Resumen de Evaluación de la depresión, ansiedad e ira en pacientes con VIH/SIDA

José Hernández Quero, Gualberto Buela Casal, María Paz Bermúdez Sánchez, Inmaculada Teva Álvarez

• español

  Introducción: La infección por el VIH constituye una enfermedad que, aunque actualmente se considera de carácter crónico, implica para el paciente que la padece unos niveles altos de incertidumbre y enfrentarse con una enfermedad rodeada de estigmatización y rechazo por parte de la sociedad. La depresión, la ansiedad y la ira son las reacciones emocionales que se manifiestan con más frecuencia entre los pacientes seropositivos. Igualmente, la infección por el VIH supone incertidumbre que se relaciona con elevados niveles de ansiedad y depresión debido a que los pacientes no conocen cómo va a evolucionar la enfermedad. Considerando la importancia de los aspectos emocionales en la infección por el VIH, se plantea esta investigación cuyos objetivos son evaluar si existen diferencias en la muestra de pacientes con VIH en cuanto a sintomatología depresiva, ansiedad estado, ira estado, ira rasgo y expresión de la ira en función del sexo, del estadio de la infección, del nivel de linfocitos CD4, del nivel de carga viral, de la vía a través de la cual se infectaron y de la presencia de lipodistrofia. Otro objetivo es evaluar si existen diferencias entre la muestra de personas con VIH/SIDA evaluada y el grupo normativo en cuanto a síntomas de depresión, ansiedad estado, ira estado, ira rasgo y expresión de la ira.

  Método: En la presente investigación participaron 100 pacientes con VIH/SIDA. De ellos, 37 eran mujeres y 63 varones que acudían a visitas médicas a diferentes hospitales de la Comunidad Autónoma de Andalucía (España). El rango de edad de los pacientes oscilaba entre los 18 y 70 años. La media de edad era de 39.55 años y la desviación típica era de 7.49. Los instrumentos de evaluación empleados fueron el Inventario de Depresión de Beck (BDI), la subescala de ansiedad estado del Inventario de Evaluación de Ansiedad Estado-Rasgo (STAI) y el Inventario de Expresión de Ira Estado-Rasgo (STAXI-2). El diseño de este estudio es de tipo ex post facto retrospectivo.

  Resultados: Se encontraron diferencias estadísticamente significativas en ansiedad estado en función del nivel de carga viral y en función de la lipodistrofia. Se destacaron mayores niveles de ansiedad estado en el grupo con un nivel de carga viral medio y en el grupo que no presentaba lipodistrofia. Asimismo, se encontraron diferencias estadísticamente significativas en ira estado en función del estadio de la infección. Los mayores niveles de ira estado se presentaron en el grupo en fase sintomática. La mayoría de los varones con VIH/SIDA mostró niveles de sintomatología depresiva localizados entre la depresión leve, moderada y grave. Sin embargo, en la mayor parte del grupo de mujeres no hubo rasgos de depresión. En cuanto a la ansiedad, una gran proporción de los varones presentó ansiedad estado, lo que en general no ocurrió con las mujeres. Gran parte de los varones y de las mujeres tenían niveles bajos de ira estado. En cuanto a la variable ira rasgo, los resultados han puesto de manifiesto que aproximadamente la mitad de los varones y gran parte de las mujeres no la presentan. Por último, respecto a la expresión de la ira, más de la tercera parte de los varones y de las mujeres de la muestra no solían expresarla.

  Discusión: Los elevados niveles de ansiedad y de síntomas de depresión en el grupo de varones se pueden deber a una incertidumbre respecto de la evolución de la enfermedad. Por otro lado, dado que la mayoría de los varones se encuentra en los estadios asintomático y sintomático, las propias manifestaciones de la enfermedad podrían contribuir a la presencia de niveles elevados de ansiedad y de sintomatología depresiva. El estadio de la infección puede ser un factor que explique los mayores niveles de ira estado de los pacientes en estadio sintomático. Los resultados obtenidos se podrían utilizar para diseñar programas de intervención en que se aborden los factores emocionales más prevalentes en esta población, como la depresión y la ansiedad. Algunos aspectos que serían importantes evaluar en futuras investigaciones en pacientes con VIH/SIDA son el apoyo social, los estilos de afrontamiento, el nivel de estigmatización percibido y la percepción de control de la salud por parte del paciente

• English

  Introduction.

  HIV infection is a chronic-character illness which implies a high level of uncertainty for patients. Indeed, HIV infection involves confronting an illness surrounded by social stigma and refusal. There following are some of the situations that suppose big emotional repercussions: When an individual does not know whether he/she is infected, when he/she receives HIV diagnosis, or when he/she must say to other people that he/ she is HIV positive. The emotional effects are depression, anxiety, and anger, which are frecuent emotional reactions among HIV infected patients. These reactions disappear when the patient adapts to his/her condition of HIV infected. Likewise, the uncertainty that produces HIV infection is related both to high levels of anxiety and depression because patients do not know how their infection will evolve. Anger and depression constitute other emotional factors related to a faster evolution of HIV infection. In addition to that, depression has effects over the fullfillment of the HIV infection treatment guidelines. Considering the importance of emotional aspects in HIV infection, this research's aims were to verify the differences in the sample of patients with HIV that has been evaluated regarding characteristics of depression, state of anxiety, state of anger, trait of anger, and expression of anger according to gender, stage of HIV infection, CD4 cells, viral load, transmission way, and the presence of lipodystrophy. Another aim was to verify if there were any differences between the sample of persons with HIV/AIDS that has been evaluated and the normative group in symptoms of depression, state of anxiety, state of anger, trait of anger, and expression of anger.

  Method.

  In the present research paticipated 100 HIV/AIDS-infected patients; 37 of them were women and 63 were men. The patients attended medical visits in different hospitals of Andalusia (Spain). The age rank of these patients was between 18 and 70 years. The average age was 39.55 years and the standard deviation was 7.49. The instruments used for the assessment were the Beck Depression Inventory (BDI), the subscale of state of anxiety of the State-Trait Anxiety Inventory (STAI), and the State-Trait Anger Expression Inventory (STAXI-2). The data were collected in three hospitals of the Andalusian region by the same investigator and the confidentiality of the data was guaranteed. Another information collected were clinical data of the patients from the case histories. The statistic program SPSS 11.0 was used for the analysis of the data. This study has an ex post facto retrospective design.

  Results.

  The results showed statistically significant differences in state of anxiety according to the viral load and lipodystrophy, with higher levels of state of anxiety in the group that had a halfway point in viral load and in the group that did not show lypodistrophy. On the other hand, there were statistically significant differences in the state of anger according to the stage of HIV infection, with higher levels of anger in the group that was in the symptomatic stage of HIV infection. In this study it has been found that most men with HIV/AIDS showed symptoms of depression that were between slight, moderate, and severe depression. In contrast, a big part of the group of women did not show characteristics of depression. With regard to anxiety, an important proportion of men showed a state of anxiety, while women did not show it in most cases. Most men and women presented a low level of state of anger. In the variable trait of anger, it has been found that approximately half of the men was in the normal rank. In the group of women, the majority was in the normal rank of trait of anger too. Finally, with regard to expression of anger, more of a third of the men and women with HIV/AIDS did not express anger.

  Discussion.

  The stage of the HIV infection could be a factor that explains the high presence of characteristics of depression in men. Women could have better ways to confront the illness than men. The high levels of depression symptoms and anxiety in the group of men could be explained by the ignorance about how the infection will evolve. Other results indicated that patients infected by heterosexual relationships showed higher anxiety than patients infected by the intravenous use of drugs. This fact could be explained by a higher presence of cognitions related to the evolution of the HIV infection or risk behaviors in people who were infected by heterosexual intercourse. Patients with a halfway point in viral load showed higher levels of state of anxiety and state of anger than patients with low viral load, because people with halfway point in viral load were more aware of the deterioration produced by the HIV infection and they did not assume it. The stage of HIV infection could be a factor that explains the higher levels of state of anger in patients in the symptomatic stage. The presence of lipodystrophy implies a deterioration of corporal image in patients that suffer this syndrome. It has been found that patients who did not have lipodystrophy showed higher levels of state of anxiety than the patients with lipodystrophy. This result is incongruent with other studies that have been made. It is suggested that this is an effect of a small sample. However, two explanations can be advanced about this result. On the one hand, lipodystrophy has nowadays a subjective diagnosis, and it could be the case that many patients’ lipodystrophy has not being diagnosed, when they actually have the syndrome. On the other, it has been observed that there are delays when the data related to lipodystrophy must be gathered in case histories and thus it is not known if a patient endures lipodystrophy exactly. It could be the case that a patient suffers lipodystrophy and this fact does not appear in the case history.

  Considering that depression and anxiety are frequent disorders in patients with HIV/AIDS and that these factors influence the immune system, the results obtained could be used for the design of intervention programs whose aims would be the assessment and the intervention of depression and anxiety. Some aspects which would be important to assess in future researches with HIV/AIDS patients are social support, levels of perceived stigma, and the perception of health control.