A study on depression in people living with HIV/AIDS in South-West part of Uttar Pradesh, India

Abstract

HIV/AIDS and depression are often thought to be interlinked. HIV positive cases may trigger symptoms of depression which, in turn, may result in risky sexual behavior and spread of HIV. Interviews were conducted in 104 patients of HIV/AIDS at the Anti-Retroviral Therapy (ART) Clinic of a teaching hospital in Uttar Pradesh (India) to study depression and examine its prevalence and association, if any, with some socio-demographic and clinical variables. The tools used to assess anxiety and depression and their severities were General Health Questionnaire (GHQ) 28 and Montgomery-Asberg Depression Rating Scale (MADRS) . The majority of patients were of age 35 years & above (62%), males (67%), married (85%), Hindus (88%), literate (73.1%), unemployed (35%) and of upper-lower socio-economic status (52%). Significant association of depression was found with religion, occupation and socio-economic status. Depression and anxiety were also found to be significantly associated with each other. There was, however, no association of depression with respondents' age, gender, marital status, education, habitat, income, duration of illness from HIV/AIDS and the CD4 count. The high prevalence rate (67.3%) of depression amongst HIV patients in our study may be taken as marker to alert Counsellors of country's ART Clinics for possible risk of depression in HIV patients. The above findings however, should be interpreted in the light of the fact that a parallel control group in the study was not included, studied sample was not large enough and the tools used to study the subjects for depression and anxiety were not adequately standardized.

Prevalence of depression among HIV-positive patients treated with antiretrovirals at different stage of infection

“…The relationship of lower CD4 levels and depression has been documented from different parts of the World [5,[29][30][31]. Although, some studies failed to find a significant association between depression and CD4 cells count [9,10]. The progression of HIV infection was poorer in patients suffering from depression in our study.…”

“…Among studies conducted in India, the prevalence was found to be 16% in Maharashtra, South-West Indian state [7]. Some Indian studies also report higher rates of depression, 49% to 67% [8][9][10][11]. Further comparison of the prevalence of depression between our and these studies is difficult due to different study instruments diagnosing depression, methodologies, study population, and clinical settings.…”

“…This prevalence of depression in patients treated with ART is higher than the prevalence in the general population [2]. This high prevalence is supported by another study conducted in the Northern state of India, emphasizing the need for early diagnosis and prompt treatment of depression in HIV patients [10]. Encouragingly, the proportion of mildly depressed patients was higher in our study: 57/70 (81.9%), predicting a good value for money and efforts in this direction, as a periodic screening of HIV patients for depression can easily detect and manage mild depression cases.…”

“…Each of the nine items of this questionnaire is scored from 0 ('not at all') to 3 ('nearly every day'). Total score ranges from 0 to 27 and severity of depression is classified as: none or minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe (20)(21)(22)(23)(24)(25)(26)(27). Sensitivity and specificity, for the local (Hindi) version of PHQ-9, which was used in the study in diagnosing depression was reported to be 99% and 90%, respectively [24].…”

“…WHO staging is a clinical staging of HIV/AIDS patients based on HIV-associated symptoms. It has four stages: asymptomatic, mild symptoms, advance symptoms, and severe symptoms represented by roman numbers I, II, III, and IV, Previous studies have documented a high prevalence of depression among people living with HIV/AIDS (PLHA), varying from 8.1% to 67.3%, quite higher than overall prevalence of depression [2][3][4][5][6][7][8][9][10][11]. Among many comorbidities associated with HIV/AIDS patients, depression ranks higher than most of the others.…”