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From the Osher Center for Integrative Medicine at the University of California San Francisco, San Francisco, California.
Address reprint requests to: Judith Tedlie Moskowitz, PhD, Osher Center for Integrative Medicine at the University of California San Francisco, 1701 Divisadero, Suite 150, San Francisco, CA 94115. Email: moskj{at}ocim ucsf.edu
Received for publication June 18, 2002; revision received October 1, 2002.
OBJECTIVE: The objective of this study was to test the association of positive affect as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) with risk of AIDS mortality, controlling for the other CES-D subscales and laboratory measures of disease progression.
METHODS: Data come from the San Francisco Men’s Health Study, a prospective study of a household probability sample of single men in San Francisco. The subjects were 407 men who were HIV+ at study baseline.
RESULTS: In time-dependent Cox proportional hazards models, the positive affect subscale of the CES-D was significantly associated with lower risk of AIDS mortality (RR = 0.89, CI = 0.84–0.95). When risk estimates were adjusted for time-dependent covariates of CD4, serum ß2-microglobulin, P24 antigen, antiretroviral use, and the other subscales of the CES-D, positive affect remained significantly predictive of lower risk of AIDS mortality (RR = 0.90, CI = 0.85–0.97). When the CES-D subscale predictors were lagged by 12, 24, and 36 months in order to address the possibility that positive affect was simply a marker for better health, positive affect remained significantly predictive lagged by 12 months and marginally predictive lagged by 24 months.
CONCLUSIONS: Positive affect seems to be the "active ingredient" in the association of scores on the CES-D depressive mood scale and mortality in this sample of HIV+ men. Future work should expand the traditional negative-affect-only focus to encompass the significant role that positive affect plays in living with HIV.
Key Words: positive affect, • CES-D, • HIV/AIDS, • mortality.
Abbreviations: AIDS = acquired immunodeficiency syndrome;; AZT = zidovudine;; CES-D = Center for Epidemiologic Studies Depression Scale;; CI = confidence interval;; ddI = dideoxyinosine;; ddC = dideoxycytidine;; HAART = Highly Active Antiretroviral Therapy;; HIV = human immunodeficiency virus;; RR = relative risk;; SD = standard deviation.
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