Beyond Viral Suppression: Social Determinants Associated with Depression Among People with HIV in the All of Us Research Program
Study Purpose
Examine demographic and social determinants of health associated with depression among people with HIV (PWH) using data from the NIH All of Us Research Program.
Theoretical Framework
Theoretical Foundation: Syndemic Theory (Singer et al., 2017)
This study is grounded in syndemic theory, a framework that emphasizes how co-occurring epidemics cluster within populations, interact synergistically, and are driven by shared social, economic, and structural conditions. Rather than viewing HIV and depression as independent comorbidities, syndemic theory frames them as mutually reinforcing conditions that emerge from, and are sustained by, contexts of poverty, stigma, discrimination, and limited access to resources. Within this framework, depression among PWH is understood not only as an individual clinical outcome but also as a product of the social environments in which PWH live. Accordingly, this study examines demographic and social determinants of health, including socioeconomic status, housing, insurance, and experiences of discrimination, as factors that may differentiate PWH with and without depression. Although this cross-sectional design does not formally test the synergistic interactions central to syndemic theory, the framework guided the selection of variables and the interpretation of findings, positioning social conditions as key drivers of the co-occurrence of HIV and depression.
Overall Study Design
This retrospective, cross-sectional study uses EHR and survey data from the NIH All of Us Research Program Controlled Tier. People with HIV were classified into three groups: (1) those with an EHR diagnosis of depression, (2) those without a depression diagnosis who reported depressive symptoms on a survey item (possible undiagnosed depression), and (3) those with neither. Among participants with a depression diagnosis, the date of the first recorded depression diagnosis was compared with the date of the first recorded HIV diagnosis to classify depression as preceding or following HIV diagnosis.
Limitation
The timing of depression relative to HIV diagnosis was based on the earliest diagnosis dates available in the All of Us EHR. Because EHR data are limited to participating health systems, diagnoses made in other care settings may not be captured, so recorded first-diagnosis dates may not reflect the true onset of either condition. Similarly, the absence of a depression diagnosis code does not rule out depression, which may lead to misclassification.
PI: Josh Matacotta