The Impact of Apathy and Depression on Quality of Life in Patients Infected With HIV
May 8, 2003
Although highly active antiretroviral therapy (HAART) for HIV has significantly improved disease prognosis, challenges remain for patients living with a chronic medical condition. As a result, the importance of quality of life (QOL) among HIV patients continues to be a critical component of patient care. Recent studies have identified a range of factors that influence QOL, including increased viral load; decreased CD4 count; physical disability; and elevated fatigue. Psychosocial factors such as limited social support, restricted financial resources and poor access to health care are associated with lower QOL.
Neuropsychiatric aspects of HIV are also strongly associated with overall QOL, with depression being the most common. Apathy -- a reduction in goal-directed behavior that is manifested by decreased behavioral, cognitive, or psychological activity -- has recently been identified as a potentially important neuropsychiatric symptom associated with HIV. In the current study, the authors examine the contribution of apathy and depression on QOL among individuals infected with HIV.
A total of 45 HIV-positive patients (16 males, 29 females) were recruited from an academic HIV care program, with the majority being infected with HIV through IV drug use. Those excluded from the study include patients with a history of bipolar disease or schizophrenia, neurologic disorder, learning disability, or developmental disability. Average age for the patient was 42.7 (5.7) and 95.5 (63.7) months since diagnosis. All patients were taking HAART and all but two were asymptomatic. The median CD4 cell count was 310. The study included 22 control subjects who were recruited from the community and met the same exclusion criteria. The control group averaged 38.6 (10.7) years of age.
In a single testing session, participants completed demographic questionnaires and self-report measures of apathy, mood and QOL. All measures were administered and scored according to standard procedures.
Study results revealed that while apathy is more prevalent in HIV-infected subjects compared to the noninfected control subjects, the impact of apathy on QOL is relatively minimal when compared to depression. The clinical implications of the study are twofold. First, the frequency of apathy is far less than the frequency of clinically significant depression. The current study, as well as previous investigations, suggests that approximately 20 percent to 30 percent of HIV-positive patients report apathy ratings that exceed the threshold for clinical significance, compared to 80 percent reporting depression ratings that exceed the threshold for clinical significance. This study clearly indicates that depression is more common than apathy in this population.
The second major clinical implication is that the impact of apathy on health-related QOL is far less than the impact of depression. Despite the higher rates of both apathy and depression in this sample, only depression is strongly associated with ratings of health-related QOL and should remain the primary mental health concern for practitioners who provide treatment for HIV-infected individuals.
Demographic factors associated with an increased risk of depression include comorbid substance abuse, an increased number of severe life events, greater physical disease, and low social support. In addition, women, homosexual men, and those with a history of psychiatric illness prior to seroconversion are more likely to experience significant depression following seroconversion.
Depression increases with greater HIV disease severity and increased sense of hopelessness regarding one's physical health. In addition to the effectiveness of pharmacotherapy and psychotherapeutic interventions for HIV-positive individuals, there is preliminary evidence that successful treatment of HIV with HAART is associated with reductions in depression severity. Depression is associated with reduced QOL and poor adherence to HIV treatment regimes. Furthermore, there is some evidence that depression compromises the immune system, and in turn hastens progression of the disease. The authors concluded that "effective treatment of depression has the potential to significantly influence the mental and physical health of a population living with a chronic condition that continuously presents physical, social, and psychological challenges."
AIDS Patient Care and STDs
03.03; Vol. 17; No. 3: P. 115-120; David Tate, B.S.; Robert H. Paul, Ph.D.; Timothy P. Flanigan, M.D.; Karen Tashima, M.D.; Justin Nash, Ph.D.; Christine Adair, B.S.; Robert Boland, M.D.; Ronald A. Cohen, Ph.D.
This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update. Visit the CDC's website to find out more about their activities, publications and services.