人类免疫缺陷病毒感染者抑郁障碍、自杀风险和日常生活能力的研究

Depression and suicidality in human immunodeficiency viruses infected persons

目的研究人类免疫缺陷病毒(H IV)感染者抑郁症和自杀观念的流行情况及其与日常生活能力改变的关联。方法对28例H IV阳性者及23例H IV阴性者,用复合性国际诊断用检查提纲中文版调查抑郁症的总发生率和自杀史,用贝克抑郁问卷(BD I)评估当前抑郁障碍及自杀风险的严重程度,用日常生活能力问卷(ADL)评估H IV感染对日常生活能力的影响。结果(1)H IV阳性组和H IV阴性组中分别有22例(79%)和1例(4%)符合抑郁症的诊断标准(P<0.001);H IV阳性组BD I总分[(22.4±12.7)分]高于H IV阴性组[(6.6±7.8)分;P<0.001]。(2)H IV阳性组和H IV阴性组中分别有18例(64%)和2例(9%)有过自杀观念。(3)H IV阳性组ADL总分[(17.1±5.2)分]高于H IV阴性组[(14.0±0.0)分;P<0.001]。(4)BD I与H IV状况的交互作用是有显著贡献(F=23.95,P<0.001)的自变量,抑郁障碍与H IV状况的相互作用是有意义(F=13.29,P=0.001)的预测因子。结论H IV感染的人群中抑郁症的发生率及自杀风险均较高,抑郁的严重程度和日常生活能力受损有显著相关性。

Objective The purpose of this study was to examine the rates of major depression and suicidality and their associations with change in daily functioning in a sample of human immunodeficiency viruses （HIV） infected persons and HIV-negative controls. Methods The participants were 28 HIVpositive persons and 23 demographically matched HIV-negative controls. Major depressive disorder （MDD） and history of suicidality were determined with the Chinese version of Composite International Diagnostic Interview （ CIDI）, and current severity of depression and suicidal ideation were assessed with the Beck Depression Inventory （ BDI）, and daily functioning with the Activity of Daily Living （ADL） questionnaire. Results Almost 79% （ n = 22） of HIV-positive persons but just 4% （ n = 1 ） of HIV-negative controls met the criteria for MDD during their lifetime. Only one of the 22 HIV-positive individuals with MDD had a previous diagnosis of MDD, and the remaining 21 participants developed MDD within 6 months after testing HIV positive. In those 21 ones, 5 （24%） reported severe depressive symptom （BDI total 〉29）, 7 （33%） reported moderate severe symptom （BDI = 17-29）, and 4 （19%） had active suicidal thoughts even after the median of 16 months from learning of their HIV infection. Both depression and HIV status independently predicted worse daily functioning. In HIV-positive subjects with depression, only two had received a psychiatric evaluation and were in treatment for their depression. Conclusion Our study presents evidence of high rates of major depression and suicidality in HIV infected persons. Most developed depression within six months after learning of their HIV infection and about two-thirds of them still reported moderate to severe levels of depression symptoms after an average of two years from learning of their HIV infection. The severity of depression is significantly associated with impairment in daily functioning.