For women with HIV, depression can be deadly. A Yale study of women with the aids virus found that death rates for those with chronic depressive symptoms were two times higher than for those with no depressive symptoms. Chronic depression was also associated with significantly greater decline in CD4+ count, an important measure of immune function.

Clinical levels of depression have been reported by 30 to 60 percent of women with HIV. In the first study to look at the association between depression and the course of AIDS in women, 765 women from four regions of the United States were followed over a period of seven years as part of the HIV Epidemiological Research Study. The findings were published in the March 21 issue of JAMA: The Journal of the American Medical Association. The study leader, Jeannette R. Ickovics, Ph.D., associate professor of epidemiology and public health, said that “although the mechanism for this effect is not fully understood, it is clear that depression causes more advanced disease progression. We saw such high rates that either these women were not getting treatment or the treatment they received was inadequate. Yet depression is a treatable chronic disease. If we identify and treat depression among women with hiv, we have the opportunity to enhance their emotional well-being as well as extend their years of life.”

Women in the general population have higher rates of depression than men, and women with advanced HIV were found to be particularly vulnerable to the effects of depression, according to the new study. The findings show that “mental health services should be routinely integrated with primary care for HIV,” Ickovics said.