2005, Number 5
Assessment of depression, anxiety, and anger in HIV/AIDS patients.
Teva I, Bermúdez MP, Hernández-Quero J, Buela-Casal G
Full text
Language: Spanish
References: 33
Page: 40-49
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ABSTRACT
Introduction. HIV infection is a chronic-character illness which implies a high level of uncertainty for patients. Indeed, HIV infection involves confronting an illness surrounded by social stigma and refusal. There following are some of the situations that suppose big emotional repercussions: When an individual does not know whether he/she is infected, when he/she receives HIV diagnosis, or when he/she must say to other people that he/she is HIV positive. The emotional effects are depression, anxiety, and anger, which are frecuent emotional reactions among HIV infected patients. These reactions disappear when the patient adapts to his/her condition of HIV infected. Likewise, the uncertainty that produces HIV infection is related both to high levels of anxiety and depression because patients do not know how their infection will evolve. Anger and depression constitute other emotional factors related to a faster evolution of HIV infection. In addition to that, depression has effects over the fullfillment of the HIV infection treatment guidelines. Considering the importance of emotional aspects in HIV infection, this research's aims were to verify the differences in the sample of patients with HIV that has been evaluated regarding characteristics of depression, state of anxiety, state of anger, trait of anger, and expression of anger according to gender, stage of HIV infection, CD4 cells, viral load, transmission way, and the presence of lipodystrophy. Another aim was to verify if there were any differences between the sample of persons with HIV/AIDS that has been evaluated and the normative group in symptoms of depression, state of anxiety, state of anger, trait of anger, and expression of anger.Method. In the present research paticipated 100 HIV/AIDS- infected patients; 37 of them were women and 63 were men. The patients attended medical visits in different hospitals of Andalusia (Spain). The age rank of these patients was between 18 and 70 years. The average age was 39.55 years and the standard deviation was 7.49. The instruments used for the assessment were the Beck Depression Inventory (BDI), the subscale of state of anxiety of the State-Trait Anxiety Inventory (STAI), and the State-Trait Anger Expression Inventory (STAXI-2). The data were collected in three hospitals of the Andalusian region by the same investigator and the confidentiality of the data was guaranteed. Another information collected were clinical data of the patients from the case histories. The statistic program SPSS 11.0 was used for the analysis of the data. This study has an ex post facto retrospective design.
Results. The results showed statistically significant differences in state of anxiety according to the viral load and lipodystrophy, with higher levels of state of anxiety in the group that had a halfway point in viral load and in the group that did not show lypodistrophy. On the other hand, there were statistically significant differences in the state of anger according to the stage of HIV infection, with higher levels of anger in the group that was in the symptomatic stage of HIV infection. In this study it has been found that most men with HIV/AIDS showed symptoms of depression that were between slight, moderate, and severe depression. In contrast, a big part of the group of women did not show characteristics of depression. With regard to anxiety, an important proportion of men showed a state of anxiety, while women did not show it in most cases. Most men and women presented a low level of state of anger. In the variable trait of anger, it has been found that approximately half of the men was in the normal rank. In the group of women, the majority was in the normal rank of trait of anger too. Finally, with regard to expression of anger, more of a third of the men and women with HIV/AIDS did not express anger.
Discussion. The stage of the HIV infection could be a factor that explains the high presence of characteristics of depression in men. Women could have better ways to confront the illness than men. The high levels of depression symptoms and anxiety in the group of men could be explained by the ignorance about how the infection will evolve. Other results indicated that patients infected by heterosexual relationships showed higher anxiety than patients infected by the intravenous use of drugs. This fact could be explained by a higher presence of cognitions related to the evolution of the HIV infection or risk behaviors in people who were infected by heterosexual intercourse. Patients with a halfway point in viral load showed higher levels of state of anxiety and state of anger than patients with low viral load, because people with halfway point in viral load were more aware of the deterioration produced by the HIV infection and they did not assume it. The stage of HIV infection could be a factor that explains the higher levels of state of anger in patients in the symptomatic stage. The presence of lipodystrophy implies a deterioration of corporal image in patients that suffer this syndrome. It has been found that patients who did not have lipodystrophy showed higher levels of state of anxiety than the patients with lipodystrophy. This result is incongruent with other studies that have been made. It is suggested that this is an effect of a small sample. However, two explanations can be advanced about this result. On the one hand, lipodystrophy has nowadays a subjective diagnosis, and it could be the case that many patients’ lipodystrophy has not being diagnosed, when they actually have the syndrome. On the other, it has been observed that there are delays when the data related to lipodystrophy must be gathered in case histories and thus it is not known if a patient endures lipodystrophy exactly. It could be the case that a patient suffers lipodystrophy and this fact does not appear in the case history.
Considering that depression and anxiety are frequent disorders in patients with HIV/AIDS and that these factors influence the immune system, the results obtained could be used for the design of intervention programs whose aims would be the assessment and the intervention of depression and anxiety. Some aspects which would be important to assess in future researches with HIV/AIDS patients are social support, levels of perceived stigma, and the perception of health control.
REFERENCES
17. MOLASSIOTIS A, CALLAGHAN P, TWINN SF, LAM SW: A pilot study of the effects of cognitive-behavioral group therapy and peer support/counselling in decreasing psychological distress and improving quality of life in Chinese patients with symptomatic HIV disease. AIDS Patient Care ST, 16:83-96, 2002.