Psychological distress in the first year after diagnosis of HIV infection among women in South Africa

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Cross-sectional studies on psychological responses associated with an HIV diagnosis are replete, but a paucity of research exists to evaluate the changes and stability of these responses, particularly among black African women. One hundred and five HIV-positive black and coloured women were studied as they reported for follow-up health management at the outpatient clinic for infectious diseases at Tygerberg Hospital in Cape Town, South Africa. They were assessed at baseline and 51 returned for a follow-up interview six months later. Assessments involved use of the Mini-International Neuropsychiatric Interview (MINI), the Carver Brief COPE, and the Sheehan Disability Scale. Negative life events and risk behaviours were also evaluated. Fifty-nine women (56.2%) were diagnosed with at least one psychiatric disorder on the MINI at baseline. The most frequent diagnosis was major depression (38.1%), followed by dysthymic disorder (22.9%). A diagnosis of HIV or AIDS exacerbated the premorbid state of 19% of the women who reported a past history of depression. Twelve women (11.4%) were at risk for suicide, while 19% met criteria for a clinical diagnosis of post-traumatic stress disorder (PTSD) and 6.7% met the diagnosis of generalised anxiety disorders. At follow-up, 26 (51%) were diagnosed with at least a psychiatric disorder. Eleven (21.6%) met the criteria for major depression, while eight (15.7%) had a past history of depression. The number of women with PTSD increased from 19% of the total sample at baseline to 29.4% of those interviewed at follow-up. Conversely, the number with dysthymia dramatically decreased from 24 women (22.9%) at baseline to just one woman at follow-up. The number displaying suicidality also decreased from 12 at baseline to four at follow-up. At both baseline and follow-up, the number and impact of negative life events significantly increased the likelihood of major depression persisting or recurring, but this association was not found for PTSD. These findings indicate that, over time, there is variability in psychiatric morbidity among coloured and black African women living with HIV and that a high number of negative life events may increase the likelihood of persistent major depression in these women.