression was 79% in a group of HIV-infected individuals in China, which was significantly higher than a HIV− comparison group (4%). In contrast to the experience in western developed settings, where first onset of major depression generally precedes HIV, in our Chinese sample, almost all depressive episodes first commenced within 6 months after known seropositivity. Over half of the Chinese HIV+ group had suicidal thoughts, and one-third had either made a plan for
Acknowledgement
We thank Donald Franklin for his assistance in training and data quality control and Deborah Lazzaretto for her statistical consultation. Supported in part by National Institute of Mental Health Grant MH-62512. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of Veterans Affairs or the United States Government.
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