Abstract
BackgroundMajor depression is believed to affect treatment adherence and overall quality of life (QoL) of people living with HIV/AIDS (PLWHA). Comorbid major depression contributes to a two-fold higher risk of mortality among PLWHA. Understanding the relationships of major depression, adherence to antiretroviral therapy (ART) and QoL is important to identify areas for intervention. The aim of this study is to examine relationship of major depressive disorder (MDD) and adherence to ART with QoL, and to investigate socio-demographic and clinical factors associated with MDD, adherence and QoL among PLWHA in Northwest Ethiopia.MethodA cross-sectional study was conducted in the ART clinic of Felege-Hiwot referral hospital in Northwest Ethiopia from July to October 2019. Adult PLWHA were selected using a systematic random sampling technique. Data were collected using interview administered questionnaires and chart reviews. Mini International Neuropsychiatric Interview and WHOQOL-HIV-BREF-Eth instruments were used to measure MDD and QoL respectively. Adherence to ART was assessed using pill count data from patients’ adherence monitoring chart. Univariate and multivariate Poisson regressions were used to assess associations of socio-demographic and clinical factors with MDD and adherence to ART. A multivariate linear regression was used to examine the associations of both MDD and adherence with overall QoL.ResultOf the total of 393 invited participants, 391 (99.5%) completed the interviews. MDD was negatively associated with overall QoL: participants with MDD had a lower QoL score of 0.17 points compared to those with no MDD. MDD was associated with reduced adherence to ART when functional disability was controlled (RR = 1.43; 95%CI = 1.05, 1.96; p = 0.025). However, there was no statistical association between adherence to ART and overall QoL. Functional disability was associated with both MDD (RR = 5.07; 95%CI = 3.27,7.86; p < 0.001) and overall QoL (β = 0.29; 95%CI = 0.21,0.36; p < 0.001).ConclusionThe relationship between MDD and QoL indicates the need for feasible, acceptable and evidence-based mental health interventions to reduce depression and improve overall QoL of PLWHA. We recommend future studies investigate causal relationships of MDD, adherence to ART and QoL of PLWHA to better understand priority areas for intervention.
Highlights
Major depression is believed to affect treatment adherence and overall quality of life (QoL) of people living with HIV/AIDS (PLWHA)
This paper presents 1) the prevalence and associated factors of major depressive disorder (MDD), 2) the prevalence and associated factors of adherence to antiretroviral therapy (ART), 3) the factors associated with QoL, and 4) the associations of MDD and adherence to ART with overall QoL among PLWHA in Northwest Ethiopia
Association of MDD and adherence to ART with overall QOL After controlling for socio-demographic and clinical factors associated with overall QoL, results of the multivariate linear regression show that MDD was negatively associated with overall QoL: participants with MDD had a lower QoL score of 0.06 compared to those with no MDD (95%CI = 0.89, 0.99; p < 0.047)
Summary
Major depression is believed to affect treatment adherence and overall quality of life (QoL) of people living with HIV/AIDS (PLWHA). Comorbid major depression contributes to a two-fold higher risk of mortality among PLWHA. Comorbid major depression affects the clinical outcomes of HIV/AIDS [1,2,3] and contributes to a two-fold higher risk of mortality [4]. Major depression is the most common mental disorder among people living with HIV/AIDS (PLWHA) and is estimated to be two to three times higher in PLWHA than in general population [4, 7,8,9]. A systematic review of studies from Ethiopia reported a 37% pooled prevalence of probable depression among PLWHA [12] which was much higher compared to the 11% pooled prevalence in the general population [13]
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