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  3rd International Workshop on HIV & Women
January 14-15, 2013
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Depression Scores Rise Yearly After Age 40 for HIV+ Women But Not Men
  Third International Workshop on HIV and Women, January 14-15, 2013, Toronto

Mark Mascolini

Depression scores rose significantly every year for HIV-positive women after age 40 but fell for men in a 1300-person analysis of the Ontario HIV Treatment Network [1]. Larger proportions of women than men had mild or severe depressive symptoms.

Depression is a much-studied condition in people with HIV infection, but differences between women and men in severity and correlates of depressive symptoms remain poorly understood. Researchers from the Ontario HIV Treatment Network Cohort Study conducted this cross-sectional study to address those issues.

The analysis involved 1060 men and 267 women who completed the 20-item Center for Epidemiologic Studies Depression Scale (CES-D). The investigators categorized a score above 15 as mild depressive symptoms and a score above 21 as severe depressive symptoms. (This instrument screens for depressive symptoms; it does not diagnose depressive disorders.) To identify independent predictors of depression, the researchers used variables that previous research found linked to depression, including age, duration of HIV infection, HIV risk factors, HIV-related stigma, and education. They also assessed depression scores ranked into several quantiles--10th, 25th, 50th, 75th, and 90th.

More than 80% of study participants were taking antiretrovirals, and the rate was significantly higher in women (88% versus 81%, P = 0.02). But a lower proportion of women than men had an undetectable viral load (68% versus 75%, P = 0.02). The same proportion of women and men, 43%, had a CD4 count at or above 500, and similar proportions had a CD4 count under 200 (12% of women and 10% of men).

Significantly higher proportions of women than men were black (57% versus 13%), came from an HIV-endemic country (59% versus 10%), had a an annual household income below $40,000 (67% versus 47%), and had a high school education or less (42% versus 30%) (P < 0.0001 for all comparisons). Compared with women, men were more likely to be white, to be born in Canada, and to have longer durations of HIV infection (12 versus 8 years) and antiretroviral therapy (9 versus 5 years) (P < 0.0001 for both).

Women had a significantly higher median CES-D score than men: 13 (interquartile range [IQR] 5 to 26) versus 9 (IQR 3 to 20) (P = 0.0004). Higher proportions of women than men had a CES-D score above 15 (44% versus 33%, P = 0.002) and a CES-D score above 21 (31% versus 23%, P = 0.003).

Starting at 40 years of age, CES-D scores of women increased significantly at a rate of 0.4 per year (P = 0.005). In contrast, CES-D scores of men began falling after age 40. The 75th percentile of depression scores for women was 6 points higher than the 75th percentile for men.

Several variables predicted having a total CES-D score at the 50th quantile in both women and men, including having a disability, having an HIV stigma score at or above 50, and reporting psychologically relevant recent life events or ongoing problems. Factors associated with a total CES-D score at the 50th quantile only in women were age 40 or older, injection drug use, and disability. Factors that predicted the same outcome only in men were unemployment and reporting psychologically relevant early childhood events. Taking an efavirenz-based regimen lowered chances of a CES-D score at this level in men but not in women.

Comparisons of psychological and emotional differences between women and men are complicated by women's tendency to be more forthcoming when testing for these problems. Still, the researchers concluded that "gender differences exist in the severity and correlates of depression in people with HIV."

They propose that mental health programs for HIV-positive people should "consider active screening for depression in women, particularly women with HIV over the age of 40."


1. Aljassem K, Raboud JM, Benoit A, et al. Differences in severity and correlates of depression between men and women living with HIV in Ontario, Canada. Third International Workshop on HIV and Women, January 14-15, 2013, Toronto. Abstract O_07.