The more cumulative time that HIV-positive women spend with depression, the higher their risk of death, according to a study in which just 30 percent of women took antiretroviral (ARV) treatment during follow-up.

Publishing their findings in Clinical Infectious Diseases, researchers decided against the typical means of analyzing depression’s effect on people with HIV. Rather than considering depression as a binary risk factor—meaning people either have a history of depression or they do not—they looked at depression on a continuum by measuring the cumulative days that women with HIV spent depressed and how this correlated with their risk of death.

The scientists analyzed data on 818 women participating in the Women’s Interagency HIV Study. The women entered the study in phases starting in 1998 and continuing through 2012. All the women in the cohort analyzed for this new paper had untreated HIV upon entering the study and were followed for up to 10 semiannual visits, or five years.

The women’s depressive symptoms were measured over time according to the Center for Epidemiologic Studies Depression scale. This allowed the study authors to estimate the cumulative days the women had depression during follow-up.

Upon their entry into the study, the women had a median age of 38. Sixty-six percent were Black and 19 percent were white. Thirty-eight percent had less than a high school education, 31 percent had a high school diploma and 30 percent had more than a high school education.

The women were followed for a cumulative 3,292 years or a median of 4.8 years each.

Ninety-four women died during follow-up, for a mortality rate of 2.9 deaths per cumulative 100 years of follow-up.

By the end of follow-up, the women in the overall cohort spent a median 366 days depressed, with the 25thto 75thpercentile ranging between 95 and 853 days. A total of 171 women were lost to follow-up and 553 were administratively censored—meaning their follow-up time was truncated for technical reasons.

Those who died had a median 435 cumulative days of depression. Those lost to follow-up or administratively censored spent a cumulative 355 days depressed.

The study authors calculated that for each 365 days spent with depression, women had a 72 percent increased risk of death.

“In this sample of WLWH [women living with HIV], increased CDWD [cumulative days with depression] elevated mortality rates in a dose-response fashion,” the researchers concluded. “More frequent monitoring and enhanced depression treatment protocols designed to reduce CDWD may interrupt the accumulation of mortality risk among WLWH.”

To read the study abstract, click here.