Qualitative study of the influence of antidepressants on the psychological health of patients on antiretroviral therapy in Uganda

Abstract

The study set out to explore how HIV-positive individuals conceptualise and describe depression and its manifestation in their lives, and how this may change over time in the context of antiretroviral therapy (ART) and antidepressant treatment. We conducted in-depth interviews using a semi-structured interview guide with 26 adult HIV-positive clients receiving ART in Uganda. We asked the participants to describe their depression and its impact on their general health, physical functioning and psychological wellbeing, as well as the influences of receiving ART or antidepressant treatment. Although depressive experience among the patients was largely described in terms of criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), some of the symptoms used to describe depression, such as 'thinking too much' or worrisome thoughts, did not fit into the DSM-IV criteria. The participants attributed their depression to news of the HIV diagnosis, a fear of dying, the potential socioeconomic consequences of their HIV infection on their family, ART side-effects and continued bad health. Their subjective reports indicated that the treatment of depression with antidepressants had made a positive impact on their general and psychological health. These findings highlight the need for models of HIV care that integrate mental health services and promote the diagnosis and treatment of depression in culturally sensitive ways so as to improve the quality of life and health outcomes for clients. However, keeping the particular study design in mind, these findings should be interpreted as preliminary.

Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda

“…Anxiety and distress associated with HIV among women has been reported in previous studies [85–87]. The experience of pregnancy and postpartum among WLWH has been characterized by negative emotions including fear, anxiety, guilt, and sadness in previous research [85, 86].…”

“Thinking too much”: A systematic review of a common idiom of distress

“…For example, as Shankar et al (2006) describe, “The impact of mental illness was seen on the patient through psychological and behavioral symptoms […] such as thinking too much” (p. 226). Similarly, Okello et al (2012) found that “the most common singular symptom used by participants to characterize depression was rumination about worries or ‘having too many thoughts” (p. 42).…”

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

“…Many of the respondents described their depression in terms of “thinking too much”, somatic complaints such as sleep difficulties, eating problems, and aches, as well as generally feeling bad about a variety of psychosocial adversities related to poverty, stigma from their HIV status, lack of social support, significant grief and loss, and limited economic opportunities 20 (for more detail about depression experiences in our sample please see Okello et al, 2012). Experiences related to depression suggest a hopelessness and lack of control over their health and functioning.…”

“…Furthermore, cross-cultural studies of depression among PLHA in Uganda have shown that patients are more comfortable presenting their somatic symptoms, rather than emotional or affective symptoms, 20 making it even more challenging to distinguish depression from manifestations of HIV disease.…”