Impact of Integrated and Measurement-Based Depression Care: Clinical Experience in an HIV Clinic

Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Psychosomatics (Impact Factor: 1.86). 01/2012; 53(1):51-7. DOI: 10.1016/j.psym.2011.07.004
Source: PubMed


Just as in heart disease and diabetes, depression in HIV/AIDS is associated with negative outcomes. While randomized trials have shown the efficacy of treatment for depression in HIV/AIDS, the implementation of evidence-based treatments in real-world settings remains a challenge.
The objective of this study was to assess the effectiveness of a collaborative, measurement-based approach to depression care, including psychopharmacologic and ancillary psychological therapies in patients with HIV/AIDS and to examine whether or not effective depression treatment would also improve virologic and immunologic outcomes.
This was a retrospective chart review of patients referred for depression to a co-located psychiatry consultation service embedded within an infectious diseases outpatient clinic at an urban tertiary hospital. Data extracted at initial assessment and at last appointment included: axis I diagnosis, whether the patient was on an antidepressant, whether the patient was on a stimulant, BDI-II score, HIV RNA level, and CD4 cell count.
One hundred twenty-four patient charts were included. Pre- vs. post-treatment analyses revealed significant reductions in depression (average BDI-II score of 23 to 15.7, p = 0.00001) and HIV RNA (14.1 K to 4 K copies/mL, p = 0 .003), and significant increases in CD4 count (518 to 592 cells/μL, p = 0.001). Additionally, more participants were prescribed antidepressants and stimulants at post- vs. pre-treatment.
Taking a collaborative, measurement-based approach to depression care appears to be an effective method for improving depression, virologic, and immunologic outcomes in depressed patients with HIV/AIDS illness.

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