A Qualitative Analysis of the Effects of Depression and Antidepressants on Physical and Work Functioning among Antiretroviral Therapy Clients in Uganda

Abstract

Depression is common among people living with HIV/AIDS in sub-Saharan Africa. Yet, little is known about how depression influences physical health and socioeconomic well-being in the context of antiretroviral therapy (ART). Semi-structured interviews with 40 adult HIV clients receiving ART in Uganda were conducted to assess experiences prior to and after HIV diagnosis and initiation of ART. Content analysis revealed themes that were suggestive of the following patterns: 1) functioning decreased after patients were diagnosed with HIV, but improved following ART, 2) depression is associated with lower physical health functioning and work status levels after both HIV diagnosis and ART, and 3) antidepressant medication is associated with better functioning compared to depressed patients not receiving depression treatment. These findings suggest that depression plays a role in the deleterious effects of HIV on functioning, and that antidepressant treatment provided alongside ART may serve to help individuals regain functioning, particularly employment. These findings highlight the potential value of integrating depression treatment into HIV care.

Greater Depressive Symptoms and Higher Viral Load Are Associated with Poor Physical Function among Latino Men Living with HIV

“…This finding is consistent with other studies on the general population 5 –8,32 and among PLWH. 9,11 Findings support prior studies that relied on clinically diagnosed depression rather than prospective assessment of depression concomitant with physical function among PLWH. 9,33 We found a function score that was on average 10 points lower in patients with depression, adjusted for the effects of age, income, years living with HIV, ART, and comorbidities.…”

“…34 Although depression can lead to frailty and physical limitations, the reverse direction has also been found. 10,11 Therefore, additional longitudinal research is necessary to understand more fully the bidirectional relationship between depression and physical function. Regardless of causal direction, treating depression at early stages is important, because it can foster physical activity and prevent the development of new or further physical function limitations.…”

“…9 Other studies, however, have noted that people with depression often reported limitations in physical function. 10,11 The association between depression and physical function is relevant for HIV-infected populations, because adults living with HIV have a greater risk of developing depression, which has been associated with worse health outcomes, including physical function. 11,12…”

Prevalence and factors associated with depression in people living with HIV in sub-Saharan Africa: A systematic review and meta-analysis

“…Only one study in Uganda where the diagnosis was made by a psychiatrist reported that 65% of the PLHIV had MDD. Among them, 61.5% were diagnosed after becoming HIV-positive and 38.4% after starting ART [ 38 ].…”

“…Depression is often considered as a logical outcome in PLHIV and is difficult to diagnose due to its common symptoms with HIV disease such as fatigue, sleeping problems, loss of appetite and cognitive impairment [ 6 , 39 ]. PLHIV report also more easily somatic symptoms than emotional or affective ones [ 38 ]. The lack of time available in primary health care settings, the lack of knowledge of the clinicians on mental health and the poor integration of mental health services in SSA contribute to the difficulties to identify patients with depression [ 80 ].…”