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Depression highly prevalent among people living with HIV in sub-Saharan Africa
Michael Carter, 2017-09-29 07:30:00
Depression is very
common among people living with HIV (PLHIV) in sub-Saharan Africa (SSA),
according to the results of a systematic review and meta-analysis published in PLOS One. Prevalence range between 9%
and 32%, but differed between screening tools and also according to
antiretroviral therapy (ART) status. Risk factors for depression included
economic hardship, female sex and immunosuppression, but there was little
consistency between studies.
“This analysis of
the available most recent literature confirmed that depression in PLHIV
represents an increasing concern in SSA,” write the authors. “The prevalence of
depression is high even if the variability of the data does not allow to
describe the phenomenon and to identify strong predictors.”
HIV is now a
chronic manageable condition in most settings, including sub-Saharan Africa. Globally,
the mental health of HIV-positive individuals is an increasing concern. World
Health Organization (WHO) ART guidelines recommend that patients should be
screened for depression, the presence of which has been associated with poorer
health outcomes, low quality of life and sub-optimal adherence to ART.
western countries has shown that HIV-positive patients are up to three times
more likely to have depression compared to individuals in the general
population. Little, however, is known about the prevalence and risk factors for
depression among people with HIV in sub-Saharan Africa.
A team of
investigators therefore undertook a systematic review and meta-analysis of
studies published before April 2016 reporting on the prevalence of major
depressive disorder (MDD) and depressive symptoms.
A total of 66
studies were included in the review. Some 55 papers reported on the prevalence
of major depression and/or depressive symptoms, including ten on MDD only, 40
on depressive symptoms only and five on both. Eleven studies analysed only risk
factors associated with depression. The vast majority of studies – 53 (83%) - were published between 2010 and 2016.
“Since 2010, the
number of studies on depression in African PLHIV has substantially increased,”
comment the investigators, “highlighting the increasing concern on this
emerging public health issue.”
showed a 19% prevalence overall of MDD.
MDD prevalence was
12% among ART-treated patients and 24% among mixed/untreated patients. But
estimates varied between individual studies, from a low of 3% among ART-treated
patients to a high of 34% among treatment-naïve individuals.
depressive symptoms was 31% overall. But there was considerable variability
between studies, with prevalence varying between 14% and 32% in ART-treated
patients and between 9% and 31% in mixed/untreated patients.
with MDD included low CD4 cell count, disability, younger age, being female,
stigma, opportunistic infections, unemployment, negative life experiences, poor
quality of life, co-morbidities (including tuberculosis) and a history of
mental health problems.
depressive symptoms included immune suppression, poorer physical health, being
female, lower levels of education, unemployment and stigma.
graded the studies included in their analysis as low, with some of very low
further research is needed to validate the most accurate diagnostic tools; on
how to best administer these tests; and evaluation of MDD and/or depressive
symptoms in especially at risk populations, including older patients, women and
are at increased risk of developing viral resistance and other poor outcomes
because of low level of ART adherence, and more specifically older patients who
have even a less efficient immune system,” conclude the researchers. “This may
become a significant public health hazard, deserving preventive and corrective
measures to assure PLHIV better quality of life and outcomes in SSA.”