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Effect of dysthymia on receipt of HAART by minority HIV-infected women.

Turner BJ, Fleishman JA

Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. bturner@mail.med.upenn.edu

BACKGROUND: Receipt of highly active antiretroviral therapy (HAART) differs by gender and racial/ethnic group and may reflect an effect of mood disorders. OBJECTIVE: We examined the effects of dysthymia and major depression on HAART use by 6 groups defined by gender and race/ethnicity (white, black, Hispanic). MAIN OUTCOME MEASURE: Self-reported HAART use in the past 6 months. DATA SOURCE: Interview data from the HIV Cost and Services Utilization Study (HCSUS). Independent variables measured in or before the first half of 1997, and HAART use measured in the second half of 1997. ANALYSES: Multivariate logistic regression of depression and dysthymia on HAART use by 6 patient groups. PARTICIPANTS: One thousand nine hundred and eighty-two HIV-infected adults in HIV care in 1996 and with a CD4 count <500 in 1997. RESULTS: Highly active antiretroviral therapy receipt was the highest for white men (68.6%) and the lowest for Hispanic women (52.7%) and black women (55.4%). Dysthymia was more prevalent in women (Hispanic, 46%; black, 27%; white, 31%) than men (Hispanic, 23%; black, 18%; white, 15%). The prevalence of major depression was greater in whites (women, 35%; men, 31%) than minorities (women, 26%; men, 21%). Compared with white men without dysthymia, the adjusted odds ratios (AORs) of HAART were significantly lower for black women (0.50 [95% confidence interval [95% CI] 0.29 to 0.87]) and Hispanic women (0.45 [95% CI 0.25, 0.79]). Among patients with depression and no dysthymia, minority women had HAART use (AOR=1.28 [95% CI 0.48 to 3.43]) similar to white men. LIMITATIONS: Self-report data from the early era of HAART use; causation cannot be proven; mental health diagnoses may not meet full DSM IV criteria. CONCLUSIONS: Dysthymia is highly prevalent in minority women and associated with a 50% reduction in the odds of receiving HAART. This underrecognized condition may contribute more than depression to the "gender disparity" in HAART use.

Published 19 November 2006 in J Gen Intern Med, 21(12): 1235-41.
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