Depression and anxiety in Depression and anxiety in correlation to will to meaning correlation to will to meaning

of life and quality of life in of life and quality of life in Slovenian HIV-infected Slovenian HIV-infected

patients  patients  

Teja OblakAnja Pasarič

Ljubljana, Slovenia,

October 2008

INTERDISCIPLINARY STUDYINTERDISCIPLINARY STUDY

Authors: Teja Oblak, Medical faculty Anja Pasarič, Medical faculty Veronika Ručna, Faculty of arts,

Department of Psychology

- University of Ljubljana, Slovenia

Mentors: Mojca Matičič, PhD, MD, Clinic for infectious diseases and febrile illnesses, University medical centre Ljubljana

Borut Škodlar, MSc, MD, University psychiatric hospital Ljubljana

• 1. patient - 1987, 1. HAART application - 1988

• 0,01% of population, 1/1.000

• men 85%, women 15%

• 1. MSM, 2. MSW, 3. IDU

• centralized health care

• basic health insurance – covered

• WHO – approved testing and counselling

HIVHIV INFECTION IN SLOVENIA INFECTION IN SLOVENIA

Klavs I, Bergant N, Kustec T, Kastelic Z. HIV infection in Slovenia. Annual report 2007. Ljubljana: Institute for public health; 2007; 5-13.

Matičič M, Klavs I, Tomažič J, Vidmar L, Poljak M. Counselling before and after testing for HIV infection. Med Razgl 1997; 36 (Suppl): 215-20.

HIVHIV INFECTION IN 21.CENTURY INFECTION IN 21.CENTURY

HAART longer life expectancy

• broad team of medical specialists• comorbidites - mental disorders

substance abuse HCV

• stigma, quality of life

interdisciplinary study infectology + psychiatry + psychology

Deeks SG. Antiretroviral treatment of HIV infected adults. BMJ 2006; 332 (7556): 1489-93.

Angelino AF. Impact of psychiatric disorders on the HIV epidemic. Top HIV Med 2008; 16 (2): 99-103.

STRUCTURE OF OUR STUDYSTRUCTURE OF OUR STUDY• 4 areas: depression, anxiety, will to meaning of life, quality of life• self – report questionnaire• pilot study, 10 ambulant HIV – infected patients• high Cronbach : 0,92 - 0,96

• cross – sectional study• 162 HIV - infected patients• questionnaires sent by post & returned

annonymously (June – December 2006)

QUESTIONNAIREQUESTIONNAIRE

Hospital Anxiety and Depression Scale (HADS)©Zigmond&Snaith

• depression, anxiety (14 questions, 0-3)

• 8-10 = symptoms of depression/ anxiety,

• 11-21 = clinically significant depression/anxiety

• αHADS= 0,907

QUESTIONNAIREQUESTIONNAIRE

WHOQOL HIV BREF ©WHO HIV Group• sociodemography, 6 domains of QOL + general QOL (31 questions,

0-1&4-20) • rating: 4-10= low, 11-15=moderate, 16-20=high QOL in domains;• QOL: 100 –80% high, 80%-50% moderate,, <50%- low • αqhoHIV = 0,786

+ 2 questions on mental health care now/past

Purpose in life test, part A (PIL) ©Crumbaugh&Malcholick• will to meaning, suicidality, fear of death (20 questions, 1-7)• 93-112 = moderate will, 113-140 high will to meaning of life• αPIL= 0,938

HYPOTHESES

• Depression, anxiety – present!

• Depression, anxiety - will to meaning , quality of

life.

• HAART - QOL, will to meaning, symptoms of

depression and anxiety.

• HADS, WHOQOL HIV BREF -> reliable screening

tests.

METHODSMETHODS• non - parametric population

• descriptive statistics

• differences in variance: chi square, Mann –

Whitney U test, Friedman test

• correlations: Kendall tau b coefficient, Kruskal –

Wallis test

• p<0,01, p<0,05

• SPSS 13.0. ©SPSS Inc., Chicago, USA

RESULTSSociodemographical characteristics

• 111 of 162 (68,5%), 17 women (15,3%), 94 men (84,7%) (p=0,000)

• M=42,3 years, SD=±10,5, median=41 years

• high school (51,4%), university (32,4%)

• living alone > living with someone (p=0,001)

Objective clinical characteristics• mean(CD4+ T ly) = 478, SD=± 239,7

• <40 copies HIV RNA = 70,3% (p=0,000)

• HAART (55,9%)

• 2 drugs (43,2%), 3 drugs (35,1%) (p=0,000)

Subjective clinical characteristics

RESULTS

• presence of illness: yes (79,3%) (p=0,000)

• health: good or very good (62,1%) (p=0,006)

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

yes no unspecified

Psychiatric/psychological care present

Psychiatric/psychological care past

Table 1 – Descriptive statistics of studied parameters (N=111)

Parameters(N=111)

DEPRESSION(0-21)

ANXIETY(0-21)

WILL TO MEANING(0-140)

QUALITY OF LIFE domains

(4-20)

Mean 4,2 6,3 106,1 14,4 – 15,7

SD ± 0,4 ±0,5 ±2,1 ±3-3,8

Median 3 5 113 15, 16

Interquartile range

1,3,7 3,5,9 90, 113, 125 /

Prevalence 21,6% 32,4% 26,1% 2,7-11,7%

Gender – dependent

♂29% - ♀25% ♂41% - ♀38% ♂25% - ♀29% /

Table 2 – Prevalence of fear of death and suicidal thoughts among studied HIV-infected patients (N=111)

Other (N=111) (answer 1 and 2)

fear of death 16,2%

suicidal thoughts 21,6%

Table 3 – High general quality of life and satisfaction with life among studied HIV – infected patients (N=111)

QOL (N=111) High

General QOL 65%

Satisfaction with health 68%

RELATIONSHIPS & CORRELATIONS 1 (p<0,05)

subjective health status, suicidal thoughts

• subjective symptomatic status

• gender• abacavir/lamivudin

(Kivexa®)• education• age• fear of death

DEPRESSION ANXIETY WILL TO MEANING

RELATIONSHIPS & CORRELATIONS 2 (p<0,01, p<0,05)

physical QOL

psychological QOL

social QOL

spiritual QOL

independency

satisfaction with health

marital status

HAART

nelfinavir (Viracept®)

stavudin (Zerit®)

CORRELATIONS 3 (p<0,01, p<0,05)

DEPRESSION

WILL TO MEANING

ANXIETY spiritual QOL

DISCUSSION representative of HIV-infected population with limitations

Klavs I, Kastelic Z. Recorded cases of aids and HIV infection in Slovenija on 30. 6. 2006. Ljubljana: Institute for public health Slovenia; 2006; 2-3.

DEPRESSION, ANXIETY • = vs. HIV-infected in Brasil, India, USA, UK (23-

75%)• vs. Slovenian breast cancer patients (to 57%)• correlations similar

WILL TO MEANING • vs. HIV-infected in USA (90,4)• vs. cancer patients • vs. non-clinical Slovenian teachers• = suicidal thoughts, fear of death vs. HIV-infected

elsewhere• abacavir/lamivudin (Kivexa®)!

QUALITY OF LIFE • = vs. HIV-infected in Croatia,

India • correlations similar

• high reliability for HADS, PIL, WHOQOL HIV BREF

• stigma on psychological problems and mental disorders

DISCUSSION

CRITIQUE

• status of not-responding patients (31,5%)?

• number of women

• × control group

• × substance abuse

• profound interview -> reasons

• assessment of suicidality

PRACTICAL APPLICATION• HADS, WHOQOL HIV-BREF → routine screening

for HIV-infected p.• high-risk patients

• psychiatrist → member of health care team for HIV-infected patients

1. single, living alone

2. suicidal thoughts

3. bad health, symptomatic status subjectively

4. Viracept®, Zerit®, Kivexa®

• first study on HIV patients

• 4 areas: depression, anxiety, will to meaning,

QOL

• important % of depression, anxiety, suicidal

thoughts, low will to meaning, low QOL

• high-risk patients

• reliable screening tests – HADS, WHOQOL HIV-

BREF

CONCLUSION

THANK YOU THANK YOU

FOR YOUR ATTENTION!FOR YOUR ATTENTION!