Psychological stress and depression in older patients with intravenous drug use and human immunodeficiency virus infection: implications for intervention

We aim to assess the age-related differences in psychological stress and depression in patients with human immunodeficiency virus (HIV) infection. Prospective, longitudinal, observational study of patients with HIV followed at a university affiliated VA Medical Center. Fifty-six consecutive patients with HIV infection aged 19-68 were studied. Data on demographics, living arrangements, education, employment, income, social, religious, and community support, medical status, psychological stress, depression, and coping was assessed at baseline and every 6 months. Instruments for psychological testing included Beck Depression Inventory, Profile Mood Status (POMS) scale and ways of coping scale (inventory of coping with illness scale). Sixty-nine per cent (38/56) of the patients were older than 35 years of age. Older patients exhibited significantly greater emotional and psychological stress; the mean POMS score for older patients was 56.8 as compared to 21.5 for younger patients (P=0.004). Older patients had significantly greater depression (P=0.001), higher tension and anxiety (P=0.005), greater anger and hostility (P=0.03), greater confusion and bewilderment (P=0.01), and more fatigue (P=0.003) as compared with younger patients. Older patients were significantly more likely to have intravenous drug use as an HIV risk factor (P=0.02), less likely to be employed (P=0.005), and more likely to use non-traditional therapies (P=0). Intravenous drug use was an independent predictor of psychological stress in older patients. Patients with HIV, older than 35 years of age, are significantly more likely to suffer from depression and psychological stress; intravenous drug use was an independent predictor of stress. Interventions for the treatment of depression should be especially sought in this subgroup of patients with HIV.