Abstract
BackgroundThere are limited data on the prevalence and approaches to screening for depression among pregnant women living in resource poor settings with high HIV burden.MethodsWe studied the reliability and accuracy of the Center for Epidemiologic Studies Depression (CES-D) scale in 123 (36 HIV-infected and 87 -uninfected) pregnant women receiving antenatal care at Gulu Regional Referral Hospital, Uganda. CES-D scores were compared to results from the psychiatrist-administered Mini-International Neuropsychiatric Interview (MINI) for current major depressive disorder (MDD), a “gold standard” for assessing depression. We employed measures of internal consistency (Cronbach’s alpha), and criterion validity [Area Under the Receiver Operating Characteristic Curve (AUROC), sensitivity (Se), specificity (Sp), and positive predictive value (PPV)] to evaluate the reliability and validity of the CES-D scale.Results35.8% of respondents were currently experiencing an MDD, as defined from outputs of the MINI-depression module. The CES-D had high internal consistency (Cronbach’s alpha = 0.92) and good discriminatory ability in detecting MINI-defined current MDDs (AUROC = 0.82). The optimum CES-D cutoff score for the identification of probable MDD was between 16 and 17. A CES-D cutoff score of 17, corresponding to Se, Sp, and PPV values of 72.7%, 78.5%, and 76.5%, is proposed for adoption in this population and performs well for HIV-infected and -uninfected women. After adjusting for baseline differences between the HIV subgroups (maternal age and marital status), HIV-infected pregnant women scored 6.2 points higher on the CES-D than HIV-uninfected women (p = 0.032).ConclusionsThe CES-D is a suitable instrument for screening for probable major depression among pregnant women of mixed HIV status attending antenatal services in northern Uganda.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0303-y) contains supplementary material, which is available to authorized users.
Highlights
There are limited data on the prevalence and approaches to screening for depression among pregnant women living in resource poor settings with high HIV burden
In Sub-Saharan Africa (SSA), the reported prevalence of major depressive disorder (MDD) among adult people living with HIV (PLHIV) ranges broadly, from 71.3% in Zambia [3] to 47% in Uganda [4], 43.7% in South Africa [5], and 30% in Zimbabwe [6]
HIV infected women were oversampled to achieve a minimum ratio of 1 HIV infected: 2 HIV uninfected participants, our sample has a higher proportion of HIV infected women than the 10.3% age adjusted prevalence of HIV previously observed at antenatal care (ANC) clinics in northern Uganda [26]
Summary
There are limited data on the prevalence and approaches to screening for depression among pregnant women living in resource poor settings with high HIV burden. Since the first Global Burden of Disease (GBD) report was released in 1996 [1], the impacts that HIV infection and major depressive disorders (MDDs) have had on medical and public health systems have greatly increased. The 2010 GBD report indicated that HIV infection has risen from being the 33rd to the 5th contributor to the global burden of disease, while MDDs have risen from being the 15th leading cause to being the 11th [2]. While there has been a surge of information and strategies for managing or preventing HIV infection, practical strategies for managing MDDs remain limited, in resource poor settings. Depression has been associated with increased rates of HIV disease progression and mortality [8], inequity in decision-making and relationship power among heterosexual couples [9], and AIDS-related stigma [10]
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