Abstract
BackgroundTruck drivers in sub-Saharan Africa are at high risk for both mental health disorders and sexually transmitted infections. We sought to determine the prevalence of depression among a sample of long-distance truck drivers seeking services at roadside wellness clinics in Kenya and explore the relationship between depression and sexual risk behavior.MethodsWe used data from an interviewer-administered questionnaire from 284 truck drivers in Kenya who participated in a randomized controlled trial evaluating whether offering oral HIV self-testing could increase HIV test uptake. Depression was categorized based on the Patient Health Questionnaire-9 score, with a score ≥10 indicative of probable major depressive disorder (MDD). Sexual risk behavior was operationalized as the number of condomless sex partners in the past 6 months.ResultsThe mean participant age was 36.9 years, 83.0% were married, and 37.0% had a secondary school education or higher. Overall, 24% of participants had probable MDD, and 58.2% reported having one condomless sex partner in the past 6 months, whereas 27.3% reported having had two or more. In a multivariable Poisson regression model adjusted for demographic and other relevant variables, including number of sex partners, MDD was significantly associated with a greater number of condomless sex partners (adjusted prevalence ratio 1.63, 95% confidence interval [1.25–2.12], p < 0.001). General self-efficacy significantly mediated the association between MDD and number of condomless sex partners.ConclusionsThe high prevalence of depression highlights the need to test the feasibility and acceptability of mental healthcare interventions for this population, possibly integrated with HIV prevention services. Future research is needed to better understand the association between depression and sexual risk behavior, as well as the role of self-efficacy.
Highlights
Few published studies have comprehensively explored the epidemiology of depression among truck drivers and none, to our knowledge, have done so in sub-Saharan Africa
Participants had worked as a truck driver on average for 8.8 years (SD 1⁄4 7.0), more than half (58.1%) usually drove alone, and in the previous 30 days, participants spent a mean of 21.6 days (SD 1⁄4 23.0) on the road
When comparing across studies that used the Patient Health Questionnaire (PHQ)-9 from non-community-based samples, this estimate was higher than a sample of HIV-positive adult men attending clinics in Uganda (12%) (Wagner et al, 2011), but lower than in a study among adult men who have sex with men (MSM) in coastal Kenya enrolled in an HIV research study (42%) (Secor et al, 2015)
Summary
Few published studies have comprehensively explored the epidemiology of depression among truck drivers and none, to our knowledge, have done so in sub-Saharan Africa. A small number of studies in sub-Saharan Africa have explored the relationship between depression and sexual risk, including in a general population at risk for HIV infection in South Africa (Smit et al, 2006; Nduna et al, 2010) and among social networks of young men in Tanzania (Hill et al, 2016) This relationship is complex, one possible explanation may be that maladaptive thought patterns arising from depression, such as those related to impulsivity and hopelessness (Wang et al, 2015), might lead to the adoption of risky behavior and increase the propensity for self-harm. Future research is needed to better understand the association between depression and sexual risk behavior, as well as the role of self-efficacy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
