Determinants of Common Mental Disorders Among People Living with HIV/AIDS Attending ART Service in Southern Ethiopia

Common mental disorders and associated factors among adults after COVID-19 pandemic in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Global mental health has been threatened by the COVID-19 pandemic, both directly through long-lasting neuropsychiatric disorders that occur during primary infection in affected individuals and indirectly through stressful and disruptive societal changes. Thus, this study determined the pooled prevalence of common mental disorders and associated factors among adults after COVID-19 pandemic in Ethiopia.

METHODS

This systematic review and meta-analysis were conducted using primary published and unpublished studies that were retrieved from various databases. Studies conducted on adults, published in English, and conducted in Ethiopia were included in this review. A standardized data extraction format developed from Excel was used to collect the data. A random effect meta-analysis model was used to estimate the pooled effect size of all included studies at a 95% confidence interval. The heterogeneity was evaluated by Cochran Q test and the I-squared. Funnel plot and egger tests were used to determine publication bias.

RESULTS

A total of 20 studies were eligible for this systematic review. The pooled prevalence of common mental disorders among adults was 40.44% (95%CI: 31.86-49.02%). Female gender (AOR = 1.88, 95% CI: 1.33-2.44), unemployed (AOR = 2.05, 95% CI: 1.12-2.98), poor social support (AOR = 3.12, 95% CI: 2.08-4.17), substance use (AOR = 2.5, 95% CI: 1.58-3.41), history of mental illness (AOR = 1.73, 95% CI: 1.01-2.44), family history of mental illness (AOR = 2.47, 95% CI: 1.54-3.41), and chronic medical illness (AOR = 1.6, 95%CI:1.02-2.17) were risk factors for common mental disorders.

CONCLUSION

In this study, more than one-third of adults were affected by common mental disorders after the onset of the COVID-19 pandemic. This indicated that, in order to reduce the prevalence of common mental disorders, enhancing the provision of mental health services should be improved after the COVID-19 pandemic. Screening for common mental disorders should be given, especially to females, unemployed people, substance users, chronic medically ill people, those with a history of mental illnesses, and those with a family history of mental illness. Strengthening social support during the COVID-19 pandemic is also important.

PROSPERO PROTOCOL REGISTRATION

The registration ID for this systematic review is CRD42024496826.

Prevalence and correlates of common mental disorders in people living with HIV in primary health care facilities in Ekurhuleni district

BACKGROUND

 There is paucity of data regarding the prevalence of common mental disorders (CMDs) in people living with HIV (PLHIV) in Ekurhuleni Health District (EHD), South Africa. Also, there is an association between CMDs and poor HIV treatment outcomes. Guidelines therefore recommend that healthcare practitioners screen for CMDs in PLHIV.

AIM

 To determine the prevalence and correlates of CMDs in PLHIV in primary health care facilities in Ekurhuleni district.

SETTING

 Seven primary health facilities in Ekurhuleni district.

METHODS

 A cross-sectional study was conducted in which data were collected from 403 randomly selected participants, using a questionnaire that incorporated the scores of the Patient Health Questionnaire (PHQ)-9, generalised anxiety disorder (GAD)-7 and substance use disorder (SUD) criteria of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). The proportion screening positive for CMDs was calculated. 'R' statistical software was used for univariate and multivariate analysis, with a confidence interval (CI) of 95%.

RESULTS

 Most participants (63%) were female and the mean age was 43 ± 11 years. Forty per cent of participants screened positive for CMDs, 16.6%, 15.1% and 24.1% screened positive for depression, GAD and SUD, respectively. Common mental disorders were associated with poor adherence and HIV non-suppression, while increasing age and being female were associated with reduced risk of CMDs. The risk of severe SUDs in males was 11 times compared to females. During assessment, clinicians screened only 16%, 14% and 40% of the cohort for depression, GAD and SUDs, respectively.

CONCLUSION

 The prevalence of CMDs remains high. Adherence to recommendations to screen for CMDs in PLHIV is low.Contribution: This study reveals a low CMD screening rate, estimates the prevalence of CMDs in PLHIV in Ekurhuleni district, and its impact.

Mental health burden among females living with HIV and AIDS in sub-Saharan Africa: A systematic review

Mental health problems, particularly depression and anxiety, are common in women and young girls living with HIV/ AIDS particularly in low- and middle-income (LMICs) countries where women's vulnerability to psychiatric symptoms is heightened due to the prevalent intersectional stressors such as stigma and intimate partner violence. However, no synthesized evidence exists on the mental health burden of females living with HIV/AIDS (FLWHA) in Africa. This systematic review aimed to synthesize the current evidence on the mental health burden among FLWHA in sub-Saharan Africa. A systematic literature review of articles published from 2013-2023 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Five electronic databases; PubMed, MEDLINE with full text, Scopus, Academic Search Complete, and Health Source: Nursing Academic Edition were searched for articles published in English. Nineteen articles (15 quantitative, 3 qualitative, and 1 case study) from over 7 African countries met the inclusion criteria. The majority of the studies' quality was determined to be moderate. The prevalence of depression ranged from 5.9 to 61% and anxiety from 28.9 to 61%. Mental health burden was a logical outcome of HIV diagnosis. Predictors of mental health outcomes in the context of HIV/AIDS were identified as intimate partner violence (IPV), stigma, childhood traumas, sexual abuse, poverty, unemployment, and social isolation. Social support and resilience were identified as protective factors against mental illness in FLWHA. Mental illness had a deleterious effect on viral suppression rates among FLWHA, resulting in delayed initiation of antiretroviral therapy treatment and increased mortality but had no impact on immune reconstitution in the face of ART adherence. Given the high prevalence rates of depression and anxiety and their relationship with HIV progression, it is crucial that mental health care services are integrated into routine HIV care.

Comparing the effect of a multisectoral agricultural intervention on HIV-related health outcomes between widowed and married women

INTRODUCTION

Widowed women make up 18-40% of the 12 million women living with HIV in eastern and southern Africa. Widowhood has also been associated with greater HIV morbidity and mortality. We compared the effectiveness of a multisectoral climate adaptive agricultural livelihood intervention (called Shamba Maisha) on food insecurity, and HIV related health outcomes among widowed and married women living with HIV in western Kenya.

METHODS

We implemented Shamba Maisha (NCT02815579) using a cluster-randomized control trial design. The intervention arm received an US$175 in-kind loan to purchase a micro-irrigation pump, seeds, and fertilizer, and received eight training sessions on sustainable agriculture and financial management. Study outcomes were measured every 6 months over a 24-month follow-up period and trends in outcomes assessed using multilevel mixed-effects models.

RESULTS

The trial enrolled 232 (61.5%) married and 145 (38.5%) widowed women. Widowed women (mean age 42.8 ± 8.4 years) were older than married women (35.8 ± 9.0 years) (p < 0.01). Almost all widowed women (97.2%) self-identified as household heads compared to 10.8% of married women. Comparing widowed vs married women, reduction in food insecurity (-3.13, 95%CI -4.42, -1.84 vs. -3.08, 95%CI -4.15, -2.02), depressive symptoms (-0.21, 95%CI -0.36, -0.07 vs. -0.19, 95%CI -0.29, -0.08), internalized stigma (-0.33, 95%CI -0.55, -0.11 vs. -0.38, 95%CI -0.57, -0.19), and anticipated stigma (-0.46 95%CI -0.65, -0.28 vs. -0.35, 95%CI -0.50, -0.21) was similar for both groups. In contrast, improvements in social support (-2.22, 95%CI -3.85, -0.59 vs. -4.00, 95%CI -5.16, -2.84; p = 0.08) and reduction in enacted stigma (0.01, 95%CI -0.06, 0.08 vs. -0.14, 95%CI -0.20, -0.09; p < 0.01) were weaker for widowed than married women.

CONCLUSIONS

Our study is among the first comparing the effect of a livelihood intervention on HIV health outcomes among widowed and married women. Widowed women experienced similar benefits as married women on individual-level outcomes, but weaker benefit on outcomes dependent on their external environment like enacted stigma and social support. Future trials and programs targeting widowed women should bolster stigma reduction and social support.