Stress and depression may make a great difference in the health of people infected with HIV, according to three new reviews of the data on the subject.
Scientists haven't yet proved that personal attitude and mental health directly affect the progress of HIV infection and Aids. But the research strongly points to a link, said Dr Gail Ironson, lead author of the one of the reviews.
"We've got enough studies with people followed over time (to show) that it's not a fluke. You can see how consistent the evidence is," said Ironson, professor of psychology and psychiatry at the University of Miami.
Researchers have long tried to understand the link between people's emotional lives and the progression of HIV. Many HIV patients have histories of depression, stress and trauma that could potentially affect their physical health.
The reviews examining these issues were published in the June edition of the journal Psychosomatic Medicine.
Depressed susceptible to disease
In her review, Ironson and a co-author looked at a number of studies examining the effect of factors such as social support, personality and spirituality.
"Psychological states do predict whether you're going to stay healthy longer or whether your disease is going to progress faster," Ironson concluded.
According to one measure of the strength of the immune system, depressed people become susceptible to disease at twice the rate of other patients, she said.
Jane Leserman, professor of psychiatry at the University of North Carolina, found similar results in her review of studies between 1990 and July 2007.
Psychological problems can contribute to worsening health in a variety of ways, such as making it less likely that patients will take their medications as directed, Leserman explained. On the other hand, research suggests that "enhancing stress management can have protective effects in terms of the immune system," she said.
Concrete facts more convincing
It may sound obvious that stress and depression make people sicker. But "people want the proof, and we're providing the evidence," Leserman said. "Without that evidence, I don't think HIV researchers would really take it that seriously."
Another study in the journal suggests that interventions that improve mental health might also boost the immune health of HIV-infected people. Adam Carrico of the University of California, San Francisco, and Michael Antoni, of the University of Miami, reviewed 14 studies on the subject conducted between 1987 and 2007. They write that, "psychological interventions represent a viable adjuvant treatment that can assist patients with improving psychological adjustment and potentially enhancing immune status."
According to Leserman, researchers could definitively link mental issues to physical health by launching what's known as the "gold standard" of research - a randomised, double-blind study. Hypothetically, researchers could track two randomly chosen groups of HIV patients, some whom are depressed and stressed and others who aren't.
But such a study would require researchers to not let the depressed patients be treated for mental problems, which is ethically and practically not possible. Both Leserman and Ironson believe that it is crucial to boost the health of HIV patients by helping them deal with the mental challenges they face outside of their disease.
"We should not give up on these people," Leserman said. "We should work with them to try to improve their lives."
Ironson put it this way: "I would encourage patients to view the glass as half full instead of half empty. There's scientific evidence that that [good mental health] is related to slower disease progression." – (Randy Dotinga/HealthDay News)