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 Table of Contents  
ORIGINAL ARTICLES
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 16-20

Study of depression in people living with HIV/AIDS attending antiretroviral treatment center


1 Department of Community Medicine, PCMC’s Postgraduate Medical Institute and Yashwantrao Chavan Memorial Hospital, Pimpri, Pune, India
2 Department of Community Medicine, Swami Ramanand Teerth Rural Government Medical College, Ambajogai, Maharashtra, India

Date of Submission14-Feb-2022
Date of Acceptance06-Jun-2022
Date of Web Publication19-Sep-2022

Correspondence Address:
Bhagyashri S Bhure
Vishwa Residency Building D402, Sant Tukaram Nagar, Pimpri, Pune 411018, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/DYPJ.DYPJ_15_22

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  Abstract 

Background: Depression, being the most common neuropsychiatric complication of HIV, is also associated with increased healthcare utilization, decreased quality of life, and poor adherence to antiretroviral therapy (ART). Depression is a multidimensional disorder affected by a variety of biological, psychological, and social determinants, and this relation becomes more complicated in HIV patients. The current study therefore aimed to assess the prevalence of depression in adult people living with HIV/AIDS using Patient Health Questionnaire 12 (PHQ12) and to study the various sociodemographic factors and clinical variables associated with depression in adult people living with HIV/AIDS. Materials and Methods: A cross-sectional study was conducted at an ART center in a tertiary care hospital in HIV/AIDS patients of 20–60 years of age. Sociodemographic and clinical characteristics were studied, and PHQ12 was used to assess depression. The χ2 test was applied to test association among depression, sociodemographic variables, and clinical variables of study subjects. Results and Conclusion: Out of the 372 study subjects 169 (45.4%) suffered from depression. Female sex, nuclear family, rural residence, lowered socioeconomic class (lower middle and below), illiteracy, widowed person, and opportunistic infection were significantly associated with depression (P < 0.05) in people living with HIV/AIDS. There was no significant association between prevalence of depression and age group, religion, CD4 count, and WHO staging.

Keywords: Depression, HIV/AIDS, people living with HIV/AIDS, PHQ12


How to cite this article:
Bhure BS, Ankushe RT. Study of depression in people living with HIV/AIDS attending antiretroviral treatment center. D Y Patil J Health Sci 2022;10:16-20

How to cite this URL:
Bhure BS, Ankushe RT. Study of depression in people living with HIV/AIDS attending antiretroviral treatment center. D Y Patil J Health Sci [serial online] 2022 [cited 2022 Oct 5];10:16-20. Available from: http://www.dypatiljhs.com/text.asp?2022/10/1/16/356511




  Introduction Top


HIV/AIDS is one of the most grievous illnesses that humans have ever faced. AIDS has emerged as one of the major challenges of modern world. In spite of awareness and education about this disease, HIV patients are still considered to be social outcast and treated bitterly by the community at large. According to the UNAIDS data 2020, it is estimated that currently 37.7 million people globally were living with HIV AIDS.[1] Around 2.3 million people in India were living with HIV and Maharashtra had the highest number of people living with HIV (PLHIVs) (3.90 lakh).[2]

Mental health problems accounted for 13% of the global burden of disease and are highly intertwined with infectious diseases such as HIV/AIDS.[3],[4] Depression is a mental health disorder which is characterized by depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration.[5],[6] Currently, an estimated 350 million people are affected by depression worldwide and it is predicted that depression could be the second most important cause of the global disease burden in recent years.[5],[6]

Despite its prevalence, depression is commonly underdiagnosed and consequently untreated in general population. In primary care, physicians miss between one half to two-thirds of patients having depression. Depression is often viewed as an expected reaction to a medical illness.[7],[8] Bing et al.[9] reported that as many as one in three persons with HIV may suffer from depression. Depression in people living with HIV/AIDS (PLHA) could be triggered by stress, difficult life events, side effects of medications, or the effects of HIV on the brain, and it might even accelerate HIV’s progression to AIDS.[10],[11]

Negative social consequences such as broken homes and loss of employment present with the PLHA. This often leads to restricted options for marriage, employment, and may even lead to divorce. The stigma attached to the disease is often a leading cause of patients landing up with severe depression.[12] HIV/AIDS, though such a big public health problem worldwide, not enough data are available regarding association of HIV and depression. Therefore, this study was undertaken to evaluate the association between HIV/AIDS and depression in an Indian setting. Results of this study may help bridge the gap in the knowledge and provide a baseline for the PLHAs at the ART centers of the country.


  Materials and Methods Top


A cross-sectional study was undertaken at ART center of Government Medical College, Maharashtra, India. The study period was from October 1, 2018 to December 31, 2018. Sample size was determined by using the Cochran formula N = z2pq/d2, where P = 67%,[13] with 5% absolute error at 95% confidence interval. By considering non-response rate of 10%, the adjusted sample size was 372. Patients aged 20 years or more and willing to participate in the study and those who gave informed consent for the study were included, whereas patients more than 60 years of age were excluded from the study.

The purpose of the study was explained to the participants, and signed informed consent was taken from them. Confidentiality of patients was maintained. Approval for the study has been granted by the Ethical Committee Board of Government Medical College.

About 372 patients were selected from the list of patients available at the ART center using systematic random sampling. More than 3000 patients enrolled in the ART center. From the list of patients, the first patient was selected by a lottery method and then every eighth patient was selected to meet the sample size of 372.

Data regarding sociodemographic factors such as age, sex, religion, education, marital status, type of family, occupation, and socio-economic status and clinical variables such as mode of transmission and duration of illness were collected using a predesigned and pretested proforma. Data regarding CD4 count and WHO staging were collected from the existing medical records at the ART center. For socio-economic status determination, the modified BG Prasad classification was used.[14]

Depression was assessed by using the validated Patient Health Questionnaire (PHQ12).[15] The descriptive statistics was computed for background variables. The χ2 test was applied to know the association between the attributes.


  Results Top


Sociodemographic characteristics

The sociodemographic characteristics of the respondents are shown in [Table 1]. Majority of the respondents (38.98%) were from 41–50 years of age group: 59.95% were females, 80.65% Hindus, and 68.82% married. More than half (53.49%) of the respondents were from joint family, 59.94% were from rural background, 59.95% literate, and from lower middle class and below (81.72%).
Table 1: Sociodemographic characteristics of study subjects

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Clinical history

Clinical history of respondents is included in [Table 2]. All of the patients of the ART clinic were referred by a Medical Doctor for treatment. More than half of the respondents (73.92%) were detected as HIV-positive more than 3 years ago. The respondents (60.22%) were having CD4 count >500. They frequently reported heterosexuality as a possible route for HIV transmission (98.39%). More than half of the respondents (84.95%) were free from any opportunistic infection, and 91.40% of the respondents were from WHO stage 1.
Table 2: Clinical history of study subjects

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Depression among study subjects

The depression level studied in PLHAs is shown in [Table 3]. The prevalence rate of depression was found to be (169) 45.4%. Majority of the patients were either mildly depressed (29.83%) or moderately (14.52%) depressed. Only 1.08% of patients were severely depressed.
Table 3: Levels of depression among study subjects according to PHQ12

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Depression and demographic and clinical variables

When investigated for the presence of depression and its association with various sociodemographic and clinical variables [Table 4], a significant association of depression was detected with female sex (P = 0.0001), nuclear family (P = 0.001), rural residence (P = 0.004), lowered socio-economic class (P = 0.0003) (lower middle and below), illiteracy (P = 0.0001), widowed person (P = 0.0001), and opportunistic infection (P = 0.0001). Variables such as age group, religion, CD4 count, and WHO staging did not exhibit any association with the depression.
Table 4: Association of depression with demographic and clinical variables

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  Discussion Top


Depression is a major problem in HIV-infected patients, and it can lead to poor adherence to ART, treatment failure, HIV progression, and death. In our study, majority of the respondents were from the age group 41–50 years, females, married, Hindu, literate, and from joint family and rural residence. A significant association of depression was found with female sex, nuclear family, rural residence, lowered socio-economic class, illiteracy, widowed person, and opportunistic infection.

Our study showed that 45.4% of the participants were depressed. In similar studies, Rai and Verma[13] and Bhatia and Munjal[16] found prevalence rates of depression of 67.3% and 58.75% among HIV sero-positive individuals, respectively. In another study, Himelhoch et al. state that depression is the most extensively studied psychiatric co-morbidity, affecting HIV-infected patients, with estimates of lifetime prevalence rates ranging from 4% to 45%.[17] In similar studies, Kaharuza et al.[18] and Bhatia et al.[19] found the prevalence rate of depression to be 47% in Uganda and 45% in USA, respectively. Collaborating with these reports, our findings point out that depression could be relatively frequent among HIV/AIDS patients.

Socio-economic factors have been reported as predisposing factors in HIV infection and have also been found to be relevant factors in depression related to HIV disease progression.[20],[21] Our study participants with low socio-economic status were more depressed than those who had higher socio-economic status. A similar relationship has also been found in a study from Pakistan, in which they reported significant association of depression with poor socio-economic status.[22] Studies have shown that poor socio-economic state affects people’s ability to cope with HIV infection.[23]

We found female gender to be associated with depression; similar findings were reported by Bhatia and Munjal.[16] Studies done in general population have also shown female gender as risk factors for depression.[24]

Other important correlates found in this study were illiterate and widowed persons more prone to depression. Similar findings were reported by Bhatia and Munjal[16] and Deshmukh et al.[25] They found illiteracy and single person (widowed) are independent predictors of depression in people with HIV/AIDS and found to be statistically associated with it.

In addition, this study also showed that recent opportunistic infections were associated with increased occurrence of depression. Opportunistic infections are often associated with hospitalization and diminished functional status, which could affect patients’ psychosocial and economic conditions. This result is in agreement with studies done by Deshmukh et al.,[25] Seid et al.,[26] and Beyamo et al.[27]

Our study showed no significant association between depression and age group, religion, CD4 count, and WHO staging of the respondents. Almost similar results have also been found in other studies.[13],[28] More planned studies with sufficiently large samples, however, are needed to examine such hypotheses.

Limitations of the study

This study has some limitations. First, this was a cross-sectional study, undertaken in a special population group that is HIV-positive. Hence, its results on depression, particularly with regard to its prevalence rate, cannot be compared with other studies, undertaken in general populations. Secondly, ours was a quantitative enquiry to assess depression levels in HIV patients, with qualitative tools such as focussed group discussions and in-depth interviews would have put forth some more facts of the disease as respondents often have many issues and experiences to share with the study investigators. Thirdly, a parallel control group in this study was not considered. A high rate of depression among the studied PLHAs should therefore be viewed in light of this fact.


  Conclusion Top


Depressive symptoms are significantly higher in people with HIV/AIDS compared with the general population. The higher prevalence of depressive symptoms in people with HIV/AIDS is an important public health issue that urges the incorporation of mental healthcare and depression screening in routine HIV/AIDS care.

Acknowledgment

The authors would like to thank Hon. Dr. Sudhir Deshmukh (Dean of GMC Latur) and Hon. Dr. Siddheshwar Birajdar (Head of Dept of Medicine S.R.T.R.GMC Ambajogai) for their technical, administrative guidance, and logistic support. Last but not the least, credit goes to all the eligible men and women who spent their valuable time to participate in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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