Estradiol variability, stressful life events, and the emergence of depressive symptomatology during the menopausal transition

To examine the role of estradiol fluctuation in triggering depressive symptoms in the menopause transition and assess the role of recent very stressful life events (VSLEs) as a moderating factor in this relationship

Histories of abuse predict stronger within-person covariation of ovarian steroids and mood symptoms in women with menstrually related mood disorder

Individual differences in sensitivity to cyclical changes in ovarian steroids estradiol (E2) and progesterone (P4) have been implicated in the pathophysiology of menstrually related mood disorder (MRMD). However, no prospective studies have investigated psychosocial risk factors for sensitivity to hormone effects on mood in MRMD. Using a repeated measures approach and multilevel models, we tested the hypothesis that a history of abuse provides a context in which within-person elevations of E2 and P4 prospectively predict daily symptoms

Intensity, Chronicity, Circumstances, and Consequences of HIV-Related Fatigue: A Longitudinal Study

HIV-related fatigue remains the most troubling complaint of seropositive people. Researchers often use tools to measure fatigue that were developed for other patient populations; thus, the measurement of fatigue specific to HIV is needed. This article describes results from the HIV-Related Fatigue Scale (HRFS) including: (a) the variability in intensity and chronicity of HIV-related fatigue, (b) the circumstances surrounding changes in fatigue, (c) the impact of fatigue on activities of daily living (ADLs), and (d) the consequences of HIV-related fatigue. We collected data every 3 months over a 3-year period from 128 people. HIV-related fatigue was chronic and did not appear to remit spontaneously; those who were the most fatigued at the beginning of the study remained the most fatigued over 3 years. Fatigue interfered more with instrumental activities of daily living than basic ADLs; it also interfered with work, family, and social life. Stress and depression increased fatigue

Fatigue in HIV-Infected People: A Three-Year Observational Study

HIV-related fatigue remains the most frequent complaint of seropositive patients

Daytime Sleepiness, Nighttime Sleep Quality, Stressful Life Events, and HIV-Related Fatigue

In this report we describe the relationships between daytime sleepiness, nighttime sleep quality, stressful life events, and HIV-related fatigue in a sample of 128 individuals; we are reporting the baseline results of a longitudinal observational study. We examined sleep using the Pittsburg Sleep Quality Index (PSQI) (a measure of the quality of nighttime sleep), and the Epworth Sleepiness Scale (ESS), (a measure of daytime sleepiness). Recent stressful life events were measured via a methodology developed in a previous 9-year HIV study. Poor nighttime sleep was significantly correlated with fatigue intensity (r = 0.46, p < 0.05), as was daytime sleepiness (r = 0.20, p < 0.05). However, in multiple regression models, the association between stress and fatigue intensity was not explained by daytime sleepiness and was only partially explained by nighttime sleep quality. Further research is needed to better elucidate these relationships

Trauma, stressful life events and depression predict HIV-related fatigue

Despite the fact that fatigue is a common and debilitating symptom among HIV-infected persons, we know little about the predictors of fatigue in this population. The goal of this cross-sectional study was to examine the effects of early childhood trauma, recent stressful life events and depression on intensity and impairment of fatigue in HIV, over and above demographic factors and clinical characteristics. We studied 128 HIV-infected men and women from one southern state. The median number of childhood traumatic events was two and participants tended to have at least one moderate recent stressful event. Multiple regression findings showed that patients with less income, more childhood trauma, more recent stressful events and more depressive symptoms had greater fatigue intensity and fatigue-related impairment in daily functioning. Recent stresses were a more powerful predictor of fatigue than childhood trauma. None of the disease-related measures (e.g. CD4, viral load, antiretroviral medication) predicted fatigue. Although stress and trauma have been related to fatigue in other populations, this is the first study to examine the effects of traumatic and recent stressful life events on fatigue in an HIV-infected sample

Demographic and Illness-Related Variables Associated With HIV-Related Fatigue

Fatigue is one of the most debilitating symptoms suffered by those with HIV infection, yet little is known about its correlates. Our primary aims are to describe the degree to which fatigue affects daily functioning and the demographic and illness-related predictors of fatigue. The sample (n = 128) was composed of primarily poor, unemployed people of color. Fatigue most often interfered with the ability to think quickly, perform household chores, exercise, work, engage in recreational activities, walk, plan activities, and think clearly. The consequences of fatigue were highest for lowered motivation, difficulty concentrating, increased drowsiness, losing patience, and interference with work, family, and social life. Multiple linear regression analyses revealed statistically significant associations of employment status, monthly income, current antidepressant use, and number of years living with HIV infection as predictors of fatigue. These must be better understood in order to develop interventions to successfully ameliorate HIV-related fatigue

Co-Morbidity of Irritable Bowel Syndrome and Chronic Pelvic Pain: a One-Year Follow-Up Study

Background: Significant co-morbidity between Irritable Bowel Syndrome (IBS) and chronic pelvic pain (CPP) has been reported (35-39%). IBS affects 10-20% of the general population, and is the most common condition diagnosed by gastroenterologists. Patients with IBS have abdominal pain and abnormal stool. CPP affects 12-39% of women and is defined as non-cyclical pain of at least 6-month duration. Previous research at UNC has reported a comorbidity between IBS with CPP of 35% and has identified distinct characteristics between these two groups. It has been hypothesized that co-morbid IBS with CPP is associated with higher pain report, poorer quality of life and treatment response and should be evaluated thoroughly in the treatment of women with chronic pelvic pain. Objective: To evaluate baseline pain and psychological characteristics, clinical pain improvement over time, and effectiveness of treatments among CPP patients with and without co-morbid IBS

Open-label Trial of Lamotrigine Focusing on Efficacy in Vulvodynia

OBJECTIVE—Chronic pelvic pain (CPP) affects 15% of women and has a high rate of psychiatric comorbidity. Vulvodynia, a vulvar pain syndrome that includes vulvar vestibulitis, is the most common subtype of CPP. This study examined the efficacy of lamotrigine for the treatment of CPP using an open-label design. STUDY-DESIGN—Forty-three women with CPP were recruited from a specialty pelvic pain clinic. Of these, 31 completed 8 weeks of active treatment. Outcome variables included the McGill Pain Rating Index and subscales of pain intensity and the Hamilton Depression and Anxiety Rating Scales. RESULTS—We found significant reductions in all pain and mood measures at the 8-week visit compared to baseline. In particular, women with vulvodynia-type CPP (N=17) had robust reductions in pain and mood symptoms. CONCLUSION—CPP is a heterogeneous disorder, with psychiatric comorbidity and poor treatment response. This open-label study suggests that treatment with lamotrigine in women with the vulvodynia subtype of CPP may be helpful in addressing both the pain and mood symptoms associated with this disorder

Living in rural New England amplifies the risk of depression in patients with HIV

<p>Abstract</p> <p>Background</p> <p>The importance of depression as a complication of HIV infection is increasingly understood, and people living in rural areas are at increased risk for depression. However, it is not known whether living in rural areas amplifies the risk of depression in patients with HIV.</p> <p>Methods</p> <p>We compared the prevalence of depression between rural and metropolitan HIV patients seen at the Dartmouth-Hitchcock HIV Program in a retrospective cohort study. Using the validated Rural-Urban Commuting Area Score, we categorized patients as living in small town/rural areas, micropolitan or metropolitan towns. Then, using a multivariate logistic regression model to adjust for demographic factors that differed between rural and metropolitan patients, we estimated the impact of living in rural areas on the odds of depression.</p> <p>Results</p> <p>Among 646 patients with HIV (185 small town/rural, 145 micropolitan, 316 metropolitan), rural patients were older, white, male, and men who have sex with men (ANOVA, F-statistic < 0.05). The prevalence of depression was highest in rural patients (59.5 vs. 51.7 vs. 41.2%, F statistic < 0.001), particularly rural patients on antiretroviral therapy (72.4 vs. 53.5 vs. 38.2%, F-statistic < 0.001. A multivariate logistic regression model showed that the odds of depression in rural patients with HIV were 1.34 (P < 0.001).</p> <p>Conclusion</p> <p>HIV-infected patients living in rural areas, particularly those on antiretroviral therapy, are highly vulnerable to depression.</p