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WHO Neuropsychiatric AIDS Study, Cross-sectional Phase IStudy Design and Psychiatric Findings
Mario Maj, MD, PhD;
Robert Janssen, MD;
Fabrizio Starace, MD;
Michael Zaudig, MD;
Paul Satz, PhD;
Bhirom Sughondhabirom, MD;
Mesu'A-Kabwa Luabeya, MD;
Rolf Riedel, MD;
David Ndetei, MD;
Helena M. Calil, MD, PhD;
Eric G. Bing, MD;
Michael Louis St., MD;
Norman Sartorius, MD, PhD
Arch Gen Psychiatry. 1994;51(1):39-49.
Abstract
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Background
Most available studies on the psychiatric, neuropsychological, and neurological complications of HIV-1 infection and AIDS have been conducted in Western countries, on samples of well-educated, mostly white, homosexual men. Concerns about generalizability of the results of those investigations prompted the WHO to implement the cross-cultural venture called WHO Neuropsychiatric AIDS study.
Methods
This project aims to assess the prevalence and natural history of HIV-1-associated psychiatric, neuropsychological, and neurological abnormalities in representative subject samples enrolled in the five geographic areas predominantly affected by the HIV-I epidemic. Assessment is made by a data collection instrument including six modules. The intercenter and intracenter reliability in the use of each module has been formally evaluated. The study consists of a cross-sectional phase and a longitudinal follow-up.
Results
The cross-sectional phase was completed in five centers. This paper reports on the results of psychiatric assessment, which revealed a significantly higher prevalence of current mental disorders in symptomatic seropositive persons compared with seronegative controls among intravenous drug users in Bangkok and homosexuals/bisexuals in São Paulo. The mean global score on the Montgomery-Asberg Depression Rating Scale was significantly higher in symptomatic seropositive individuals than in matched seronegative controls in all centers.
Conclusions
These results suggest that the significance of the psychopathological complications of symptomatic HIV-1 infection may have been underestimated by previous studies conducted on self-selected samples of well-educated, middle-class, mostly white, homosexual men.
Author Affiliations
From the Division of Mental Health and Global Programme on AIDS World Health Organization, Geneva, Switzerland (Drs Maj, Starace, and Sartorius); the Department of Psychiatry I, University of Naples, Italy (Drs Maj and Starace); the Division of HIVIAIDS, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Janssen and St. Louis); the Max-Planck Institute for Psychiatry, Munich, Germany (DrZaudig); the Neuropsychiatric Institute, UCLA, Los Angeles, Calif (Drs Satz and Bing); the Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand (Dr Sughondhabirom); the Centre of Neuropsychopathology, University of Kinshasa (Zaire), (Dr Luabeya); the Projet SIDA, Kinshasa, Zaire (Drs Luabeya and St. Louis); the Department of Psychiatry, University of Munich (Germany), (Dr Riedel); the Department of Psychiatry, University of Nairobi(Kenya), (Dr Ndetei); and the Department of Psychobiology, Escola Paulista de Medicina, São Paulo, Brazil (Dr Calil).
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