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

ArticleinPsychosomatics 53(1):51-7 · February 2012with22 Reads
Impact Factor: 1.86 · DOI: 10.1016/j.psym.2011.07.004 · Source: PubMed

    Abstract

    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.