Systematic review of sex differences in the relationship between hormones and depression in HIV
Morgan C Turk1, Caitlin J Bakker2, Sade M Spencer3
1University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
Insights
Depression is common in HIV, especially in women. This review found links between depression and cortisol, testosterone, and oxytocin levels, with differences between sexes needing more research.
Area of Science:
- Neuroendocrinology
- Psychiatry
- Infectious Diseases
Background:
- Major depressive disorder is a common comorbidity in individuals with human immunodeficiency virus (HIV), with women disproportionately affected.
- The prevalence of depression in the HIV-positive population is three times higher than in the general population.
- Neuroendocrine and inflammatory pathway differences may explain the higher depression rates in people with HIV, particularly women.
Purpose of the Study:
- To systematically review and identify differences in neuroendocrine factors associated with depression in men versus women living with HIV.
- To explore the role of specific hormones in the increased prevalence of depression among individuals with HIV.
Main Methods:
- A comprehensive systematic search of 8 databases was conducted.
- Title, abstract, and full-text screening were performed by two independent researchers.
- Risk of bias assessment was included in the review methodology.
Main Results:
- Twenty-six articles were included, revealing significant correlations between depression and cortisol (both sexes), testosterone (men only), and oxytocin and estradiol (women only).
- No significant correlations were found for prolactin, dehydroepiandrosterone (DHEAS), or sex hormone-binding globulin (SHBG).
- Most studies focused on one sex, with limited direct comparisons; one study indicated a stronger cortisol-depression link in women.
Conclusions:
- Neuroendocrine systems play a crucial role in mental illness, and HIV's impact on hormone signaling likely contributes to depression in affected individuals.
- There is a need for more research on neuroactive hormones in HIV-related depression, especially concerning sex-based differences.
- Further high-quality studies are essential to understand these connections and guide potential treatment strategies.
Background:
Major depressive disorder is the most common neuropsychiatric comorbidity of human immunodeficiency virus (HIV), and women are more frequently affected in the general population and among those with HIV. The rate of depression in HIV is three times higher than the general population. Differences in biomarkers in neuroendocrine and inflammatory pathways are one possible explanation for the increased prevalence of depression in individuals with HIV, especially biological women. Therefore, we aimed to perform a systematic review identifying differences in neuroendocrine factors leading to depression in men versus women with HIV.
Methods:
A comprehensive search of 8 databases was performed, followed by title and abstract screening and later full-text screening by two independent researchers. A risk of bias assessment was completed.
Results:
Twenty-six full-text articles were included in the review. Significant correlations between depression and neuroendocrine marker levels were found for cortisol (both sexes), testosterone (only in men), oxytocin (only tested in women), and estradiol (only in women). No significant correlation between depression and hormone level was found for prolactin, dehydroepiandrosterone (DHEAS), or sex hormone binding globulin (SHBG). Nearly all studies included only men or women and did not directly compare neuroendocrine markers between the two sexes. One study found that the correlation between cortisol levels and depression scores was stronger in women than men.
Conclusion:
Neuroendocrine systems are highly active in the brain and important in the development and persistence of mental illness. Given that HIV can, directly and indirectly, impact hormone signaling, it is likely contributing to the high rate of depression in individuals with HIV. However, few studies explore neuroactive hormones in depression and HIV, nor how this connection may differ between the sexes. More high-quality research is needed in this area to explore the link further and inform possible avenues of treatment.
Related Concept Videos
01:18Depression: Overview
01:27Depressive Disorders: Etiology
Biological Factors in Depression
Biological predispositions significantly influence the risk of developing depressive disorders. Genetic studies highlight the role of variations in the serotonin transporter...
01:27Depressive Disorders: MDD and Dysthymia
01:26Sexually Transmitted Infections
01:05Long-term Depression
01:30Stress and Mental Health
Individuals with depression often experience challenges in both their personal and professional...