1. Depression and anxiety in correlation to will to meaning of life and quality of life in Slovenian HIV-infected patients Depression and anxiety in correlation to will to meaning of life and quality of life in Slovenian HIV-infected patients Teja Oblak Anja Pasarič Ljubljana, Slovenia, October 2008

2. INTERDISCIPLINARY 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

3. 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 HIV 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.

4. HIV 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.

5. STRUCTURE 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)

6. QUESTIONNAIRE 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 α HADS = 0,907

7. QUESTIONNAIRE 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

8. 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.

9. METHODS 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

10. RESULTS Sociodemographical 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)

11. Subjective clinical characteristics RESULTS presence of illness: yes (79,3%) (p=0,000) health: good or very good (62,1%) (p=0,006)

12. 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 4,26,3106,114,4 – 15,7 SD ± 0,4±0,5±2,1±3-3,8 Median 3511315, 16 Interquartile range 1,3,73,5,990, 113, 125/ Prevalence 21,6%32,4%26,1%2,7-11,7% Gender – dependent ♂ 29% - ♀ 25% ♂ 41% - ♀ 38% ♂ 25% - ♀ 29%/

13. 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 death16,2% suicidal thoughts21,6% Table 3 – High general quality of life and satisfaction with life among studied HIV – infected patients (N=111) QOL (N=111)High General QOL65% Satisfaction with health68%

14. 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

15. 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 ® )

16. CORRELATIONS 3 (p<0,01, p<0,05) DEPRESSION WILL TO MEANING ANXIETYspiritual QOL

17. 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®)!

18. 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

19. CRITIQUE status of not-responding patients (31,5%)?  number of women × control group × substance abuse profound interview -> reasons assessment of suicidality

20. 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 ®

21. 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

22. THANK YOU THANK YOU FOR YOUR ATTENTION!