1. Depression Treatment in HIV-infected and Uninfected Veterans: Do Rates Vary by HIV Status?
Kristen Sueoka
YSM IV

2. Collaborators WRITING COMMITTEE
Kristen Sueoka; Joseph Goulet, PhD; Adeel Butt, MD; Steve Crystal, PhD; Cynthia Gibert, MD; David Rimland, MD; Kendall Bryant, PhD; Maria Rodriguez-Barradas, MD; Amy Justice, MD, PhD
THESIS READER
David Fiellin

3. Background: Depression Treatment
Infectious Disease (ID) less comfortable than General Medicine (GM).
Are ID specialists less likely to treat?

4. Objectives
Determine whether HIV-infected veterans less likely to have depressive symptoms treated compared to uninfected veterans

5. Methods Observational cohort study
Veterans Aging Cohort Full Study: 2979 HIV+ and 3019 HIV- subjects
Baseline self-completed Patients Health Questionnaire-9 (PHQ-9)
Analyzed using bivariate models and multivariate logistic regressions

6. Forming Our Study Cohort
METHODS
-describe PMD score

7. Demographics Characteristic HIV- HIV+ Age ≥ 50 39.6% 41.7%
Race/ethnicity
Black
56.4%
59.7%
White
37.6%
34.6%
Hispanic
10.7%
12.9%
Other
4.1%
6.4%
No significant p values

8. Clinical Characteristics
HIV-
HIV+ * P
Median # Comorbid Medical Diseases
2 (0-10)
3 (0-17)
0.1
Mean # Comorbid
Medical Diseases
2.39
2.85
0.009
* Numbers do not include HIV diagnosis

9. Clinical Characteristics

10. Symptom Severity

11. Low Self-Esteem
Concentration Difficulty
Psychomotor Change

12. Treatment Rates Depressed veterans given SSRI (p=0.4)
34% HIV- veterans
38% HIV+ veterans
Depressed veterans given SSRI or Mental Health Service (p=0.8)
49% HIV- veterans
48% HIV+ veterans

13. Treatment Rates
Caucasian veterans more likely than Blacks to receive SSRI
48% vs. 30%, p<0.01
Multivariate regression for only SSRI receipt by HIV status
OR = 1.16, 95% CI = 0.84, 1.58

14. Multivariate Regression of SSRI Receipt or Mental Health Visit

15. Summary of Results Prominent neurovegetative symptoms
Low rates of treatment, regardless of HIV status
Blacks less likely to receive SSRI
Whites more likely to receive mental health services
Variation at individual clinics

16. Conclusions No difference in treatment rates by HIV status
Site variation – opinion leader effect?
How should we diagnose depression in those with chronic medical disease?

17. Acknowledgements PI and Co-PI: AC Justice, DA Fiellin
Participating VA Medical Centers: Atlanta (D. Rimland, C Jones-Taylor), Baltimore (KA Oursler, R Titanji), Bronx (S Brown, S Garrison), Houston (M Rodriguez-Barradas, N Masozera), Los Angeles (M Goetz, D Leaf), Manhattan-Brooklyn (M Simberkoff, D Blumenthal, J Leung), Pittsburgh (A Butt, E Hoffman), and Washington DC (C Gibert, R Peck)
Core Faculty: S Braithwaite, C Brandt, K Bryant, R Cook, J Conigliaro, K Crothers, J Chang, S Crystal, N Day, J Erdos, M Freiberg, M Kozal, M Gaziano, M Gerschenson, B Good, A Gordon, J Goulet, M Hernan, K Kraemer, J Lim, S Maisto, K Mattocks, P Miller, L Mole, P O’Connor, R Papas, H Paek, J Robins, C Rinaldo, M Roberts, J Samet, B Tierney, J Whittle
Staff: D Cohen, A Consorte, D Gibson, K Gordon, F Kidwai, F Levin, K McGinnis, M Rambo, J Rogers, M Skanderson, F Whitsett
Major Collaborators: Immunology Case Registry, Pharmacy Benefits Management, Framingham Heart Study, Women’s Interagency HIV Study, Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Health Economics Research Center (HERC), Center for Health Equity Research and Promotion (CHERP)
Funded by: National Institute on Alcohol Abuse and Alcoholism (2U10 AA 13566); National Institute on Aging (K23 G00826); Robert Wood Johnson Generalist Faculty Scholar Award; an Inter-Agency Agreement between National Institute on Aging, National Institute of Mental Health, and the Veterans Health Administration; the VHA Office of Research and Development; and, VHA Public Health Strategic Health Care Group.

18. Acknowledgements
Thank you to the Yale Medical School Office of Student Research for their support.