Risk for Major Depressive Disorder Increased Within First 2 Years of HIV Diagnosis

Within the first 2 years of diagnosis, the relative risk for major depressive disorder, receipt of antidepressants, and suicide was higher among patients with vs without HIV infection.

Patients with HIV infection are at increased risk for major depressive disorder (MDD), particularly within the first 2 years HIV diagnosis. These study results were published in Clinical Infectious Diseases.

Researchers conducted a nationwide, population-based, matched cohort study to assess the risk for MDD among patients with HIV infection. Eligible patients were enrolled at 10 specialized outpatient centers from 1995 through September 2021 and observed in intervals of 12 to 24 weeks. Patients with HIV infection were matched 1:10 against those without HIV infection (controls) by date of birth and sex. An additional cohort comprising the siblings of patients (n=5807) with and without (n=82,411) HIV infection was included and assessed to determine whether familiar factors influence the risk for MDD. Assessed outcomes included diagnosis of MDD, frequency of inpatient and outpatient psychiatric hospital contact, time to first and frequency of redeemed prescriptions for antidepressants, receipt of electroconvulsive therapy (ECT), and mortality due to suicide.

The final analysis included 5943 HIV-positive patients and 59,430 HIV-negative patients, of whom the median age was 38 (IQR, 31-47) years, 25% were women, and 6% and 4% had Charlson comorbidity index (CCI) scores of 2 and above, respectively. The siblings of patients with and without HIV infection were similar in terms of age (median, 36 years), sex (48% women), and percentage of those with CCI scores of 2 and above (3%).

Overall, patients with vs without HIV infection had increased relative risk for all assessed outcomes within the first 2 years of HIV diagnosis, with results as follows:

  • MDD (hazard ratio [HR], 3.3; 95% CI, 2.5-4.4);
  • Receipt of antidepressants (HR, 3.0; 95% CI, 2.7-3.4);
  • Receipt of ECT (HR, 2.8; 95% CI, 0.9-8.6); and
  • Mortality due to suicide (HR, 10.7; 95% CI, 5.2-22.2).
Our results demonstrate that clinicians should be attentive to symptoms of depression in people recently diagnosed with HIV.

In regard to the siblings of patients with vs without HIV infection, the researchers observed no relative increased risk for MDD or receipt of ECT between the cohorts. Although the siblings of HIV-positive patients showed increased relative risk for mortality due to suicide (HR, 1.4; 95% CI, 0.8-2.7) and receipt of antidepressants (HR, 1.1; 95% CI, 1.0-1.2), it was not to the same extent as those with HIV infection.

The researchers noted reverse causality and familiar factors as unlikely to influence the relationship between HIV infection and increased risk for MDD.

Limitations of this study include the lack of data on alcohol and substance use, potential misclassification of outcomes, and potentially imprecise risk estimates among the cohort of siblings.

According to the researchers, “Our results demonstrate that clinicians should be attentive to symptoms of depression in people recently diagnosed with HIV.”

Disclosure: This research was supported by Gilead 2022, and multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Infectious Disease Advisor


Vollmond CV, Tetens MM, Paulsen FW, et al. Risk of depression in people with human immunodeficiency virus: a nationwide population-based matched cohort study. Clin Infect Dis. Published online July 19, 2023. doi:10.1093/cid/ciad415