The risk is particularly high in the first 2 years after an HIV diagnosis.
Individuals living with HIV are significantly more likely to be diagnosed with depression, take antidepressants, receive electroconvulsive therapy (ECT), and commit suicide than population controls, particularly in the first 2 years after diagnosis, according to new research findings.
The nationwide study, conducted in Denmark, compared almost 6000 individuals living with HIV with more than 59,000 matched controls over 20 years. According to the study findings, individuals with HIV were around 3 times more likely to develop depression, use antidepressants, and undergo ECT in the first 2 years after their HIV diagnosis, and were 10 times more likely to commit suicide compared to their counterparts without HIV.
“It’s much higher than I expected,” said lead author Lars Omland, MD, PhD, DrMedSci, in a press release. “Our findings clearly highlight the serious mental health implications of being given a diagnosis of HIV and the importance of clinicians looking out for symptoms of depression in this high-risk population. Caring for people with HIV, which has traditionally focused on their physical health, should place more emphasis on their mental health.”
Earlier research has suggested that HIV may be associated with depression, but studies have been inconclusive. Additionally, no studies have examined whether familial factors may influence the link between HIV infection and depression.
To find out more, investigators used Denmark’s national health registers to look for records of depression (diagnoses, use of antidepressants, ECT, and suicide) in 5943 individuals diagnosed with HIV between 1995 and 2021. They compared these patients’ risk of depression with 59,430 sex- and date-of-birth matched controls from the general population, and also compared the risks between 5807 siblings of individuals with HIV and 82,411 siblings of controls. The investigators adjusted for a range of factors likely to influence the results, including sex and age.
Overall, individuals with HIV had double the risk of depression and treatment with ECT compared to controls, 1.5 times greater risk of antidepressant use, and 3.5 times increased risk for suicide. The risks were much higher in the 2 years after diagnosis.
When comparing yearly proportions of participants using psychiatric hospitals due to depression, either inpatient or outpatient, and use of antidepressants in the 10 years before and after study inclusion, the analysis found an increased proportion of psychiatric hospital use both prior to, and especially after HIV diagnosis. For example, 2 years before study inclusion, 6.4% of those with HIV used antidepressants, which was 1.2% more than controls. This difference increased to 3.1% in the 2 years after study inclusion.
Interestingly, the study found that siblings of those living with HIV also faced an increased risk of depression diagnosis, use of antidepressants, and suicide compared to population controls, but lower than for those living with HIV. This suggests that family-related factors are unlikely to explain the greater risk observed for those with HIV.
“The higher risk of developing depression and suicide in both people living with HIV and their siblings is very troubling, and we need to dig deeper to understand the causes,” Omland said in the press release. “One potential explanation for the increased risk of depression and suicide among siblings of people living with HIV could be stress and stigma related to a loved one being diagnosed with a chronic disease. It’s also possible that risk factors for depression and HIV infection overlap.”
The authors noted that although the study was large, it was observational, and they cannot rule out the possibility that other unmeasured factors, such as alcohol and illicit drug use, and uncontrolled for confounding factors may have influenced the results. They also noted that because the study was conducted in Denmark, it may not apply to other populations.
People living with HIV at substantially higher risk of depression and suicide, especially in first 2 years after diagnosis. News release. EurekAlert. April 3, 2023. Accessed April 5, 2023. https://www.eurekalert.org/news-releases/984677