PREVALENCE AND PREDICTORS OF DEPRESSIVE, ANXIETY AND SUBSTANCE USE DISORDERS IN HIV-INFECTED AND UNINFECTED MEN - A LONGITUDINAL EVALUATION

Background. There is little agreement on whether the prevalence of psy chiatric disorder is elevated in HIV-seropositive (HIV +) populations compared with uninfected persons. However, evaluation of this issue ha s been limited by difficulties of sampling, study design and failure t o control for other risk factors for disorder. Methods.Prevalence and clinical characteristics of DSM-III-R major depressive disorder genera lized anxiety disorder, adjustment disorder, and alcohol and substance abuse/dependence were evaluated in a representative sample of HIV+ me n attending primary care physicians' offices in a defined geographical area. Lifetime prevalence at baseline and 1-year rates during longitu dinal follow-up were determined for the 113 HIV+ men, as well as 57 HI V- men, via standardized interview. Multivariate analyses considered u nique and combined effects of HIV serostatus and other risk factors on likelihood of disorder. Results. Although there were no differences i n lifetime rates prior to baseline, HIVS men were at greater risk for disorders during the prospective study period. For MDD, this effect wa s maintained even after controlling for other risk factors. Several of these other factors bore their own effects: regardless of HIV serosta tus, men were susceptible to psychopathology if at baseline they were younger, had a lifetime psychiatric history, or had poor social suppor ts or a low sense of personal mastery. Conclusions. The risk of certai n psychiatric disorders appears uniquely elevated in HIVS men. Since o ther factors also influence risk, interventions designed to minimize p sychopathology during HIV infection should attend to both HIV-related and non-HIV-related risk factors.