Association Between Subjective Age and Depressive Symptoms Among Middle-Aged and Aging HIV-Positive and HIV-Negative Men in the Multicenter AIDS Cohort Study

Abstract

Introduction Older subjective age, or felt age, has been positively associated with being HIV-positive and having less than a high school education, depressive symptoms, diabetes, and medium and low aging satisfaction. To our knowledge, there is no literature exploring the association between subjective aging and depression among people living with HIV. Data from the Multicenter AIDS Cohort Study (MACS) was used to understand the role that subjective aging plays on depression among people who are living with and without HIV. We hypothesized that feeling older will be negatively associated with presenting symptoms of depression among men living with HIV compared to men living without HIV following an adjustment to the model to control for covariates. Methods The MACS is an observational cohort study that follows sexual minority men living with and without HIV in four sites within the United States: Baltimore, Maryland/Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania/Columbus, Ohio. MACS participants attend semiannual visits that collect social, behavioral, medical history, and specimens using an Audio Computer-Assisted Self-Interview and standardized clinical examinations. The study design of the MACS has been described elsewhere. From 1984 to 2018, 7,352 men have been enrolled the MACS. 1,118 of these men were included in this study from the MACS substudy, ‘Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men’, which was administered in six waves between March 2016 and September 2019. We used cross-sectional data from October 2016 to April 2017. Odds ratios (including 95% CIs) were generated using logistic regression models to test the association of subjective age with the presence of depressive symptoms (defined as a score >=16 using the Center for Epidemiological Study Depression scale). Odds ratios were adjusted for age, race/ethnicity, educational attainment, smoking status, history of hypertension, renal disease, dyslipidemia, liver disease, diabetes and HIV status. Results After adjusting for covariates, older age discrepancy was associated with higher odds of depressive symptoms (vs younger discrepancy; OR: 4.00; 95% CI: 2.39-6.69). Increasing age (5-year increase; OR: 0.81; 95% CI: 0.72-0.91) was associated with lower odds of depressive symptoms. Lower educational attainment was associated with higher odds of depressive symptoms (less than high school degree vs graduate school; OR: 5.33; 95% CI: 1.96-14.53) (high school vs graduate school: OR: 1.93; 95% CI: 1.10-3.37). There was no statistically significant association of HIV status or other covariates with risk of depressive symptoms. Conclusion Our findings demonstrated a statistically significant positive association between older subjective age (independent of increasing chronological age) and greater risk of depressive symptoms. We also found that having a high school or less than a high school education also increased this risk. Statistical significance was not present based on HIV status or other covariates in the adjusted model. Health care professionals should be aware of their patient’s perception of aging in order to address depressive symptoms related to feeling older. Counteracting a person feeling older can be achieved through exercising regularly, prioritizing preventive care, maintaining a vibrant social life, and having an optimistic attitude on the years ahead of them.