Abstract
Recent blue-ribbon panel reports have concluded that HIV treatment programs in less wealthy countries must integrate mental health identification and treatment into normal HIV clinical care and that research on mental health and HIV in these settings should be a high priority. We assessed the epidemiology of depression in HIV patients on antiretroviral therapy in a small urban setting in Cameroon by administering a structured interview for depression to 400 patients consecutively attending the Bamenda Regional Hospital AIDS Treatment Center. One in five participants met lifetime criteria for MDD, and 7% had MDD within the prior year. Only 33% had ever spoken with a health professional about depression, and 12% reported ever having received depression treatment that was helpful or effective. Over 2/3 with past-year MDD had severe or very severe episodes. The number of prior depressive episodes and the number of HIV symptoms were the strongest predictors of past-year MDD. The prevalence of MDD in Cameroon is as high as that of other HIV-associated conditions, such as tuberculosis and Hepatitis B virus, whose care is incorporated into World Health Organization guidelines. The management of depression needs to be incorporated in HIV-care guidelines in Cameroon and other similar settings.
Highlights
More than 25 million people have died from HIV/AIDS, most of them in sub-Saharan Africa (SSA) where HIV/AIDS is the leading cause of mortality. [1] In 2010, SSA accounted for approximately two-thirds of global cases. [1] Despite recent global initiatives to improve the availability of and access to antiretroviral therapy (ART) in SSA, the continued high adult mortality due to HIV/AIDS in this region results in significant social and economic consequences.Cameroon, located in central Africa, has an estimated 550,000 persons living with HIV and an HIV prevalence rate of 5.5%. [2] In a number of ways, Cameroon’s experience with HIV is representative of many SSA countries
Participants reporting an episode in the past year or more recently completed a standard depressive severity rating scale called the Quick Inventory of Depressive Symptoms (QIDS) [31] that is embedded within the Composite International Diagnostic Instrument (CIDI)
Participants reported a median of 5 (IQR: 3–6) physical symptoms commonly associated with HIV infection
Summary
More than 25 million people have died from HIV/AIDS, most of them in sub-Saharan Africa (SSA) where HIV/AIDS is the leading cause of mortality. [1] In 2010, SSA accounted for approximately two-thirds of global cases. [1] Despite recent global initiatives to improve the availability of and access to antiretroviral therapy (ART) in SSA, the continued high adult mortality due to HIV/AIDS in this region results in significant social and economic consequences. [4] The major mood and anxiety disorders are five to ten times more prevalent in HIV-positive individuals than in the general U.S population, [5] with a similar increased risk found in SSA settings. In individuals with HIV/AIDS, mental illness (MI) in general and depression in particular, have been consistently associated with negative HIV-related behaviors, poor ART adherence, a critical consideration in HIV care where ART plays a central role in suppressing virus and protecting the immune system. [11,12,13,14,15,16,17] A recent meta-analysis of 95 studies encompassing 35,029 participants confirmed the consistent association of depression with poor ART adherence low-resource and high-resource settings. N To describe the severity of MDD in the patient population and to identify sociodemographic and clinical variables associated with a greater risk of depressive illness
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