Overview

Depression is one of the most common causes of years of life spent living with disability globally, and is considerably more prevalent among people with HIV infection than in the non–HIV-infected population. Severe depression can best be conceptualized as a medical comorbidity of HIV infection that HIV health care practitioners need to screen for and manage among their patients. Other mental illness comorbidities that are common among people with depression often need to be addressed as well.

As commonly used, the term depression can refer to everything from a transient low mood to a severe and disabling condition that interferes with performing life’s most basic tasks. This module is focused only on depression that meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for either Major Depression or Persistent Depressive Disorders (dysthymia). Other forms of depression will be discussed in the differential diagnosis.

Moderate to severe depression among people with HIV infection is associated with increased substance use, poor functioning, poor quality of life, and suicidal behavior, as well as many negative HIV-related outcomes including increased risk behaviors that could lead to HIV transmission, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, more rapid progression of HIV illness, and increased morbidity and mortality. There is evidence that being in treatment for depression is associated with improvements in these HIV-related outcomes. In addition, treating depression successfully reduces suffering and disability.