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  2nd International Workshop on HIV & Women
January 9-10, 2012
Bethesda, Maryland
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More Depression in HIV+ Women Than Men, Regardless of ART,
in 15-Country Study

  2nd International Workshop on HIV & Women. January 9-10, 2012, Bethesda, Maryland

Mark Mascolini

Women in routine HIV care had higher rates of depression and anxiety than men in the same clinics, regardless of whether these women had started antiretroviral therapy (ART), according to results of a 15-country study in Western Europe and Canada [1]. Antiretroviral-naive women had a marginally higher rate of combined depression and anxiety than antiretroviral-experienced women.

Prior research found higher depression prevalence in women with HIV than in HIV-positive men [2]. But CRANIum Study investigators [1] found that fewer than 25% of depression studies in HIV populations report findings by gender, and only about 7% of depression studies have focused solely on women.

To advance the understanding of depression and anxiety in women with HIV, CRANIum researchers planned this comparative study of antiretroviral-treated and untreated women and men in care for HIV infection. All study participants were older than 18. The investigators aimed to recruit a group in which two thirds were antiretroviral experienced and 40% were women. Everyone with antiretroviral experience had taken the same regimen for more than 9 months at the time of the study. No one had active central nervous system infection or malignancy, no one had a stroke or transient ischemic attack ("mini-stroke"), and no one had abused drugs or alcohol in the past 3 months.

Study participants completed the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression. The questionnaire has 7 questions pertaining to anxiety and 7 pertaining to depression, and each answer has four options scored from 0 to 3. A score above 8 on the anxiety questions indicates anxiety, and a score above 8 on the depression questions indicates depression.

Of the 2863 participants from 15 countries, 1096 (38.3%) were women, 861 (78.6%) of whom had antiretroviral experience. Among treatment-experienced people, half were taking a protease inhibitor and half a nonnucleoside. Age averaged 43 years in both women and men. A lower proportion of women than men were Caucasian (67.2% versus 85.9%, P < 0.0001), and women had a longer duration of HIV infection (112.2 months versus 89.6 months, P < 0.0001).

Significantly fewer women than men were single (44.2% versus 56.1%, P < 0.0001), and significantly fewer women had completed secondary school (73.7% versus 87.3%, P < 0.0001). Significantly more women than men had children (66.1% versus 22.7%, P < 0.0001), and significantly more women were unemployed (41% versus 28.3%, P < 0.001). A higher proportion of men than women abused drugs or alcohol in the past year (15.8% versus 3.7%, P < 0.0001).

Almost all women (more than 98%) completed both the anxiety questionnaire and the depression questionnaire.

A significantly higher proportion of women than men met criteria for depression (17.9% versus 14.3%, P = 0.01), and among women that proportion did not differ significantly between those without and with antiretroviral experience (20.8% versus 17.2%, P = 0.2). But a significantly higher proportion of antiretroviral-naive women than men had depression (20.8% versus 10.6%, P < 0.0001).

A nearly significantly higher proportion of women than men screened positive for anxiety (35.3% versus 32%, P = 0.07), and again the proportion did not differ significantly between naive and experienced women (39.1% versus 34.3%, P = 0.18). A higher proportion of naive women than naive men had anxiety (39.1% versus 30.6%, P = 0.02).

In another comparison that stopped just short of statistical significance, a higher proportion of women than men had both depression and anxiety (13.9% versus 11.5%, P = 0.06). A marginally higher proportion of naive than experienced women had both depression and anxiety (17.5% versus 12.9%, P = 0.07).

Univariate analysis identified four factors associated with depression--a previous psychiatric diagnosis, previous central nervous system infection, psychiatric services in the past year, and documented antiretroviral resistance. Factors associated with anxiety were a previous psychiatric diagnosis, documented antiretroviral resistance, awareness of antiretroviral resistance, and illegal substance use in the past year.

The study also revealed that small and equivalent proportions of women and men (4% and 4.4%) had a negative screen for depression but were prescribed an antidepressant at the time of testing.

The CRANIum investigators believe their findings "support a strategy of regular screening for, and clinical management of, anxiety and depression for all female HIV-infected patients."


1. Bayon C, Robertson K, Wolf E, et al. The prevalence of a positive screen for anxiety and/or depression in HIV-1 infected women across Western Europe and Canada: the CRANIum study. 2nd International Workshop on HIV & Women. January 9-10, 2012, Bethesda, Maryland. Abstract O_01.

2. Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58:721-728. http://archpsyc.ama-assn.org/cgi/content/full/58/8/721.