CHANGES IN DEPRESSIVE SYMPTOMS AS AIDS DEVELOPS

Objective: The authors sought to determine whether rates of depressive symptoms change from early-to-late-stage HIV-1 infection and to deter mine the predictors of depressive symptoms as AIDS develops. Method: T he data for this study were from 911 HIV-seropositive men-community vo lunteers from four U.S. cities-who entered the 10-year Multicenter AID S Cohort Study without a diagnosis of AIDS and subsequently developed AIDS. The subjects underwent semiannual follow-ups during the study pe riod. The outcomes measures-overall depressive symptoms, nonsomatic de pressive symptoms, syndromal depression, and severe depression-were as sessed over the 5 years before and the 2 years after AIDS diagnosis fr om responses on the Center for Epidemiologic Studies Depression Scale (CES-D Scale). Results: Depressive symptoms were stable over time from month 60 to month 18 before AIDS developed. However, beginning 12-18 months before AIDS diagnosis, there was a significant rise in all meas ures of depression, which reached a plateau within 6 months before AID S developed. At this plateau, there was a 45% increase in mean CES-D S cale scores above baseline. An elevated CES-D Scale score in the earli er stages of infection, a self-report of AIDS-related symptoms (such a s rash and lymphadenopathy), concurrent unemployment, cigarette smokin g, and limited social supports were consistent predictors of higher ra tes of depression as AIDS developed. Conclusions: There is a dramatic, sustained rise in depressive symptoms as AIDS develops, beginning as early as 18 months before clinical AIDS is diagnosed. Prior depression , HIV-disease-related factors, and psychological stressors contribute to this rise. This robust phenomenon invites further characterization.