Gender disparities in depression severity and coping among people living with HIV/AIDS in Kolkata, India.

Dallas Swendeman,Soma Roy,Toorjo Ghose,Anne E Fehrenbacher,Rishi Das,Protim Ray,Stephanie Sumstine,Smarajit Jana,Nancy Sohler

doi:10.1371/journal.pone.0207055

Abstract

People living with HIV/AIDS (PLH) experience high rates of depression and related psychosocial risk factors that vary by gender. This study examines gender differences in depression severity among antiretroviral therapy (ART) patients (n = 362) from a large government ART clinic in Kolkata, India. Hypotheses for multiple linear regression models were guided by an integrated gendered stress process model focusing on variables reflecting social status (age, partner status), stressors (stigma), and resources (income, social support). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS); 22% of the sample reached the cutoff for severe depression, 56% moderate, and 13% mild depression. Compared to men, women reported lower income, education (50% no formal education vs. 20% men), availability of emotional and instrumental support, and were less likely to be married or cohabiting (53% women vs. 72% of men). However, more women had partners who were HIV-positive (78% women vs. 46% men). Overall, depression severity was negatively associated with availability of emotional support and self-distraction coping, and positively associated with internalized HIV/AIDS stigma, availability of instrumental support, and behavioral disengagement coping. Interactions for instrumental support by income and partner status by age varied significantly by gender. Analyses stratified by gender indicated that: 1) Frequently seeking instrumental support from others was protective for men at all income levels, but only for high-income women; and 2) having a partner was protective for men as they aged, but not for women. These results suggest that gender disparities in depression severity are created and maintained by women’s lower social status and limited access to resources. The effect of stigma on depression severity did not vary by gender. These findings may inform the tailoring of future interventions to address mental health needs of PLH in India, particularly gender disparities in access to material and social resources for coping with HIV.Trial Registration: ClinicalTrials.gov registration #NCT02118454, registered April 2014.

Highlights

India has the third largest population of people living with HIV/AIDS (PLH) in the world, estimated at 2.3 million [1]
We proposed a novel theoretical model, which posits that gender disparities in depression severity among PLH in India are maintained and exacerbated by an unequal distribution of stressors, resources, and social status between men and women
Men in the sample had significantly higher social status across several demographic variables compared with women, consistent with gender disparities in the Indian general population

Summary

Introduction

India has the third largest population of people living with HIV/AIDS (PLH) in the world, estimated at 2.3 million [1]. High prevalence of depression has consistently been documented among PLH in India [3,4,5,6,7,8]. The few studies that have examined gender differences in depression among PLH in India have found higher prevalence and severity of depression among women than men [9, 10]. No studies to our knowledge have examined whether the relationship between gender and depression among PLH in India is modified by disparities between men and women in social status, exposure to stressors, or access to resources. Internalized HIV/AIDS stigma is a common stressor for PLH, and the effect of stigma on depression might vary by gender [11]. Access to and use of social support resources can modify the relationship between gender and depression [12]

Results

Discussion

Conclusion