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Kulisewa K, Minnick CE, Stockton MA, Gaynes BN, Hosseinipour MC, Mphonda S, Sansbury G, Udedi MM, Pence BW. The acceptability of antidepressant treatment in people living with HIV in Malawi: A patient perspective. Glob Public Health 2023; 18:2201327. [PMID: 37088107 PMCID: PMC10465971 DOI: 10.1080/17441692.2023.2201327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
Depression is common among people living with HIV (PLWH). Measurement-based care models that measure depression severity and antidepressant side effects, and use an algorithm to guide antidepressant prescription by non-specialized health workers represent an evidence-based treatment for severe depression in sub-Saharan Africa. We conducted in-depth interviews from June to December 2018 with eleven patients enrolled in Project SOAR-Mental Health, a pilot project integrating depression treatment into HIV care in Malawi. Patients treated with amitriptyline or fluoxetine participated in interviews exploring antidepressant acceptability through patient knowledge, side effect severity, pill burden, adherence, perceived efficacy, and tolerability. Patients described a lack of detailed antidepressant education from their providers. Variable, typically self-limiting side effects were reported from both amitriptyline and fluoxetine. While most side effects were mild, three patients reported functional impairment. Patients reported high adherence, though the additional pill burden was a challenge. Most patients found the antidepressants efficacious, tolerable, beneficial and acceptable. Although patient psychoeducation is notably lacking as a facet of clinical management, antidepressant prescription by primary care providers appears acceptable for comorbid severe depression in PLWH initiating HIV care in sub-Saharan Africa. Health workers should be mindful of dosing to minimise side effects and considerate of the additional pill burden.Trial registration: ClinicalTrials.gov ID [NCT03555669]. Retrospectively registered on 13 June 2018.
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Affiliation(s)
- Kazione Kulisewa
- Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Caroline E. Minnick
- Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Melissa A. Stockton
- Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Bradley N. Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Mina C. Hosseinipour
- Tidziwe Centre, University of North Carolina Project-Malawi, Lilongwe, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Steven Mphonda
- Tidziwe Centre, University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Griffin Sansbury
- Tidziwe Centre, University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - Brian W. Pence
- Epidemiology Department, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
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2
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Kaggwa MM, Najjuka SM, Bongomin F, Mamun MA, Griffiths MD. Prevalence of depression in Uganda: A systematic review and meta-analysis. PLoS One 2022; 17:e0276552. [PMID: 36264962 PMCID: PMC9584512 DOI: 10.1371/journal.pone.0276552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
Background Depression is one of the most studied mental health disorders, with varying prevalence rates reported across study populations in Uganda. A systematic review and meta-analysis was carried out to determine the pooled prevalence of depression and the prevalence of depression across different study populations in the country. Methods Papers for the review were retrieved from PubMed, Scopus, PsycINFO, African Journal OnLine, and Google Scholar databases. All included papers were observational studies regarding depression prevalence in Uganda, published before September 2021. The Joanna Briggs Institute Checklist for Prevalence Studies was used to evaluate the risk of bias and quality of the included papers, and depression pooled prevalence was determined using a random-effects meta-analysis. Results A total of 127 studies comprising 123,859 individuals were identified. Most studies were conducted among individuals living with HIV (n = 43; 33.9%), and the most frequently used instrument for assessing depression was the Depression sub-section of the Hopkins Symptom Checklist (n = 34). The pooled prevalence of depression was 30.2% (95% confidence interval [CI]: 26.7–34.1, I2 = 99.80, p<0.001). The prevalence of depression was higher during the COVID-19 pandemic than during the pre-pandemic period (48.1% vs. 29.3%, p = 0.021). Refugees had the highest prevalence of depression (67.6%; eight studies), followed by war victims (36.0%; 12 studies), individuals living with HIV (28.2%; 43 studies), postpartum or pregnant mothers (26.9%; seven studies), university students (26.9%; four studies), children and adolescents (23.6%; 10 studies), and caregivers of patients (18.5%; six studies). Limitation Significantly high levels of heterogeneity among the studies included. Conclusion Almost one in three individuals in Uganda has depression, with the refugee population being disproportionately affected. Targeted models for depression screening and management across various populations across the country are recommended. Trial registration Protocol registered with PROSPERO (CRD42022310122).
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, Uganda
- African Centre for Suicide Prevention and Research, Mbarara, Uganda
- Department of Psychiatry and Behavioural Neurosciences, Forensic Psychiatry Program, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Sarah Maria Najjuka
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Mark D. Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
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3
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Musisi S, Nakasujja N. Psychiatric Problems in HIV Care. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.106077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Psychiatric problems associated with HIV/AIDS are many, varied and often bidirectional and they are often neglected. Their presence compromises HIV care and prevention efforts. Unaddressed, they compromise treatment outcomes, increase HIV virus–resistant strains, leave pockets of potential HIV spread in the community and lead to poor quality of life and early death of Persons Living With HIV/AIDS. This chapter focuses on specific HIV-associated mental disorders and their management. However, the mental health problems of HIV/AIDS go beyond disorders to include social, family and community problems such as the problems faced by AIDS orphans, widowhood, family disruptions, multiple deaths, bereavements, poverty, stigma, caregiver burden, education and occupational difficulties etc. All these need to be addressed in holistic HIV care. This calls for more research and integration of mental healthcare in all HIV/AIDS treatment and prevention programs.
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Kaggwa MM, Najjuka SM, Ashaba S, Mamun MA. Psychometrics of the Patient Health Questionnaire (PHQ-9) in Uganda: A Systematic Review. Front Psychiatry 2022; 13:781095. [PMID: 35340898 PMCID: PMC8948461 DOI: 10.3389/fpsyt.2022.781095] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depression is screened by many psychological tools, whereas the Patient Health Questionnaire-9 (PHQ-9) is one of the most commonly used self-administered tools. Uganda is a culturally diverse country with a wide variety of tribes, ethnic groups, languages, and disease conditions; it is urgent to know the psychometrics of the used PHQ-9 across different cohorts. However, there is no prior review to assess its reliability in this culturally diverse country, where this review fulfills the knowledge gap. METHODS Adhering to the PRISMA guideline, a systematic search was performed in several databases (i.e., PubMed, Africa-Wide Information, AJOL, and PsycINFO, among others), and a total of 51 articles were included in this review, confirming the study inclusion criteria (e.g., using the PHQ-9). RESULTS The PHQ-9 has been used among individuals above 10 years and both genders, and the tool has been used most among the HIV patient group (n = 28). The tool is frequently administered by interviews and has been translated into several languages (mostly Luganda, n = 31). A cutoff of 10 was commonly used to identify clinical or major depression (n = 23), and its prevalence ranged from 8 to 67%. It has been validated for use in two populations, (i) HIV-positive participants and (ii) the general population attending a health facility. The sensitivity and specificity were 92 and 89%, respectively, at a cutoff score of 10, whereas 67 and 78%, respectively, at a cutoff score of 5. The Cronbach alpha ranged between 0.68 and 0.94. CONCLUSION The PHQ-9 has been used in several studies in Uganda but validated in only two populations and is commonly used in one language. Thus, validation of the tool in various populations and languages is warranted to improve the tool's acceptance in Uganda.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,African Centre for Suicide Prevention and Research, Mbarara, Uganda
| | - Sarah Maria Najjuka
- Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mohammed A Mamun
- CHINTA Research Bangladesh, Dhaka, Bangladesh.,Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh.,Department of Public Health, Daffodil International University, Dhaka, Bangladesh
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Lavakumar M, Lewis S, Webel A, Gunzler D, Gurley D, Alsop J, El-Hayek V, Avery A. Correlates of depression outcomes in collaborative care for HIV. Gen Hosp Psychiatry 2020; 66:103-111. [PMID: 32763639 DOI: 10.1016/j.genhosppsych.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Collaborative care can treat depression in HIV but existing studies have been limited by excluding patients with acute or severe depression. The purpose of this analysis is to determine if real-world implementation of collaborative care in HIV is associated with improvement in depression, and to identify correlates of depression outcomes. METHODS Collaborative care was implemented as part of a large practice transformation initiative. Change in depression, measured by PHQ-9 score, at baseline compared to 12 months post-enrollment was the outcome, which was operationalized as remission, response, and neither response nor remission. Bivariate and multivariate associations were assessed between several variables at baseline and the outcome. RESULTS Out of 416, 99 (23.79%) patients remitted and 89 (21.39%) responded (without remission). In the bivariate analysis having a documented psychiatric comorbidity was associated with low remission [31 (16.58%)]; p = 0.008. Having generalized anxiety disorder was associated with low remission [18 (15.00%)] and response rates [26 (21.67%)]; p = 0.022. Having a substance use disorder (alcohol, cocaine, or amphetamine) - was associated with poor remission [29 (16.67%)] and response [33 (18.97%)]; p = 0.004. Social isolation was correlated with lower response and remission rates (p = 0.0022). In the multivariate analysis older age was associated with higher remission rates (OR: 1.10; 95% CI: 1.005-1.194) whereas being a Medicaid beneficiary (OR: 0.652; 95% CI: 1.123-2.797), having comorbid generalized anxiety disorder (OR: 0.267; 95% CI: 0.122-0.584) or a stimulant use disorder (cocaine [OR: 0.413; 95% CI: 0.222-0.926] or amphetamines [OR: 0.185; 95% CI: 0.037-0.766]), was associated with lower remission rates. CONCLUSION We found that depression improved in our study subjects. We identified several modifiable correlates of depression outcomes.
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Affiliation(s)
- Mallika Lavakumar
- Department of Psychiatry, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America.
| | - Steven Lewis
- Center for Healthcare Research and Policy, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Allison Webel
- Francis Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States of America
| | - Doug Gunzler
- Center for Healthcare Research and Policy, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Diana Gurley
- Department of Psychiatry, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - James Alsop
- University of Minnesota School of Medicine, Minneapolis, MN, United States of America
| | - Victoria El-Hayek
- Department of Internal Medicine, MetroHealth Medical Center, Cleveland, OH, United States of America
| | - Ann Avery
- Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
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6
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Zhong H, Arjmand IK, Brandeau ML, Bendavid E. Health outcomes and cost-effectiveness of treating depression in people with HIV in Sub-Saharan Africa: a model-based analysis. AIDS Care 2020; 33:441-447. [PMID: 31986900 DOI: 10.1080/09540121.2020.1719966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
High prevalence of depression among people living with HIV (PLHIV) impedes antiretroviral therapy (ART) adherence and viral suppression. We estimate the effectiveness and cost-effectiveness of strategies to treat depression among PLHIV in Sub-Saharan Africa (SSA). We developed a microsimulation model of HIV disease and care in Uganda which captured individuals' depression status and the relationship between depression and HIV behaviors. We consider a strategy of screening for depression and providing antidepressant therapy with fluoxetine at ART initiation or re-initiation (if a patient has dropped out). We estimate that over 10 years this strategy would reduce prevalence of depression among PLHIV by 16.0% [95% uncertainty bounds 15.8%, 16.1%] from a baseline prevalence of 28%, increase adherence to ART by 1.0% [1.0%, 1.0%], and decrease rates of loss to followup by 3.7% [3.4%, 4.1%]. This would decrease first-line ART failure rates by 2.5% [2.3%, 2.8%] and increase viral suppression rates by 1.0% [1.0%, 1.0%]. This strategy costs $15/QALY compared to the status quo, and was highly cost-effective over a broad range of sensitivity analyses. We conclude that screening for and treating depression among PLHIV in SSA with fluoxetine would be effective in improving HIV treatment outcomes and would be highly cost-effective.
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Affiliation(s)
- Huaiyang Zhong
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Isabel K Arjmand
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Eran Bendavid
- Division of General Medical Disciplines, Department of Medicine, Stanford University, Stanford, CA, USA.,Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
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7
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Rubin LH, Maki PM. HIV, Depression, and Cognitive Impairment in the Era of Effective Antiretroviral Therapy. Curr HIV/AIDS Rep 2020; 16:82-95. [PMID: 30661180 DOI: 10.1007/s11904-019-00421-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Mental health disorders, especially depression, are prevalent among people living with HIV (PLWH) and are associated with cognitive impairment (CI) among HIV-uninfected (HIV-) individuals. We conducted a comprehensive review of the link between depression and cognition among PLWH. RECENT FINDINGS Studies examining depression and cognition in PLWH report high rates of current (median = 24%) and lifetime depression (42%). There is reliable evidence that depression is associated with overall CI among PLWH, and in the cognitive domains of processing speed, executive function, learning and memory, and motor function. Although few studies have examined the interaction between HIV serostatus and depression on CI, there is no evidence of a stronger association between CI and depression in PLWH compared with HIV- controls. Depression is prevalent and reliably associated with CI in PLWH, with an overall pattern of domain-specific associations similar to that of HIV- individuals.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins School of Medicine, 600 N. Wolfe St., Meyer 6-133a, Baltimore, MD, 21287-7613, USA. .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Pauline M Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
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8
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Passchier RV, Abas MA, Ebuenyi ID, Pariante CM. Effectiveness of depression interventions for people living with HIV in Sub-Saharan Africa: A systematic review & meta-analysis of psychological & immunological outcomes. Brain Behav Immun 2018; 73:261-273. [PMID: 29768184 DOI: 10.1016/j.bbi.2018.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 12/20/2022] Open
Abstract
This meta-analytic review evaluated the effectiveness of depression interventions on the psychological and immunological outcomes of people living with HIV in sub-Saharan Africa. 14 studies, yielding 932 participants were eligible. A random-effects models indicated that depression interventions were followed by large reductions in depression scores (effect size = 1.86, 95% CI = 1.71, 2.01, p < 0.01). No significant effect on immune outcome was observed, however there was a trend toward immune improvement of medium effect size (effect size on CD4 count and/or viral suppression = 0.57, 95% CI = -0.06, 1.20, p = 0.08). Pharmacological interventions appeared to have a significantly larger improvement in depression scores than psychological interventions. The greatest improvement in immune status was demonstrated in psychological treatments which incorporated a component to enhance HIV medication adherence, however these results did not reach significance. Small sample sizes and highly heterogeneous analysis necessitate caution in interpretation. The results of this meta-analysis should thus be treated as preliminary evidence and used to encourage further studies of immunopsychiatry in HIV in sub-Saharan Africa.
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Affiliation(s)
- Ruth Verity Passchier
- University of Cape Town, Department of Psychiatry and Mental Health, Anzio Road, Observatory, Cape Town, South Africa.
| | - Melanie Amna Abas
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London SE5 8AF, United Kingdom
| | - Ikenna D Ebuenyi
- Vrije Universiteit Amsterdam, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Netherlands
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London SE5 9RT, United Kingdom
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9
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Lofgren SM, Nakasujja N, Boulware DR. Systematic Review of Interventions for Depression for People Living with HIV in Africa. AIDS Behav 2018; 22:1-8. [PMID: 28900756 DOI: 10.1007/s10461-017-1906-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Depression interventions for individuals with HIV/AIDS in Africa are being increasingly evaluated. MEDLINE was searched using key terms: depression, Africa, and HIV, to identify depression interventions for HIV-infected adults in Africa. Perinatal women were excluded. Results were extracted and relative change in depression scores for interventions and net effect calculated. The MEDLINE search yielded 18 articles. Six of seven studies evaluating feasibility were positive, and seven of seven studies evaluating acceptability were also positive. Three studies investigated the effect of psychotherapy (% relative decrease of depressive symptoms for intervention: %net decrease compared to controls) (73%:39% decrease). Four studies investigated task-shifting of psychotherapy (47%:34% decrease). Three studies evaluated antidepressants (79%:39% decrease). Three studies investigated task-shifting of antidepressant treatment (82%:65% decrease). An exercise intervention was evaluated (66%:49% decrease). One trial investigated minocycline with non-statistically significant results. Finally, three studies investigated other psychosocial interventions (44%:21% decrease). Overall, the results highlight the need for large, randomized trials to establish efficacy as well as implementation studies.
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10
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Akena D, Kuteesa H, Alinaitwe R. CBT for depression and drug adherence in HIV care. Lancet HIV 2016; 3:e503-e504. [PMID: 27658862 DOI: 10.1016/s2352-3018(16)30060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 06/10/2016] [Accepted: 06/13/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda; Africa Centre for Systematic Reviews and Knowledge Translation, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Hillary Kuteesa
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Racheal Alinaitwe
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
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11
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Adejumo O, Oladeji B, Akpa O, Malee K, Baiyewu O, Ogunniyi A, Evans S, Berzins B, Taiwo B. Psychiatric disorders and adherence to antiretroviral therapy among a population of HIV-infected adults in Nigeria. Int J STD AIDS 2015; 27:938-49. [PMID: 26384949 DOI: 10.1177/0956462415600582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/22/2015] [Indexed: 12/12/2022]
Abstract
Psychiatric disorders are common among people living with HIV in Nigeria. Adherence is necessary to optimise the outcome of antiretroviral therapy. In this study, we aimed to identify associations between antiretroviral adherence, measured by one-week and one-month self-reported missed doses, and psychiatric illness in a cohort previously assessed for psychiatric disorders using the Composite International Diagnostic Interview. The study participants comprised 151 adults with major depression, anxiety or suicidal symptoms, and 302 matched-control participants. Two controls were randomly selected for each case within the same gender and education level. We compared participants with psychiatric disorders (WPDs) and no psychiatric disorders (NPDs) on selected demographic and clinical variables, in addition to adherence. Participants with one or more missed doses in the preceding month had twice the odds of having a major depressive episode as those with no missed doses during this period (OR 2.22, 95% CI 1.03, 4.79). This association remained significant after adjusting for selected risk factors. There was no statistically significant difference between WPD and NPD groups on either one-week or one-month adherence, or on age, marital status, occupational class, HIV viral load at enrolment or current CD4 cell count. Among Nigerian adults with HIV, suboptimal antiretroviral adherence is associated with, and could be a sign of, depression. Routine self-report adherence assessments may potentially be utilised in identifying individuals at risk among this population.
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Affiliation(s)
| | | | - Onoja Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria
| | - Kay Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Scott Evans
- Harvard School of Public Health, Boston, MA, USA
| | - Baiba Berzins
- Center for Global Health, Northwestern University, USA
| | - Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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Wagner GJ, Ngo VK, Nakasujja N, Akena D, Aunon F, Musisi S. Impact of antidepressant therapy on cognitive aspects of work, condom use, and psychosocial well-being among HIV clients in Uganda. Int J Psychiatry Med 2014; 48:155-66. [PMID: 25492710 PMCID: PMC5601308 DOI: 10.2190/pm.48.3.a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Depression has been found to impede several health outcomes among people living with HIV, but little research has examined whether depression treatment mitigates this influence. We assessed the impact of antidepressant therapy on measures of work, condom use, and psychosocial well-being among depressed HIV clients in Uganda. METHODS Paired t-tests and McNemar tests were used to assess change in survey data collected from participants at initiation of antidepressant therapy (baseline) and 6 months later. RESULTS Ninety-five participants completed the 6-month assessment, of whom 82 (86%) responded to treatment (defined as Patient Health Questionnaire-9 score < 5). Among study completers, work functioning improved significantly, as did measures of self-efficacy related to condom use and work (as well as general self-efficacy), and internalized HIV stigma declined; however, actual engagement in work activity and consistent condom use did not show significant change. Similar findings were observed among treatment responders. CONCLUSIONS Antidepressant treatment benefits functional capacity, psychological well-being, and cognitive intermediary factors that may be essential for behavioral change related to work and condom use, but supplementary therapeutic strategies may be needed to impact more direct behavioral change.
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