Correlates of Perinatal Depression in HIV-Infected Women

Abstract

Maternal perinatal depression (PND) may interfere with effective perinatal HIV care. In order to begin examining the prevalence and characteristics of PND in HIV-infected women, we analyzed data from the medical records of all HIV-infected women who had received perinatal care in the Maternal-Child and Adolescent Center for Infectious Diseases and Virology at LAC=USC Medical Center from 1997 through 2006. Data from 273 individual women (328 live births) were analyzed. Demographic, medical history, psychosocial, pregnancyrelated, and HIV-related factors measured during the perinatal period were examined for an association with PND using multivariate logistic regression with generalized estimating equations to account for the withinsubject correlation due to multiple births per mother. The overall prevalence of PND was 30.8%. Multivariate analysis showed that PND was significantly associated with substance abuse during pregnancy (odds ratio [OR] ¼ 2.81, 95% confidence interval [CI]: 1.35-5.82) and past history of psychiatric illness (OR ¼ 3.72, 95% CI: 2.06-6.71). Compared to mothers with CD4 nadir greater than 500 cells=mm 3 , mothers with a CD4 nadir during pregnancy #200 cells=mm 3 were 3.1 times more likely to experience PND (OR ¼ 3.01, 95% CI: 1.32-6.88). Women who had antiretroviral (ARV) medications adherence problems during pregnancy were more likely to experience PND than women who were adherent (OR ¼ 2.14, 95% CI: 1.08-4.23). These preliminary results suggest that rates of PND among HIV-infected women are substantial. We conclude that pregnant HIV-infected women should be routinely screened for PND. Prospective studies examining the bio-psycho-social markers of PND in HIV-infected women are indicated.

Perinatal Depressive Symptoms in HIV-Infected Versus HIV-Uninfected Women: A Prospective Study from Preconception to Postpartum

“…Consistent with previous findings, 19 the proportion of women with elevated perinatal depressive symptoms was high in our sample before conception (39%) and in the perinatal period (46%). There were no differences between HIVinfected and uninfected women in likelihood of clinically significant depressive symptoms.…”

“…That study was a retrospective cohort design and involved 273 predominantly minority HIV-infected women from Los Angeles between 1997 and 2006. 19 Perinatal depression was based on medical records or multidisciplinary chart notes indicating an onset of depression during pregnancy and/or within 4 weeks after delivery. The overall prevalence of perinatal depression was 30.8%, of depression during pregnancy was 22%, and of depression within 4 weeks postpartum was 18.3%.…”

“…Kapetanovic et al 19 reported that past history of a psychiatric illness, substance use during pregnancy, social stress during pregnancy, and lower CD4 + pregnancy nadir were associated with an increased risk of perinatal depression as defined by medical records and multidisciplinary notes in their sample of HIV-infected women (n = 273). Other studies have attempted to elucidate the predictors of depressive symptoms in HIV-infected women during either pregnancy or postpartum but not both time periods.…”

Routine Screening for Depression: Identifying a Challenge for Successful HIV Care

“…These findings highlight the elevated levels of psychological distress that have been found among women and mothers with HIV. 41,43 Exploring relationships of distress among women with children is important to understand how to best intervene in the clinic environment to support their daily lives.…”

Perinatal Depression and Anxiety in Women with and without Human Immunodeficiency Virus Infection

“…Pregnancy is a time of increased vulnerability for depression and anxiety in general (Gaynes et al, 2005;Ross & McLean, 2006;Viguera et al, 2011). Although high rates of depression and other mental health vulnerabilities have been reported in women with HIV in general (Basu, Chwastiak, & Bruce, 2005;Morrison et al, 2002) and during pregnancy (Kapetanovic et al, 2009, Kapetanovic, Dass-Brailsford, Nora, & Talisman, 2014Ross, Sawatphanit, & Zeller, 2009), there is a gap in the field of evidence regarding mental health in the perinatal period for women with HIV infection.…”