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Women With HIV at Risk for Undermanagement of Depression

Women With HIV at Risk for Undermanagement of Depression

PALM SPRINGS, Calif--Women with HIV represent the fastest growing
segment of the epidemic and are among the most vulnerable for
the undermanage-ment of both pain and psychological distress,
Robert Boland, MD, and Margaret McDonald, CSW, said at the Academy
of Psychosomatic Medicine meeting.

Although large epidemiologic studies have shown that depression
is commonly associated with AIDS, the depressive symptoms of women
with HIV have not been well studied.

Dr. Boland, of the Miriam Hospital, Providence, RI, reported on
a longitudinal study (the HIV Epidemiology Research Study, or
HERS, sponsored by the CDC) in which data were gathered on women
at four urban sites (Baltimore, Providence, New York, and Detroit)
using the Center for Epidemiologic Studies Depression Scale (CES-D).

In a group of predominately African-American women (261 asymptomatic
HIV seropositive women and 234 at-risk seronegative women), depression
scores for both groups were significantly higher than those in
the general population.

Women in both groups reported a dramatic number of psychosocial
stressors, Dr. Boland said, including insufficient money to pay
for housing, unsafe housing, relationship difficulties, having
been attacked or raped, and having their children taken away from

Increased Stressors the Key

Those women who were HIV seroposi-tive reported greater numbers
of psycho-social stressors than did the women who were seronegative.
Yet there were no significant differences between the two groups
in depression scores (a mean of 20 for both groups, compared with
an average of 8 for the general population).

Further analysis suggested that increases in stressors and IV
drug use were associated with higher depression scores, but HIV
status did not contribute to depression scores. Additionally,
in the seroposi-tive group, neither CD4 count nor length of time
since diagnosis affected depression scores.

At early stages of the infection, depression is not associated
with HIV status but with the presence of psychosocial stressors,
Dr. Boland suggested. "Maybe depression plays a role in acquiring
HIV. Possibly the distortions in self-image inherent in depression
may lead to reduced care in practicing safe sex or other preventive
behaviors," he said, adding that this connection may have
important implications for AIDS prevention programs.


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