Trajectories of Depressive Symptoms Among a Population of HIV-Infected Men and Women in Routine HIV Care in the United States

Abstract

Depressive symptoms vary in severity and chronicity. We used group-based trajectory models to describe trajectories of depressive symptoms (measured using the Patient Health Questionnaire-9) and predictors of trajectory group membership among 1493 HIV-infected men (84%) and 292 HIV-infected women (16%). At baseline, 29% of women and 26% of men had depressive symptoms. Over a median of 30 months of follow-up, we identified four depressive symptom trajectories for women (labeled "low" [experienced by 56% of women], "mild/moderate" [24%], "improving" [14%], and "severe" [6%]) and five for men ("low" [61%], "mild/moderate" [14%], "rebounding" [5%], "improving" [13%], and "severe" [7%]). Baseline antidepressant prescription, panic symptoms, and prior mental health diagnoses were associated with more severe or dynamic depressive symptom trajectories. Nearly a quarter of participants experienced some depressive symptoms, highlighting the need for improved depression management. Addressing more severe or dynamic depressive symptom trajectories may require interventions that additionally address mental health comorbidities.

Keywords: Depression; Depressive symptoms; Group-based trajectory models; HIV; Trajectory analysis.

Fig. 1

Depressive symptom trajectories for 292 HIV-infected women and 1493 HIV-infected men in care in CNICS between 2005 and 2014. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Solid lines indicate observed mean depressive symptom scores and dotted lines indicated predicted mean depressive symptom score in each trajectory group, as estimated from a group-based trajectory model using a censored normal specification and random intercept. For women, the “low” trajectory was modeled using a linear term, the “mild to moderate” trajectory using a quadratic term, and the “improving” and “severe” trajectories were modeled using a cubic term. For men, the “low” trajectory group was modeled using a linear term, the “mild to moderate” trajectory using a quadratic term, the “rebounding” trajectory using a cubic term, the “improving” trajectory using a quadratic term, and the “severe” trajectory using a cubic term

Fig. 2

Distribution of Patient Health Questionne-9 (PHQ-9) depressive symptoms scores and proportion receiving antidepressant treatment prescription over time, stratified by gender and assigned trajectory group (based on each participant’s highest predicted posterior group-membership probability). Box and whisker plots of depressive symptoms scores indicate median and interquartile range values in the box, minimum and maximum values in the whiskers, and outliers in the circles

Fig. 3

Multivariable odds ratios and 95% confidence intervals for the relationship between baseline covariates and membership in each depressive symptoms trajectory group, compared to the low depressive symptom trajectory group, for HIV-infected women (4 groups) and men (5 groups). Each covariate represents a comparison of that factor to all other categories of that variable based on a trajectory model that accounts for group membership probabilities and covariance across parameter values, to ensure correct standard errors and 95% confidence interval coverage. ¹Defined as participants who had their baseline PRO measure ≤ 6 months after their initial CNICS visit and had a detectable viral load within 28 days of entering CNICS care. ²Defined as participants who had their baseline PRO measure ≤ 6 months after their initial CNICS visit. ³Defined as < 50 copies/mL; rx = prescription, dx = diagnosis