PREVALENCE OF DEPRESSION AND ASSOCIATED FACTORS AMONG PEOPLE LIVING WITH HIV/AIDS IN TIGRAY, NORTH ETHIOPIA: A CROSS SECTIONAL HOSPITAL BASED STUDY

PREVALENCE OF DEPRESSION AND ASSOCIATED FACTORS AMONG PEOPLE LIVING WITH HIV/AIDS IN TIGRAY, NORTH ETHIOPIA: A CROSS SECTIONAL HOSPITAL BASED STUDY

Haftu Berhe* and Alemayehu Bayray

Department of Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia

ABSTRACT

Objective: The aim of this study was to determine the prevalence of depression and associated factors among people attending ART clinics in Tigray, Ethiopia.

Method: Institution based cross-sectional study was conducted on patients attending ART clinics for persons living with HIV/AIDS (PLWHA) at Adigrat, Mekelle and Maichew Hospitals in Tigray region. Sample size was calculated using Epi info statcalc and 269 PLWHA were included in the study. The patients were interviewed by psychiatric nurses using the 21 item Hamilton’s depression scale Questionnaire. Data was analyzed using the Statistical Package for the Social Sciences (SPSS, version 19.0). Levels of depression were calculated among various subgroups of patients, according to the Hamilton’s depression scale questionnaire. The possible associations of the presence and severity of depression with socio-demographic variables was explored using appropriate parametric and non-parametric tests. Specifically, the odds square and logistic regression was used in the exploration of associations; ethical clearance was obtained from Mekelle University College of health sciences.

Result: Out of 269 total participants, 142(52%) were females, 213 (79.2%) were from urban area and 56(20.8) were from rural. One hundred nine (40%) of the study subjects’ age range was 35-44 and 129 (48%) were married. Orthodox religion constituted 80% followed by Muslim (11.5%) and Catholic (0.4%). Sixty (22.3%) were unemployed and majority, 229(85.2%) had a minimum of primary education. Among 269 participants 43.9 % were depressed. Depression was associated with urban dwellers, with lower socio-economic class, unemployed and government employees, with OR of 3.19(1.5, 6.65), 4.43(1.35, 14.58), 2.74(1.34, 5.57), and 3.56(1.73, 7.30) respectively.

Conclusion: In summary, the magnitude of depression in PLWHA on ART was found to be high and was positively associated with urban dwellers, with lower socio-economic class, unemployed, and government employees. Hence, depression among PLWHA on ART is still under diagnosed and under treated; there is a need to incorporate mental health service as an integral component of HIV care

Depression, PLWHA

INTRODUCTION: In 2010, HIV/AIDS killed 1.8 million people, 1.2 million of whom were living in sub-Saharan Africa. Major progress has been made in delivering life-saving treatment for people living with HIV/AIDS - there are now 6.6 million people globally on treatment of which more than 5 million are in Africa. However, nearly 8 million more people are in need of treatment and HIV infection rates are far outpacing the number of people added to treatment each day ¹. Because individuals in their most productive years (15-49 years old) are most commonly infected with HIV/AIDS, the disease has a wide socioeconomic impact that threatens development progress in many poor countries, especially those in sub-Saharan Africa.

14.8 million Children in the region have already lost one or more parents to the disease. In South Africa alone, nearly one in five children are projected to be orphans by 2010, exacerbating a social dynamic that is already deeply challenged by crime, violence and unemployment. HIV/AIDS targets people during their most productive years, making economic progress in many sub-Saharan African countries even more of a challenge. Some estimates suggest that annual GDP growth in highly affected countries can be 2-4% lower than in countries with the absence of AIDS. HIV/AIDS is also a major constraint on the provision of quality education. For example, Tanzania needs around 45,000 additional teachers to make up for those who have died or left the system because of AIDS - many were their most experienced teachers ¹.

In 2005, world leaders at the G8 summit in Gleneagles and at the U.N. World Summit in New York pledged to reach near universal access to prevention, care and treatment by 2010. UNAIDS estimates that $25.1 billion will be required for the global AIDS response in 2010 to achieve universal access - treatment that reaches at least 80% of patients in need - for HIV prevention, treatment care and support in low and middle-income countries, a figure $9.2 billion higher than what was invested in the AIDS response in 2009.

Delivering these essential services will require a strengthening of health systems, especially in Africa, which is home to two-thirds of those requiring antiretroviral (ARV) treatment, but only 3% of the global health care workers to provide it.

Progress must also continue in expanding prevention efforts, making treatment less expensive and more available, and including resources for second-line regimens, pediatric formulations and diagnostic tests and equipment ².

Dramatic increases in global resources have helped many countries make significant progress in combating HIV/AIDS in recent years. HIV/AIDS medication per patient now costs as little as $140 per year, down from nearly $10,000 less than ten years ago. Lower prices have helped support a rapid scale-up of access to life-saving antiretroviral (ARV) treatment, especially in sub-Saharan Africa.

More than 5 million Africans are receiving antiretroviral treatment, up from only 50,000 in 2002. Some countries have achieved even more dramatic results. Botswana, Rwanda, and Namibia have achieved universal access and Benin, Ethiopia, Mali, Senegal, Swaziland, and Zambia had coverage rates between 50 to 80% and are making progress toward universal access. These results demonstrate that expansion of vital services can be rapidly scaled up even in developing countries ³.

Depression is the most frequently observed psychiatric disorder among HIV/AIDS patients. Its specific prevalence is difficult to identify as a result of the wide variations across the globe, ranging from 20 to above 70%. Depression has been associated with increased risky behaviors, non compliance to treatment, higher risk for co-morbid disorders and shortened survival. Failure to recognize and treat depression endangers not only the patient but the community as well ^4,5,6.

Depressive tendencies are reduced if the patient’s condition is known and accepted by the patient’s family and when he involves himself in gratifying activities which could be professional, social or otherwise. On the other hand, risks for depression among HIV/AIDS patients increase when recent affective losses occur (death or rejection of all sorts), an accelerated evolution of opportunistic infections, increasing rate of hospitalizations; its duration as well as physical deterioration. Furthermore, in patients with HIV disease, severity of depression correlates with rapidity of decline in CD4 count, suggesting that failure to treat depression may accelerate HIV disease progression and impact on survival ⁷. In addition, depressed HIV patients treated with antidepressants are more likely to adhere to antiretroviral treatment than those not ⁸. Recent findings have shown that persons with depressed mood are more likely to engage in high-risk sexual behavior ⁹.

Mental disorders associated with HIV/AIDS can result from the psychological impact of having a fatal disease, or stem from the effects of psychosocial stressors associated with the illness like stigma and discrimination. They can also result from actual neurological changes in the physical and chemical structures of the central nervous system that occur as a result of the HIV virus, opportunistic infections, or related treatments. Most HIV positive psychiatric patients actually suffer from multiple disorders. HIV/AIDS infected individuals face a number of the same stressors confronted by other patients with chronic illness, such as long-term discomfort, physical deterioration, physical and financial dependence and eventual death. HIV/AIDS may also lead to mood disorders.

However, the magnitude of depression and associated factors among PLWHA was not adequately addressed in our context. Therefore, this study was intended to fill the research gap thereby help clinicians and other stake holders be aware of and plan appropriate strategies and prevent the high suicidal rate as a result of depression related to HIV/AIDS ^{10, 11}.

A study conducted to determine the prevalence of depression among persons attending  HIV/AIDS clinic in Kingston, Jamaica, and to explore the possible role of patient-specific clinical and social issues as intermediary factors in the relationship between HIV/AIDS and depression.. Depression prevalence rates were calculated and the association between depression and age, gender, antiretroviral treatment, CD4 count, living arrangement, marital status and major stressors explored. Sixty-three patients participated in the study and 43% (n = 36) of them were depressed. No significant differences in depression rates were found with respect to any of the socio-demographic or clinical factors explored (p > 0.05).The relatively high prevalence of depression among attendees at the HIV/AIDS clinic underscores the need for depression screening in these patients ¹².

Considerable evidence suggests that people with HIV disease are significantly more distressed than the general population, yet psychiatric disorders are commonly under-detected in HIV care settings. This study examines the prevalence of three stress-related psychiatric diagnoses--depression, posttraumatic stress disorder (PTSD), and acute stress disorder (ASD), among a vulnerable population of HIV-infected patients. Among approximately 350 patients attending two county-based HIV primary care clinics, 210 participants were screened for diagnostic symptom criteria for depression, PTSD, and ASD.

Standardized screening measures used to assess for these disorders included the Beck Depression Inventory, the Posttraumatic Stress Checklist, and the Stanford Acute Stress Questionnaire. High percentages of HIV-infected patients met screening criteria for depression (38 per cent), PTSD (34 per cent), and ASD (43 per cent). Thirty eight percent screened positively for two or more disorders. Women were more likely to meet symptom criteria for ASD than men (55 per cent vs. 38 per cent, OR=1.94, CI95 per cent=1.1-3.5). ASD was detected more commonly among African-American and white participants (51 per cent and 50 per cent respectively), compared with other ethnic groups. Latinos were least likely to express symptoms of ASD (OR=0.52, CI95 per cent=0.29-0.96).

Of the 118 patients with at least one of these disorders, 51 (43 per cent) reported receiving no concurrent mental health treatment. Patients with HIV/AIDS who receive public healthcare are likely to have high rates of acute and posttraumatic stress disorders and depression. These data suggest that current clinical practices could be improved with the use of appropriate tools and procedures to screen and diagnose mental health disorders in populations with HIV/AIDS ¹³.

HIV/AIDS related disorders have a negative impact on the assumption of responsibility of other Co-morbidities and could lead to a highest lethality rate. The goal was to evaluate the prevalence of the psychiatric disorders during HIV/AIDS at infectious diseases service of "hopital du Point G". We carried out an exploratory study and descriptive energy of July 1, 2004 to bearing 31 October 2005 out of 166 patients.

The cases of HIV were defined on the basis of positivity of serology HIV by at least 2 fast tests associated or not with clinical signs with the AIDS according to CDC. Any disturbance of the higher functions was regarded as psychiatric demonstrations. The female sex was in a majority with a sex- ratio of 0.9. The ages bracket the most touched lay between 36 and 41ans. The housewives were 3