Associations among depression, suicidal behavior, and quality of life in patients with human immunodeficiency virus

Table 2 Studies that investigated without using specific psychometric instruments the association between depression/suicidality and quality of life in human immunodeficiency virus patients

Ref.	Study design	Sample size	Follow-up	Quality of life instruments	General findings	Limitations	Conclusion
Breitbart et al[39]	Follow-up study	372 patients with advanced AIDS, of which 42 were re-assessed at the follow-up (280 men, 92 female; mean age 44.4 ± 9.4 yr)	2-mo follow-up	Depression module of the SCID, HIV version, Ham-D, SAHD, DDRS, no specific psychometric instruments were used to measure quality of life	A significant association between desire for death and depression was found but desire for death was reduced in those patients who responded to antidepressants medications. However, approximately half of subjects who received antidepressant medications and/or supportive psychotherapy or counseling demonstrated little or no improvement in depressive symptoms	(1) The study was not a controlled clinical trial of antidepressant therapy; (2) Systematic bias (e.g., with more refractory patients being less likely to remain in the study) may be not excluded; (3) The failure to find significant differences about the proportion of patients with a high desire for hastened death may reflect the limited power of these analyses	Depressed patients who were successfully treated with antidepressant medications reported a significant reduction of desire for death
Haller et al[36]	Cross-sectional study	190 HIV patients (129 male, 61 female; mean age 37.3 ± 7.4 yr)	No	UM-CIDI, MCMI-III, Suicide Screener (seven-item structured interview), quality of life derived by HIV-PARSE	Overall, 26% of subjects reported suicide thoughts within 30 d of admission, 49% a suicide plan, and 48% a suicide intent. Individuals with suicidal ideation had predominantly MDD (64%), drug dependence (52%), and depressive personality disorder (50%). After regression analyses, those with MDD, dysthymia, substance abuse, thought disorder, PTSD, and borderline/avoidant personality disorders were more likely to have suicidality. Concerning the quality of life variables which were measured, leisure/social and family/friends were strongly associated with suicidal ideation	(1) The cross-sectional nature of the findings; (2) No specific psychometric instruments were used.	Subjects with substance use disorders, unstable interpersonal relations, and a restricted social environment may be considered at-risk individuals and need to be regularly screened for suicidality
Kalichman et al[37]	Cross-sectional study	113 HIV-AIDS subjects (mean age 53, age range 47-69)	No	Beck Depression Index, and WOC	Subjects who reported suicide thoughts (27%) have also higher emotional distress and poorer health-related quality of life relative to those who had not considered suicide. Furthermore, escape and avoidance were more frequently used whereas positive-reappraisal coping strategies were less frequently used by those with suicide thoughts. An association between suicide thoughts and the perception of reduced social support from friends and family was also reported. The mentioned differences remained even after controlling for symptoms of depression	(1) The small sample size; (2) The cross-sectional nature of the findings. These factors may limit the generalization of the findings	Relevant emotional distress and suicide thoughts were experienced by subjects in midlife and older individuals with HIV-AIDS
Krabbendam et al[40]	Cross-sectional study	24 HIV women (mean age 32 yr with a range of 20-49 yr)	No	In depth interviews using a qualitative semi-structured approach providing insights into feelings, perceptions, beliefs	Strong emotions and quality of life impairment were experienced by HIV-infected women directly after diagnosis. It has been suggested that one counseling session was not effective	(1) The small sample size and the cross-sectional nature of the findings may seriously limit the generalization of the present findings; (2) Counseling given once was reported to be not effective	Continuous counseling may be provided by support groups. Importantly, the counselors may be used as examples

DDRS: Desire for Death Rating Scale; SCID: Depression module of the Structured Clinical Interview for DSM-IV, HIV version; Ham-D: Hamilton Rating Scale for Depression; MDD: Major depressive disorder; MCMI: Millon Clinical Multiaxial Inventory; PTSD: Post-traumatic stress disorder; SAHD: Schedule of Attitudes toward Hastened Death; UM-CIDI: University of Michigan Composite International Diagnostic Interview; WOC: Ways of Coping Questionnaire; HIV: Human immunodeficiency virus.