One such biological factor is the peptide hormone, oxytocin. More research is needed on potentially modifiable biological factors associated with depression symptoms, especially within diverse, at-risk populations. Despite common health-related consequences of depression in PWH, depression is a heterogenous syndrome, and PWH represent a diverse group of individuals. Not only is depression common in PWH, it is also associated with poor medication adherence ( 20), reduced likelihood of sustained viral suppression ( 21), missed primary care appointments ( 22), cognitive impairment ( 23), and a doubled mortality rate ( 22) in PWH. Moreover, a recent systematic review estimated the global prevalence rate of comorbid HIV and depression to be 31% from 2000 to 2018 ( 19), representing a striking contrast from the 2015 global prevalence rate of depression at 4.4% ( 5). Although estimates vary, research suggests that the prevalence of depressive disorders in PWH is two to four times higher than in individuals without HIV, with an average of 40% to 42% of PWH experiencing depressive disorders in their lifetime ( 17, 18). People with HIV (PWH) are particularly affected by the burden of depressive symptoms. Depression is associated with numerous negative health-related outcomes, including decreased quality of life ( 7, 8) and increased risk of heart disease ( 9), hypertension ( 10), diabetes ( 11), stroke ( 12), progression to dementia ( 13, 14), and mortality ( 15, 16). In the United States, depressive disorders alone represent the fifth most common cause of disability-adjusted life years ( 6). Globally, depressive disorders were listed as the “single largest contributor to non-fatal health loss,” in the World Health Organization’s 2017 report ( 5). Depressive disorders, in particular, account for much of that burden. Mental health and substance use disorders are the leading cause of years lived with disability worldwide ( 1, 2), representing a significant and growing economic burden with an estimated global expenditure of $2.5 trillion dollars in 2010 ( 3, 4).
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