Depression and Reasons for Living among Aids Patients: Protecting Quality of Life When the End is in Sight

Abstract

Background:

Patients with AIDS are at risk for becoming depressed, pessimistic, and may begin to desire to die. The desire to live may remain strong in AIDS patients through the maintenance of physical health and a lack of pain. However, improvement in physical health is not always followed by resurgence in the will to live. Psychological variables may be important for protecting reasons for living in AIDS patients.

Aims:

The current study was designed to examine protective factors associated with the will to live among AIDS patients, including physical functioning, depression, and quality of life.

Method:

Sixty-eight AIDS patients participated in the current study during their outpatient visits to an infectious disease unit. Self-report questionnaires were administered to assess depression, quality of life, a variety of physical health variables, and reasons for living.

Results:

Analyses revealed that reasons for living reported by AIDS patients were best understood by overall quality of life. Depression was associated with pessimistic beliefs about the medical illness. Depression was not significantly related to physical functioning or role limitations.

Conclusions:

AIDS patients with poor physical functioning may maintain important reasons for living if a high sense of quality of life is achieved. The assessment and treatment of quality of life in AIDS patients should include strategies that foster a sense of achievement, strengthen interpersonal relationships, and increase positive self-expression.

Keywords

depression reasons for living quality of life AIDS

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References

Mrus

Wade

Hornung

Cotton

. Religion, spirituality, and depressive symptoms in patients with HIV/AIDS. Journal of General Internal Medicine 2006; 21: S21–S27.

Ickovics

Hamburger

Vlahov

Schoenbaum

Schuman

Boland

Moore

. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women. Journal of the American Medical Association 2001; 285(11): 1466–1474.

Gore-Felton

Koopman

Spiegel

Vosvick

Brondino

Winningham

. Effects of quality of life and coping on depression among adults living with HIV/AIDS. Journal of Health and Psychology 2006; 11(5): 711–729.

Clarke

Cook

Coleman

Smith

. A qualitative examination of ‘depression’ in hospitalized medically ill patients. Psychopathology 2006; 39(6): 303–312.

Robertson

Parsons

Van der Horst

Hall

. Thoughts of death and suicidal ideation in nonpsychiatric human immunodeficiency virus seropositive individuals. Death Studies 2006; 30(5): 455–469.

Shelton

Atkinson

Risser

JMH

McCurdy

Useche

Padgett

. The prevalence of suicidal behaviors in a group of HIV-positive men. AIDS Care 2006; 18(6): 574–576.

Carrico

Johnson

Morin

Remien

Charlebois

Steward

Chesney

. Correlates of suicidal ideation among HIV-positive persons. AIDS 2007; 21(9): 1199–1203.

Cooperman

Simoni

. Suicidal ideation and attempted suicide among women living with HIV/AIDS. Journal of Palliative Medicine 2005; 28(2): 149–156.

Roy

. Characteristics of HIV patients who attempt suicide. Acta Psychiatrica Scandinavica 2002; 107: 41–44.

10.

O'Mahony

Goulet

Kornblith

Abbatiello

Clarke

Kless-Siegel

. Desire for hastened death, cancer pain and depression: Report of a longitudinal observational study. Journal of Pain Symptom Management 2005; 29(5): 446–457.

11.

Rodin

Zimmerman

Rydall

Jones

Shephard

Moore

. The desire for hastened death in patients with metastatic cancer. Journal of Pain Symptom Management 2007; 33(6): 661–675.

12.

Mystakidou

Rosenfeld

Parpa

Katsouda

Tsilika

Galanos

Vlahos

. Desire for death near the end of life: The role of depression, anxiety, and pain. General Hospital Psychiatry 2005; 27: 258–262.

13.

Clayson

Wild

Quarterman

Kubin

Duprat-Lomon M

Coons

. A comparative review of health-related quality-of-life measures for use in HIV/AIDS clinical trials. PharmacoEconomics, 2006; 24(8): 751–765.

14.

Kudel

Farber

Mrus

Leonard

Sherman

Tsevat

. Patterns of responses on health-related quality of life questionnaires among patients with HIV/AIDS. Journal of General Internal Medicine 2006; 21: 48–55.

15.

Sullivan

. The desire for death arises from an intolerable future rather than an intolerable present. General Hospital Psychiatry 2005; 27: 256–257.

16.

Overholser

Schubert

DSP

Foliart

Frost

. Assessment of emotional distress following a spinal cord injury. Rehabilitation and Psychology 1993; 38(3): 187–198.

17.

Linehan

Goodstein

Nielsen

Chiles

. Reasons for staying alive when you are thinking of killing yourself: The reasons for living inventory. Journal of Consulting and Clinical Psychiatry 1983; 51(2): 276–286.

18.

Osman

Kopper

Linehan

Barrios

Gutierrez

Bagge

. Validation of the adult suicidal ideation questionnaire and the reasons for living inventory in an adult psychiatric inpatient sample. Psychology Assessment 1999; 11(2): 115–123.

19.

Osman

Gifford

Jones

Lickiss

Osman

Wenzel

. Psychometric evaluation of the reasons for living inventory. Psychology Assessment 1993; 5(2): 154–158.

20.

Ware

Sherbourne

. The MOS 36-item short-form health survey (SF-36). Medical Care 1992; 30(6): 473–481.

21.

Weinberger

Samsa

Hanlon

Schmader

. An evaluation of a brief health status measure in elderly veterans. Journal of the American Geriatric Society 1991; 39(7): 691–694.

22.

Frisch

Cornell

Villanueva

Retzlaff

. Clinical validation of the quality of life inventory: A measure of life satisfaction for use in treatment planning and outcome assessment. Psychology Assessment 1992; 4(1): 92–101.

23.

McAlinden

Oei

TPS

. Validation of the quality of life inventory for patients with anxiety and depression. Comprehensive Psychiatry 2006; 47: 307–314.

24.

O'Cleirigh

Safren

. Domains of life satisfaction among patients living with HIV: A factor analytic study of the quality of life inventory. AIDS Behavior 2006; 10(1): 53–58.

25.

Jones

Huggins

Rydall

Rodin

. Symptomatic distress, hopelessness, and the desire for hastened death in hospitalized cancer patients. Journal of Psychosomatic Research 2003; 55: 411–418.

26.

Kelly

Murphy

Bahr

Koob

Morgan

Kalichman

. Factors associated with severity of depression and high-risk sexual behavior among persons diagnosed with human immunodeficiency virus (HIV) infection. Health and Psychology 1993; 12(3): 215–219.

27.

Uldall

Koutsky

Bradshaw

Hopkins

. Psychiatric comorbidity and length of stay in hospitalized AIDS patients. American Journal of Psychiatry 1994; 151(10): 1475–1478.

28.

Beck

. The current state of cognitive therapy. Archives of General Psychiatry 2005; 62: 953–959.

29.

Malone

Oquendo

Haas

Ellis

Mann

. Protective factors against suicidal acts in major depression: Reasons for living. American Journal of Psychiatry 2000; 157(7): 1084–1088.

30.

Dobrov

Thorell

. “Reasons for living”—Translation, psychometric evaluation and relationships to suicidal behavior in a Swedish random sample. Nordic Journal of Psychiatry 2004; 58: 277–285.

31.

Liu

Ostrow

Detels

Johnson

Kingsley

Jacobson

. Impacts of HIV infection and HAART use on quality of life. Quality of Life Research 2006; 15: 941–949.

32.

Chan

Chung

Lee

. Illness-related factors, stress and coping strategies in relation to psychological distress in HIV-infected persons in Hong Kong. AIDS Care 2006; 18(8): 977–982.

33.

Griswold

Evans

Spielman

Fishman

. Coping strategies of HIV patients with peripheral neuropathy. AIDS Care 2005; 17(6): 711–720.