Psychosomatics 39:82-83, February 1998
© 1998 The Academy of Psychosomatic Medine
Depression in HIV-Infected Persons
Robert J. Boland, M.D., Brown University School of Medicine, Department of Psychiatry and Human Behavior, Department of Psychiatry, Miriam Hospital, Providence, RI
Key Words:
TO THE EDITOR: Fukunishi and colleagues1 present a very compelling look at their population of Japanese human immunodeficiency virus (HIV)-positive patients. They find that their HIV-infected patients, though not having major depression, have stronger depressive symptoms than a control group. These depressive symptoms correlate with immature coping strategies (avoidance) and poor social support.
This finding is in keeping with our current understanding of the relationship between negative life events and depression. It is not simply a cause-and-effect relationship, and it is modulated by several variables. In keeping with Fukunishi et al.'s findings, Klerman2 has suggested that coping styles and social supports are important variables in predisposing one for a depressive illness. Other factors, such as early life experiences, personality, and genetic predisposition,3 surely play a role as well.
Premorbid factors play an important role in depression. The implication that the Japanese cohort patients had depressive symptoms, because of having HIV, is only one possible interpretation of the data. In our group of HIV-infected patients, dysthymia is common and usually precedes the onset of HIV. One can even postulate that depressive symptoms may make some patients more likely to contract HIV. In the setting of poor self-esteem, feelings of worthlessness and even passive suicidality, it is likely that people will be less likely to avoid high-risk behavior. It would be important for the authors to collect information on their patients as to premorbid mental illness (even subsyndromal) and to verify the control subjects had similar premorbid risks.
It would also be helpful to know how the patients contracted HIV. Different risk groups may have different risk factors for depression. For example, Rabkin and colleagues4 recently reported on a group of men for whom progression of disease was not associated with depression. These men were white, well educated, generally middle class, and part of a supportive community of gay men in New York City. Obviously, this group would not be comparable to, for example, the impoverished woman we see at our clinic or the Japanese cohort described by Fukunishi and colleagues.
REFERENCES
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Fukunishi I, Hosaka T, Negishi M, et al: Avoidance coping behaviors and low social support are related to depressive symptoms in HIV-positive patients in Japan. Psychosomatics 1997; 38:113–118[Abstract/Free Full Text]
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Klerman GL: Discussion, part II, in Stress and Mental Disorders, edited by Barrett JE, Rose RM, Klerman GL. New York, Raven Press, 1979, pp. 111–120
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Kendler KS, Kessler RC, Walters EE, et al: Stressful life events, genetic liability, and onset of an episode of major depression in women. Am J Psychiatry 1995; 152:833–842[Abstract/Free Full Text]
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Rabkin JG, Goetz RR, Remien RH, et al: Stability of mood despite HIV illness progression in a group of homosexual men. Am J Psychiatry 1997; 154:231–238[Abstract]
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