What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review

Abstract

The expansion of AIDS treatment initiatives in resource-poor settings provides an opportunity for integrating mental health care into these programs. This systematic review of the literature on HIV and mental illness in developing countries examines the mental health risk factors for HIV, mental health consequences of HIV, psychosocial interventions of relevance for HIV-infected and affected populations, and highlights the relevance of these data for HIV care and treatment programs. We reviewed seven studies that measured the prevalence of HIV infection among clinic and hospital-based populations of people with mental illness or assessed sexual risk behavior in these populations; 30 studies that described the mental health consequences of HIV infection; and two reports of psychosocial interventions. The review demonstrates the need for methodologically sound studies of mental health throughout the course of HIV, including factors that support good mental health, and interventions that employ identified variables (e.g. coping, family support) for efficacy in reducing symptoms of mental illness. Promising intervention findings should encourage investigators to begin to study the implementation of these interventions in HIV service settings.

Validity/Reliability of PHQ-9 and PHQ-2 Depression Scales Among Adults Living with HIV/AIDS in Western Kenya

“…PHQ-2 ≥3 demonstrated high sensitivity (85%) and specificity (95%) for diagnosing any PHQ-9 depressive disorder (AUC, 0.97), and 91% and 77%, respectively, for diagnosing PHQ-9 MDD (AUC, 0.91). Psychometrics were also good within four gender/age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) subgroups.CONCLUSIONS: PHQ-9 and PHQ-2 appear valid/ reliable for assessing DSM-IV depressive disorders and depression severity among adults living with HIV/AIDS in western Kenya. …”

“…With one exception 15 , the sparse literature on depression among individuals living with HIV/AIDS in sub-Saharan Africa has shown elevated rates of depression relative to community samples 3,8,10,[16][17][18][19][20][21][22][23][24][25] , consistent with western countries [26][27][28][29] . Thus, there is an urgency to incorporating mental health into HIV/ AIDS treatment programs in sub-Saharan Africa, including western Kenya [30][31][32][33][34][35] .…”

“…With one exception 15 , the sparse literature on depression among individuals living with HIV/AIDS in sub-Saharan Africa has shown elevated rates of depression relative to community samples 3,8,10,[16][17][18][19][20][21][22][23][24][25] , consistent with western countries [26][27][28][29] . Thus, there is an urgency to incorporating mental health into HIV/ AIDS treatment programs in sub-Saharan Africa, including western Kenya [30][31][32][33][34][35] .Depression in sub-Saharan Africa presents in forms (culturespecific idioms, somatic, based on interpersonal relationships or spiritual in nature) that may obscure detection [36][37][38] . However, depression exists at possibly higher prevalence rates than in western countries 37 according to 16 studies 4,5,7,[9][10][11][38][39][40][41][42][43][44][45][46][47] , and an additional 13 studies cited in 37 , of community and non-HIVspecific clinic populations, with generally higher rates for women than men 37,…”

Mental Health and Physical Health (Including HIV/AIDS)

“…In a review of studies of mental health problems of HIV infected people in developing countries, Collins et al (2006) also found a significantly higher prevalence of depressive symptoms among HIV positive people compared with controls. Feelings of anxiety and distress are a normal and arguably even a healthy response to a diagnosis of HIV.…”

Interventions and approaches to integrating HIV and mental health services: a systematic review

“…Previous systematic reviews have examined HIV risk behaviours among adults with severe mental illness (Meade and Sikkema 2005); the link between mistreatment in childhood disorders, mental health disorders, and HIV infection (Spies et al 2012); and literature on HIV and mental illness in low income countries (Collins et al 2006). Studies have also reviewed intervention trials to improve mental health among PLHIVs in LMICs (Sikkema et al 2015); as well as interventions using specific approaches like cognitive-behavioural therapy (Crepaz et al 2008) or that target specific disorders such as depression (Sherr et al 2011), anxiety ) and suicidality among PLHIV.…”