Depression and Suicidal Behaviors Among HIV-Infected Inmates in Lesotho: Prevalence, Associated Factors and a Moderated Mediation Model

Depressive symptoms and its determinants among people living with HIV in Africa: systematic review and meta-analysis

BACKGROUND

In Africa, depressive symptoms are prevalent among people living with HIV (PLHIV), significantly impacting their adherence and overall quality of life. The combined burden of HIV and depressive symptoms worsens health outcomes, leading to an increased risk of morbidity and mortality.

OBJECTIVES

To estimate the pooled prevalence and identify the associated factors of depressive symptoms among people living with HIV in Africa.

METHODS

In this study, we reviewed articles that evaluated the prevalence of depressive symptoms and its contributing variables. The primary studies were searched using the following databases: African Journal Online, Science Direct, EMBASE, Google Scholar, and PubMed. A Microsoft Excel spreadsheet was employed to extract the data, which was then exported to STATA version 14 for further analysis. While publication bias was examined using a funnel plot and Egger's test, heterogeneity was tested using the I2 test.

RESULTS

The estimated pooled prevalence of depressive symptoms among people living with HIV was determined to be 33.32%. Based on the sub-group analysis the higher prevalence of depressive symptoms was found in East Africa, and perinatal women. Furthermore, being female, experiencing stigma, having poor social support, a CD4 count < 200, and comorbid chronic illnesses were significant predictors of depressive symptoms.

CONCLUSION

This review concluded that one-third of people living with HIV in Africa suffered from depressive symptoms. Additionally, individuals experiencing stigma, poor social support, a CD4 count < 200, and comorbid chronic illnesses, as well as females suffered more from depressive symptoms. Therefore, mental health assessments should address these factors.

PROSPERO REGISTRATION NUMBER

CRD42024516528.

Sex differences in help-seeking behavior for depression in Lesotho: findings from a national survey

BACKGROUND

Given the many adverse health outcomes associated with depression, it is imperative to promote help-seeking behaviors. However, in Lesotho, there are no published studies that have investigated the help-seeking dynamics for depression. As such, the following questions remain unanswered: (a) What proportion of people living with depression in Lesotho seek help? (b) Are there significant sex differences in the factors associated with help-seeking for depression? To address these questions, we examined the prevalence and sex differences in the factors associated with help-seeking for depression in Lesotho.

METHODS

Secondary data from the 2023-2024 Lesotho demographic and health survey was used. We sampled 2172 men and 1484 women. Binary logistic regression models were fitted in STATA 18. Statistical significance was set at p < 0.05.

RESULTS

Overall, the proportion of women who sought help for depression was slightly higher (17.1% [14.4-20.3]) compared to men (16.4% [14.3-18.8]). More women (43.6%) sought help for depression from formal help providers than men. Likewise, more than half of male participants (60%) sought help from informal sources. Among men, those with moderate depression had significantly higher odds of seeking help (AOR = 2.02, 95%CI: 1.56-2.61). Help-seeking was also more likely among men with secondary education (AOR = 1.98, 95%CI: 1.13-3.47), those currently in a union (AOR = 1.85, 95%CI: 1.41-2.42) or previously in a union (AOR = 2.30, 95%CI: 1.54-3.45), and those in the richest wealth index (AOR = 1.64, 95%CI: 1.06-2.53). Among women, moderate (AOR = 2.41, 95%CI: 1.76-3.32) and severe depression (AOR = 3.42, 95%CI: 2.26-5.18) significantly increased help-seeking likelihood. Women aged 45-59 years (AOR = 2.46, 95%CI: 1.36-4.45), exposed to media (AOR = 1.63, 95%CI: 1.21-2.19), or consuming alcohol (AOR = 1.36, 95%CI: 1.01-1.84) also had higher odds of seeking help.

CONCLUSION

Help-seeking for depression is low among men and women in Lesotho. However, the factors associated with help-seeking differ by sex. Among women, leveraging the media could yield more effective outcomes; among men, addressing poverty and improving education could prove effective in improving help-seeking for depression. The study also underscores a need to focus on harnessing the potential of informal support networks.

Mental health disparities in people living with human immunodeficiency virus: A cross-sectional study on physician-patient concordance and treatment regimens

BACKGROUND

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) can profoundly affect the mental health of the people living with HIV (PLWH), with higher rates of anxiety, depression, and sleep disturbances. The disparities in neuropsychological problems evaluated by physicians and self-assessed by patients are still unknown.

METHODS

A total of 5000 PLWH and 500 physicians from 167 hospitals were enrolled in this cross-sectional study from September 2022 to February 2023. 4-Item Patient Health Questionnaire (PHQ-4) was used for the evaluation of depressive issues and anxiety issues by PLWH. Each physician assessed 10 PLWH under their care for the presence of depressive or anxiety issues. The primary outcomes of this study are the concordance rates on the depressive issues and anxiety issues evaluation between physicians and PLWH. The Cohen's kappa test was used to assess the agreement between physicians and PLWH.

RESULTS

The concordance rate for the evaluation of depressive issues is 73.84% (95% confidence interval [CI]: 72.60-75.04%), and it is significantly different from the expected rate of 80% (P <0.001). Similarly, the concordance rate for the evaluation of anxiety issues is 71.74% (95% CI: 70.47-72.97%), which is significantly different from the expected rate of 80% as per the null hypothesis (P <0.001). The overestimation rate by physicians on depressive issues is 12.20% (95% CI: 11.32-13.14%), and for anxiety issues is 12.76% (95% CI: 11.86-13.71%). The mismatch rate for depressive issues is 26.16% (95% CI: 24.96-27.40%), and for anxiety issues is 28.26% (95% CI: 27.02-29.53%). The underestimation rate by physicians on depressive issues is 13.96% (95% CI: 13.03-14.95%), and for anxiety issues is 15.50% (95% CI: 14.52-16.53%). For the treatment regiments, PLWH sustained on innovative treatment regimen (IR) related to a lower prevalence of depressive issues (odds ratio [OR] = 0.71, 95% CI: 0.59-0.87, P = 0.003) and a lower prevalence of anxiety issues (OR = 0.63, 95% CI: 0.52-0.76, P <0.001). PLWH switch from conventional treatment regimen (CR) to IR also related to a lower prevalence of depressive issues (OR = 0.79, 95% CI: 0.64-0.98) and a lower prevalence of anxiety issues (OR = 0.81, 95% CI: 0.67-0.99).

CONCLUSION

Nearly one in three PLWH had their condition misjudged by their physicians. The findings underscore the need for improved communication and standardized assessment protocols in the care of PLWH, especially during the acute phase of HIV infection.

Self-injury and suicide among people living with HIV/AIDS in China: a systematic review and meta-analysis

BACKGROUND

The prevalence of self-injury and suicide is higher than the general population of people living with HIV/AIDS (PLWHA). However, the results reported in existing studies are highly variable in China. The purpose of this systematic review and meta-analysis was to synthesize the currently available high-quality evidence to explore the prevalence and influence factors of self-injury and suicide among PLWHA in China.

METHOD

We retrieve literature written in Chinese and English through databases such as PubMed, Embase, Web of Science, Cochrane Library, SinoMed, CNKI, WanFang Database, and CQVIP from inception to 1 September 2022. Sata 16.0 software was used for analysis.

RESULTS

A total of 28 studies were included with a sample size of 1,433,971 and had a satisfactory quality score of ≥ 5. The prevalence among PLWHA in China were 30% for suicidal ideation (SI), 5% for suicide attempt (SA), 8% for suicide plan (SP), 7% for attempted suicide (AS), and 3‰ for completed suicide. High stigma (OR = 2.94, 95%CI: 1.90 - 4.57), depression (OR, 3.17; 95%CI, 2.20 - 4.57), anxiety (OR, 3.06; 95%CI, 2.23 - 4.20), low self-esteem (OR, 3.82, 95%CI, 2.22 - 6.57), high HIV related stress (OR, 2.53; 95%CI, 1.36 - 4.72), and unemployment (OR, 2.50; 95%CI, 1.51 - 4.15) are risk factors for SI; high social support (OR, 0.61; 95%CI, 0.44 - 0.84) and spouse infected with HIV (OR, 0.39; 95%CI, 0.21 - 0.74) are protective factors for SI; depression (OR, 1.62; 95%CI, 1.24 - 2.13), high aggression (OR, 4.66; 95%CI, 2.59 - 8.39), and more negative life events (OR, 2.51; 95%CI, 1.47 - 4.29) are risk factors for AS; high level of education (OR, 1.31; 95%CI, 1.21 - 1.43) is risk factor for CS.

CONCLUSION

Figures indicate that approximately one-third of PLWHA had suicidal ideation, and three out of 1,000 completed suicide in China. Positive events are protective factors for self-injury and suicide among PLWHA, while negative events are risk factors. This suggests that psychosocial support and risk assessment should be integrated into the care of PLWHA.

Suicidality Among People Living With HIV From 2010 to 2021: A Systematic Review and a Meta-regression

OBJECTIVE

The association between human immunodeficiency virus (HIV)/AIDS and suicidality is not well understood, partly because of variability in results. This meta-analysis aimed to investigate the predictive value of HIV/acquired immune deficiency syndrome for incident suicidality.

METHODS

A literature review was conducted of articles published between January 1, 2010, and October 31, 2021. The following databases were searched: Embase, MEDLINE, CINAHL, Web of Science, and Scopus. The search terms included human immunodeficiency virus (HIV), suicidal behavior, auto mutilation, and self-injurious behavior. Observational studies were screened following a registered protocol, and eligible ones were meta-analyzed and followed by meta-regression.

RESULTS

A total of 43 studies were included in this systematic review, and a meta-regression included 170,234 participants. The pooled prevalence estimates of suicidal ideation, attempted suicide, and deaths by suicide were 22.3%, 9.6%, and 1.7%, respectively. The following significant risk factors for suicide ideation were found: substance use, depression, low quality of life, low social support, without HIV status disclosure, living alone, low level of memory problems, family history of suicide, and stage III of HIV. Risk factors for suicide attempts were depression and family history of suicide. An elevated risk for suicide-related death was found for people living with HIV (PLHIV) who had a psychiatric disorder and in studies conducted in hospital-based settings (versus national database studies or HIV clinic settings).

CONCLUSIONS

The risk of suicidality is high among PLHIV within all six World Health Organization regions during the modern antiretroviral therapy era. Assessment of socioeconomic and psychological factors is recommended for further management to prevent suicide among PLHIV. The present findings are useful for design of intervention protocols and development of clinical practice guidelines intended to manage the well-being of PLHIV worldwide.

Psychometric Properties of the Berger HIV Stigma Scale: A Systematic Review

Addressing HIV-related stigma requires the use of psychometrically sound measures. However, despite the Berger HIV stigma scale (HSS) being among the most widely used measures for assessing HIV-related stigma, no study has systematically summarised its psychometric properties. This review investigated the psychometric properties of the HSS. A systematic review of articles published between 2001 and August 2021 was undertaken (CRD42020220305) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additionally, we searched the grey literature and screened the reference lists of the included studies. Of the total 1241 studies that were screened, 166 were included in the review, of which 24 were development and/or validation studies. The rest were observational or experimental studies. All the studies except two reported some aspect of the scale's reliability. The reported internal consistency ranged from acceptable to excellent (Cronbach's alpha ≥ 0.70) in 93.2% of the studies. Only eight studies reported test-retest reliability, and the reported reliability was adequate, except for one study. Only 36 studies assessed and established the HSS's validity. The HSS appears to be a reliable and valid measure of HIV-related stigma. However, the validity evidence came from only 36 studies, most of which were conducted in North America and Europe. Consequently, more validation work is necessary for more precise insights.