Depressed mood and care preferences in patients with AIDS

Eight hundred ninety-seven patients with AIDS seen in ambulatory settings were questioned about whether they would accept a nursing home or a respirator if necessary to prolong their lives. Two hundred ninety-one (32.9%) said they would accept a nursing home; 102 (11.5%) said they would accept a respirator. Acceptability of these life-sustaining interventions was significantly lower in those patients who showed evidence of clinical depression on a structural screening instrument (nursing home: 29.4% vs 39.5%, p = 0.002; respirator: 9.4% vs 14.3%, p = 0.032). Depression remained significant in multivariate models of care preferences that controlled for demographics and symptom severity. Based upon follow-up interviews conducted an average of 11 months later, subjects who were initially depressed and found nursing home care unacceptable were significantly more likely to have changed their minds at follow-up if their depression was no longer present (45.7% vs 28.4%; p = 0.0005). Findings for respirator preferences were similar, but did not attain significance. We conclude that assessment for depression is essential when advance directives for care are elicited from patients with AIDS.