Abstract
BackgroundDepression and suicidal thinking occur frequently alongside HIV/AIDS, triggering profound detrimental impacts on quality of life, treatment adherence, disease progression, and mortality. Yet the psychosocial factors contributing to these psychiatric comorbidities remain underexplored, particularly in the developing country context. This study thus examined different dimensions of perceived family support in relation to depression and suicidal ideation among people living with HIV/AIDS (PLWHA) in Nepal.MethodsA cross-sectional survey of 322 adult PLWHA residing in the Kathmandu Valley, Nepal was conducted. Data were analyzed using multiple logistic regressions for correlates of Beck Depression Inventory (BDI)-Ia-defined depressive symptoms and suicidal ideation in the past 2 weeks. Perceived family support, measured using the 10-item Nepali Family Support and Difficulty Scale, was entered into separate models, in turn, as a composite score, for each sub-scale (emotional, instrumental, and negative support), and for each individual item.ResultsOverall, 25.5% of participants registered BDI-Ia-defined depression, with significantly lower rates among those with perceived family support scores in the highest (AOR = 0.19; 95% CI = 0.07, 0.55) and middle (AOR = 0.38; 95% CI = 0.17, 0.86) tertiles relative to those with lowest-tertile scores. Meanwhile, 14.0% reported suicidal thinking, with significantly lower rates among those in the highest perceived family support tertile relative to the lowest (AOR = 0.25; 95% CI = 0.07, 0.91). Broken down by support sub-scale, only negative support (i.e. family difficulty) was significant in its correlations with both outcomes – a trend similarly reflected in the item-wise analyses.ConclusionsOur findings highlight an important role for family support in determining experiences of depression and suicidality among PLWHA. Incorporating family counseling and support services – with special focus on ameliorating negative interaction and bolstering emotional support – into HIV care and treatment services may help to improve mental health along with overall wellness and treatment outcomes for HIV-positive populations in Nepal and similar settings.
Highlights
With the prolonged life expectancy made possible through introduction of highly active antiretroviral therapy (HAART), mental health issues have come to the fore as a critical problem in people living with HIV/AIDS (PLWHA)
Though reported rates of depression in PLWHA vary widely depending on regional context, diagnostic criteria, methods of measurement, and study sample, estimates are consistently high across countries – between 12% and 71% as measured by the Beck Depression Inventory (BDI) alone [1]
Participants were 58% male and had a median age of 33 years; 81% had at least some formal education, with 60% educated at an above-primary level, and 75% were employed in some capacity
Summary
With the prolonged life expectancy made possible through introduction of highly active antiretroviral therapy (HAART), mental health issues have come to the fore as a critical problem in people living with HIV/AIDS (PLWHA). Mental health problems are a serious and growing public health problem, constituting the brunt of the non-fatal burden of disease in 2010 Under this umbrella, depressive disorders represent the leading cause of disability-adjusted life years (DALYs) attributable to mental, neurological, and substance use disorders in high-income and low- and middle-income countries (LMICs) alike [5], and suicide accounts for roughly one million deaths annually worldwide [6]. High rates of suicidal ideation among PLWHA are a serious concern in that suicidal thoughts precede suicidal behaviors Such psychosocial health problems are critically important to address among PLWHA, inasmuch as they can act syndemically to the detriment of efforts to curb HIV. This study examined different dimensions of perceived family support in relation to depression and suicidal ideation among people living with HIV/AIDS (PLWHA) in Nepal
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