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Abebe GF, Alie MS, Adugna A, Asemelash D, Tesfaye T, Girma D, Asres A. Antenatal depression and its predictors among HIV positive women in Sub-Saharan Africa; a systematic review and meta-analysis. Front Psychiatry 2024; 15:1385323. [PMID: 38919635 PMCID: PMC11196764 DOI: 10.3389/fpsyt.2024.1385323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Background Antenatal depression in Human Immunodeficiency Virus (HIV) positive pregnant women can have significant adverse effects on both the mother and newborns, yet it is often overlooked in pregnancy care in Sub-Saharan Africa (SSA). Despite this, there is limited data on the combined prevalence of antenatal depression and its predictors among HIV-positive women in the region. Objective To assess the pooled prevalence of antenatal depression and its associated factors among HIV-positive women in SSA. Methods All primary cross-sectional studies published before 1st January/2024, were included. We conducted searches in relevant databases; PubMed, HINARI, Web of Science, PsycINFO, Psychiatry Online, ScienceDirect, and Google Scholar. The Joanna Briggs Institute checklist was used to critically appraise the selected studies. To assess heterogeneity among the studies, we utilized the I2 test. Publication bias was evaluated using a funnel plot and Egger's test. The forest plot was used to present the combined proportion of antenatal depression and odds ratio, along with a 95% confidence interval. Results The pooled prevalence of antenatal depression among HIV-positive women in Sub-Saharan Africa was found to be 30.6% (95% CI, 19.8%-41.3%). Factors significantly associated with antenatal depression among HIV-positive women in SSA included being unmarried (AOR: 3.09, 95% CI: 1.57 - 6.07), having a previous history of depression (AOR: 2.97, 95% CI: 1.79 - 4.91), experiencing intimate partner violence (IPV) (AOR: 2.11, 95% CI: 1.44 - 3.09), and experiencing stigma (AOR: 1.36, 95% CI: 1.05 - 1.76). Conclusion High prevalence of antenatal depression among HIV-positive women in SSA underscores the need for prioritizing identification and management. Interventions addressing factors like IPV and stigma, along with training for healthcare providers in recognizing symptoms and providing support, are recommended. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024508236.
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Affiliation(s)
- Gossa Fetene Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan, Ethiopia
| | - Melsew Setegn Alie
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
| | - Amanuel Adugna
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan, Ethiopia
| | - Daniel Asemelash
- Department of Laboratory, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Tamirat Tesfaye
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Desalegn Girma
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan, Ethiopia
| | - Abyot Asres
- School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Aman, Ethiopia
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Kanakaraj R, Umamaheswari R, Subramaniam S. Depression and its role in adherence to anti-retroviral treatment in people living with HIV and AIDS in Chennai. J Family Med Prim Care 2024; 13:1507-1510. [PMID: 38827681 PMCID: PMC11141963 DOI: 10.4103/jfmpc.jfmpc_1533_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 06/04/2024] Open
Abstract
Context The AIDS epidemic has drastically reduced in India since it was first identified in 1986, largely due to the widespread availability of anti-retroviral treatment (ART). Management of HIV is currently more focussed on long term morbidities, including mental health. Depression is the most common co-morbidity seen in people living with HIV. Depression is found to negatively affect patient adherence to ART. Poor adherence to ART leads to drug resistance and susceptibility to opportunistic infections. Aims The purpose of this study is to find the prevalence of depression among people living with HIV and to study the correlation between depression and adherence to ART. Setting and Design The study was conducted in the ART centre at Rajiv Gandhi Government General Hospital in Chennai, between August and October 2022. Methods and Materials Patient health questionnaire-9 (PHQ-9) was used to identify depression, and the Adult AIDS clinical trials group (AACTG) questionnaire was used to identify adherence. Statistical Analysis Used Data were entered in MS Excel and were analysed using Statistical Package for Social Science (SPSS) Version 16. The association between categorical data were analysed using Chi-square and Fisher exact test. The correlation between adherence and depression was done using the Spearman correlation. Results The prevalence of depression was found to be 20.2%. A mild negative correlation was found between depression and adherence. Depression was found to have a significant correlation with women, unemployed, widowed, divorced individuals, and those with diabetes mellitus and tuberculosis. Conclusion Depression is an important risk factor for adherence to ART. Though severe depression was not found in this study, mild and moderate depression was associated with reduced adherence to ART. Treating depression is likely to improve adherence and the overall wellbeing of patients with HIV and AIDS.
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Affiliation(s)
- Ranjani Kanakaraj
- CRMI, Institute of Community Medicine, Madras Medical College, Chennai, Tamil Nadu, India
| | - R Umamaheswari
- Community Medicine, Institute of Community Medicine, Madras Medical College, Chennai, Tamil Nadu, India
| | - Sudharshini Subramaniam
- Community Medicine, Institute of Community Medicine, Madras Medical College, Chennai, Tamil Nadu, India
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Bogale EK, Zewdie A, Kassie TD, Anagaw TF, Mazengia EM, Gelaw SS, Fenta ET, Eshetu HB, Kebede N. Suicidal ideation, attempt, and its associated factors among adult HIV/AIDS patients in Ethiopia: A systematic review and meta-analysis study. PLoS One 2024; 19:e0294078. [PMID: 38484019 PMCID: PMC10939232 DOI: 10.1371/journal.pone.0294078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/24/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND WHO statistics show that someone attempts suicide every three seconds and commits suicide every 40 seconds somewhere in the world. There is a scarcity of aggregate evidence in Ethiopia. The aim of this review was to assess the pooled prevalence of suicidal ideation, attempts, and associated factors among adult HIV/AIDS patients in Ethiopia to fill this gap. METHODS We extensively searched the bibliographic databases of PubMed, MEDLINE, Scopus, Google Scholar, and the Web of Science to obtain eligible studies. Further screening for a reference list of articles was also done. The Microsoft Excel Spreadsheet was used to extract data, and Stata 17 was used for analysis. To check heterogeneity, the Higgs I2 and Cochran's Q tests were employed. Sensitivity and subgroup analysis were implemented. To detect publication bias, Egger's test and funnel plots were used. RESULTS The pooled prevalence of suicidal ideation and attempts among adult HIV/AIDS patients in Ethiopia was 20.3 with a 95% CI (14, 26.5) and 11.1 with a 95% CI (6.6, 15.5), respectively. Living alone (AOR 4.98; 95% CI: 2.96-8.37), having comorbidity or other opportunistic infection (AOR 4.67; 95% CI: 2.57-8.48), female sex (AOR 2.86; 95% CI: 1.76, 4.62), having WHO clinical stage III of HIV (AOR 3.69; 95% CI: 2.15, 6.32), having WHO clinical stage IV of HIV (AOR 5.43; 95% CI: 2.81, 10.53), having co-morbid depression (AOR 5.25; 95% CI: 4.05, 6.80), having perceived HIV stigma (AOR 2.53; 95% CI: 1.67, 3.84), and having family history of suicidal attempt (AOR 2.79; 95% CI: 1.38, 5.66) were significantly associated with suicidal ideation. Being female (AOR 4.33; 95% CI: 2.36, 7.96), having opportunistic infections (AOR 2.73; 95% CI: 1.69, 4.41), having WHO clinical stage III of HIV (AOR 3.78; 95% CI: 2.04, 7.03), having co-morbid depression (AOR 3.47; 95% CI: 2.38, 5.05), having poor social support (AOR 3.02; 95% CI: 1.78, 5.13), and having WHO clinical stage IV (AOR 7.39; 95% CI: 3.54, 15.41) were significantly associated with suicidal attempts. CONCLUSION The pooled magnitude of suicidal ideation and attempt was high, and factors like opportunistic infection, WHO clinical stage III of HIV, WHO clinical stage III of HIV, and co-morbid depression were related to both suicidal ideation and attempt. Clinicians should be geared towards this mental health problem in HIV patients during management.
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Affiliation(s)
- Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Zewdie
- Department of Public Health, Collage of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Tadele Derbew Kassie
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tadele Fentabil Anagaw
- Department of Health Promotion and Behavioral Science, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Elyas Melaku Mazengia
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sintayehu Shiferaw Gelaw
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behaviour, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Nguyen NT, Nguyen T, Vu GV, Truong N, Pham Y, Guevara Alvarez G, Armstrong-Hough M, Shelley D. Depression and associated factors among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam: a cross-sectional analysis. BMJ Open 2024; 14:e077015. [PMID: 38355191 PMCID: PMC10868293 DOI: 10.1136/bmjopen-2023-077015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES To assess the prevalence of depressive symptoms and associated factors among people living with HIV (PLWH) who were current cigarette smokers and receiving treatment at HIV outpatient clinics (OPCs) in Vietnam. DESIGN A cross-sectional survey of smokers living with HIV. SETTING The study was carried out in 13 HIV OPCs located in Ha Noi, Vietnam. PARTICIPANTS The study included 527 PLWH aged 18 and above who were smokers and were receiving treatment at HIV OPCs. OUTCOME MEASURES The study used the Centre for Epidemiology Scale for Depression to assess depressive symptoms. The associations between depressive symptoms, tobacco dependence and other characteristics were explored using bivariate and Poisson regression analyses. RESULTS The prevalence of depressive symptoms among smokers living with HIV was 38.3%. HIV-positive smokers who were female (prevalence ratio, PR 1.51, 95% CI 1.02 to 2.22), unmarried (PR 2.06, 95% CI 1.54 to 2.76), had a higher level of tobacco dependence (PR 1.06, 95% CI 1.01 to 1.11) and reported their health as fair or poor (PR 1.66, 95% CI 1.22 to 2.26) were more likely to have depression symptoms compared with HIV-positive smokers who were male, married, had a lower level of tobacco dependence and self-reported their health as good, very good or excellent. CONCLUSION The prevalence of depressive symptoms among smokers receiving HIV care at HIV OPCs was high. Both depression and tobacco use screening and treatment should be included as part of ongoing care treatment plans at HIV OPCs.
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Affiliation(s)
| | - Trang Nguyen
- Institute of Social and Medical Studies, Ha Noi, Vietnam
| | | | - Nga Truong
- Institute of Social and Medical Studies, Ha Noi, Vietnam
| | - Yen Pham
- Institute of Social and Medical Studies, Ha Noi, Vietnam
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Adedeji WA, Ma Q, Raji AM, Cha R, Rasaki OM, Hutson A, Taiwo BO, Charurat ME, Yusuf OB, Fehintola FA, Gureje O, Morse GD. Prevalence of depression among people living with HIV in rural hospitals in South-Western Nigeria-Association with clinico-demographic factors. AIDS Res Ther 2023; 20:89. [PMID: 38104102 PMCID: PMC10725593 DOI: 10.1186/s12981-023-00586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023] Open
Abstract
Major depression is the most common neuropsychiatric disorder among people living with HIV (PLWH) and is predictive of high morbidity and mortality among them. This study estimated the prevalence and explored factors associated with depression among PLWH in two rural secondary health facilities providing anti-retroviral therapy (ART) services in Southwestern Nigeria between September and December 2020. The Patient Health Questionnaire-9 (PHQ-9) was used to screen and identify PLWH aged 18 years or older with depression. Descriptive statistics, bivariate and multivariate analyses were performed with SPSS version 23. A total of 172 respondents were screened. The prevalence of depression was 16.3% (95% CI 11.1%, 22.7%). Mild, moderate, and moderately severe depression was identified in 17 (9.9%), 8(4.7%) and 3(1.7%) of the participants, respectively. One (0.6%) respondent had suicidal ideation. Of PLWH with any depression, 20/28(71.4%) were within the 40-59 years of age range. None of the participants was on antidepressants. The factor most associated with depression was hypertension, with adjusted odd ratios of 9.8(95% CI 3.5-27.3, p < 0.0001). The study highlights the importance of screening for the severity of depression among PLWH in rural hospitals providing ART services in Africa. PLWH with comorbid hypertension were more likely to suffer from some form of depression.
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Affiliation(s)
- Waheed Adeola Adedeji
- Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria.
| | - Qing Ma
- Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Abiodun Muhammed Raji
- Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan, Nigeria
| | - Raymond Cha
- Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Alan Hutson
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Babafemi O Taiwo
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Man E Charurat
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Oyindamola B Yusuf
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Fatai Adewale Fehintola
- Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Gene D Morse
- Center for Integrated Global Biomedical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
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Réus GZ, Manosso LM, Quevedo J, Carvalho AF. Major depressive disorder as a neuro-immune disorder: Origin, mechanisms, and therapeutic opportunities. Neurosci Biobehav Rev 2023; 155:105425. [PMID: 37852343 DOI: 10.1016/j.neubiorev.2023.105425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/16/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023]
Abstract
Notwithstanding advances in understanding the pathophysiology of major depressive disorder (MDD), no single mechanism can explain all facets of this disorder. An expanding body of evidence indicates a putative role for the inflammatory response. Several meta-analyses showed an increase in systemic peripheral inflammatory markers in individuals with MDD. Numerous conditions and circumstances in the modern world may promote chronic systemic inflammation through mechanisms, including alterations in the gut microbiota. Peripheral cytokines may reach the brain and contribute to neuroinflammation through cellular, humoral, and neural pathways. On the other hand, antidepressant drugs may decrease peripheral levels of inflammatory markers. Anti-inflammatory drugs and nutritional strategies that reduce inflammation also could improve depressive symptoms. The present study provides a critical review of recent advances in the role of inflammation in the pathophysiology of MDD. Furthermore, this review discusses the role of glial cells and the main drivers of changes associated with neuroinflammation. Finally, we highlight possible novel neurotherapeutic targets for MDD that could exert antidepressant effects by modulating inflammation.
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Affiliation(s)
- Gislaine Z Réus
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
| | - Luana M Manosso
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - João Quevedo
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil; Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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Alum EU, Obeagu EI, Ugwu OP, Samson AO, Adepoju AO, Amusa MO. Inclusion of nutritional counseling and mental health services in HIV/AIDS management: A paradigm shift. Medicine (Baltimore) 2023; 102:e35673. [PMID: 37832059 PMCID: PMC10578718 DOI: 10.1097/md.0000000000035673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection is a public health challenge that can degenerate into acquired immunodeficiency syndrome (AIDS) if not properly managed. HIV infection shortens life expectancy to about 5 to 10 years compared to noninfected individuals. People living with HIV/AIDS (PLWHA) are prone to several health challenges as a result of a deranged immune system culminating in high morbidity and mortality. Depression is a common feature of PLWHA. Depression heightens the emergence of opportunistic infections in HIV-infected individuals, accelerates the progression to AIDS, and increased suicidal tendencies, morbidity, and mortality. Food insecurity with its resultant undernutrition contributes to HIV/AIDS-related deaths. Undernourished PLWHA are more prone to opportunistic infections due to poor immunity. Interestingly, proper diet intake can boost immunity, slow the progression of AIDS and opportunistic infections, enhance body weight, and retard depression tendencies. Undernutrition can also be ameliorated by incorporating nutritional counseling and oral nutrient supplementation in routine HIV/AIDS checkups. Therefore, to increase HIV/AIDS management outcomes, the integration of nutrition counseling, dietary supplements, and mental health services should be embraced. Thus, HIV/AIDS care centers should amplify these services. In this article, we isolated relevant studies from various databases, illuminated the interwoven relationship between HIV/AIDS, depression, and undernutrition, and also reemphasized the need for adequate nutritional intervention in the battle against HIV/AIDS. Thus, this study provides a reawakening call to focus on incorporating nutritional guides and mental health care in HIV/AIDS management protocols.
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Affiliation(s)
- Esther U. Alum
- Department of Publications and Extension, Kampala International University, Kampala, Uganda
- Department of Biochemistry, Faculty of Science, Ebonyi State University, Ebonyi State, Nigeria
| | | | - Okechukwu P.C. Ugwu
- Department of Publications and Extension, Kampala International University, Kampala, Uganda
| | | | | | - Mariam O. Amusa
- Department of Botany and Plant Biotechnology, University of Johannesburg, Johannesburg, South Africa
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Chichetto NE, Gebru NM, Plankey MW, Tindle HA, Koethe JR, Hanna DB, Shoptaw S, Jones DL, Lazar JM, Kizer JR, Cohen MH, Haberlen SA, Adimora AA, Lahiri CD, Wise JM, Freiberg MS. Syndemic trajectories of heavy drinking, smoking, and depressive symptoms are associated with mortality in women living with HIV in the United States from 1994 to 2017. Drug Alcohol Depend 2023; 249:110838. [PMID: 37352734 PMCID: PMC10726291 DOI: 10.1016/j.drugalcdep.2023.110838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Heavy drinking, smoking, and depression are common among people with HIV. Little is known about the co-occurring, synergistic effect of having two or more of these conditions long-term -a sustained syndemic - on mortality among women with HIV (WWH). METHODS Data from 3282 WWH of the Women's Interagency HIV Study from 1994 to 2017 were utilized. National Death Index review identified cause of death (n=616). Sustained syndemic phenotypes were based on membership in high-risk groups defined by group-based trajectory models of repeated self-reported alcohol use, smoking, and depressive symptoms and their co-occurrence. Cox proportional hazard models estimated associations of sustained syndemic phenotypes with all-cause, non-AIDS, and non-overdose mortality, adjusting for age, race/ethnicity, education, enrollment wave, illicit drug use, and time-varying HIV viral load and CD4+ T-cell count. RESULTS WWH were 58% Black and 26% Hispanic, with a mean baseline age of 36.7 years. Syndemic phenotypes included zero (45%, n=1463), heavy drinking only (1%, n=35), smoking only (28%, n=928), depressive symptoms only (9%, n=282), and 2+ trajectories (17%, n=574). Compared to zero trajectories, having 2+ trajectories was associated with 3.93 times greater all-cause mortality risk (95% CI 3.07, 5.04) after controlling for confounders and each high-risk trajectory alone. These findings persisted in sensitivity analyses, removing AIDS- and overdose-related mortalities. CONCLUSIONS Clustering of 2+ conditions of heavy drinking, smoking, and depression affected nearly one in five WWH and was associated with higher mortality than zero or one condition. Our findings underscore the need for coordinated screening and parsimonious treatment strategies for these co-occurring conditions.
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Affiliation(s)
| | | | | | - Hilary A Tindle
- Vanderbilt University Medical CenterNashville, TN37232, USA; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare SystemNashville, TN37212USA
| | - John R Koethe
- Vanderbilt University Medical CenterNashville, TN37232, USA
| | - David B Hanna
- Albert Einstein College of MedicineBronx, NY10461, USA
| | - Steven Shoptaw
- David Geffen School of Medicine at UCLA, Los Angeles, CA90095USA
| | - Deborah L Jones
- University of Miami Miller School of MedicineMiami, FL33136, USA
| | | | - Jorge R Kizer
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA94121USA
| | - Mardge H Cohen
- Stroger Hospital/Cook County Health and Hospitals SystemChicago, IL60612, USA
| | - Sabina A Haberlen
- Johns Hopkins Bloomberg School of Public HealthBaltimore, MD21205, USA
| | | | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory UniversityAtlanta, GA30322, USA
| | - Jenni M Wise
- University of Alabama at BirminghamBirmingham, AL35294, USA
| | - Matthew S Freiberg
- Vanderbilt University Medical CenterNashville, TN37232, USA; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare SystemNashville, TN37212USA
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Abbas Q, Nisa M, Khan MU, Anwar N, Aljhani S, Ramzan Z, Shahzadi M. Brief cognitive behavior therapy for stigmatization, depression, quality of life, social support and adherence to treatment among patients with HIV/AIDS: a randomized control trial. BMC Psychiatry 2023; 23:539. [PMID: 37491185 PMCID: PMC10367308 DOI: 10.1186/s12888-023-05013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE Individuals living with HIV/AIDs are at a high risk of many problems like depression, stigma, quality of life, decreased adherence to treatment, and lack of social support. The present study aimed to investigate the impact of brief-cognitive behavior therapy (B-CBT) on reducing depression and stigma and improving treatment adherence, quality of life, and social support among patients with HIV/AIDS attending antiretroviral therapy (ART). MATERIALS AND METHODS This randomized clinical trial was conducted at ART Clinic in the Tehsil Headquarters Hospital Shahkot Nankana Sahib from July 2021 to October 2021. After baseline screening, 126 patients met the eligibility criteria and 63 were allocated to the experimental group (EXPg = 63) and 63 to waitlist-control group (WLCg = 63). Participants' age range was from 20 to 55 years. Participants who were taking ART treatment were enrolled for the CBT treatment. Before this, all the participants completed a baseline assessment to ensure a level of severity and diagnosis. A total of eight CBT based therapeutic sessions were conducted individually with EXPg. To assess the outcomes among patients receiving ART, we used Demographic form, Patient health questionnaire, HIV stigma scale, General medication adherence scale, Multidimensional scale of perceived social support, and WHOQOL BREF scale. RESULTS Findings suggest that B-CBT significantly reduced the level of depression (i.e. F (1, 78) = 101.38, p < .000, η2 = .599), and social stigma (i.e. F (1, 78) = 208.47, p < .000, η2 = .787) among patients with HIV/AIDS. Furthermore, CBT substantially improved the level of adherence to treatment (i.e. F(1,78) = 24.75, p < .000, η2 = .503), social support (i.e. F (1, 78) = 128.33, p < .000, η2 = .606), and quality of life (i.e. F (1, 78) = 373.39, p < .000, η2 = .837) among patients with HIV/AIDS. Significant mean difference M(SD) on PHQ at post-analysis in the EXPg vs. WLCg was seen 1.22(0.47) vs. 2.30(0.68) and similarly, on MPSS at a post-analysis in the EXPg vs. WLCg 2.85(0.36) vs. 1.70(0.51) which indicates sound therapeutic outcomes. CONCLUSIONS Cognitive behavioral therapy effectively decreases the level of depression and stigma and enhances the level of social support, quality of life, and adherence to treatment among HIV/AIDS patients. It is concluded that cognitive behavior therapy is an effective treatment approach for patients with HIV/AIDS. TRIAL REGISTRATION Thai clinical trial registry (i.e. TCTR = TCTR20210702002 ).
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Affiliation(s)
- Qasir Abbas
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan.
| | - Mehru Nisa
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan
| | - Muhammad Umar Khan
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan
| | - Nida Anwar
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sumayah Aljhani
- Department of Psychiatry, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Zoobia Ramzan
- Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mafia Shahzadi
- Department of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Punjab, Pakistan
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Saxena SK, Sharma D, Kumar S, Puri B. Understanding HIV-associated neurocognitive and neurodegenerative disorders (neuroAIDS): enroute to achieve the 95-95-95 target and sustainable development goal for HIV/AIDS response. Virusdisease 2023; 34:165-171. [PMID: 37408553 PMCID: PMC10317939 DOI: 10.1007/s13337-023-00830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/07/2023] Open
Abstract
The world's sustained commitment to the HIV/AIDS response and to reaching the 2030 Sustainable Development Goal (SDG) of "ending AIDS" as a public health issue is indicated by the ambitious 95-95-95 targets for all relevant populations. Neurological conditions of AIDS (neuroAIDS) are the most significant and severe central nervous system complication associated with HIV infection in which viral antigens can enter in the brain by breaching the blood brain barrier and cause dementia, neuroinflammation and encephalopathy. The prevalence of neuroAIDS is 10-50% in people with advanced HIV disease, whereas 5-25% in people on ART. Currently, MRI, CT and other tools are used to diagnose the neuroAIDS/ HIV-associated dementia and antiretroviral therapy is widely used to treat the neuroAIDS. In spite of many advanced tools and pathogenesis of neuroAIDS, developing therapeutics remains a formidable challenge. Long acting cabotegravir type of therapeutics is an advanced stage of research which shows good results for the treatment of neuroAIDS. Therefore, here we are discussing the recent insights of the pathogenesis, possible therapeutics and current strategies and treatment to overcome the neuroAIDS.
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Affiliation(s)
- Shailendra K. Saxena
- Centre for Advanced Research (CFAR), Faculty of Medicine, King George’s Medical University (KGMU), Lucknow, 226003 India
- World Society for Virology (WSV), Northampton, Massachusetts USA
- The Indian Virological Society (IVS), New Delhi, India
| | - Deepak Sharma
- Centre for Advanced Research (CFAR), Faculty of Medicine, King George’s Medical University (KGMU), Lucknow, 226003 India
| | - Swatantra Kumar
- Centre for Advanced Research (CFAR), Faculty of Medicine, King George’s Medical University (KGMU), Lucknow, 226003 India
- World Society for Virology (WSV), Northampton, Massachusetts USA
| | - Bipin Puri
- Centre for Advanced Research (CFAR), Faculty of Medicine, King George’s Medical University (KGMU), Lucknow, 226003 India
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11
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Goodkin K, Evering TH, Anderson AM, Ragin A, Monaco CL, Gavegnano C, Avery RJ, Rourke SB, Cysique LA, Brew BJ. The comorbidity of depression and neurocognitive disorder in persons with HIV infection: call for investigation and treatment. Front Cell Neurosci 2023; 17:1130938. [PMID: 37206666 PMCID: PMC10190964 DOI: 10.3389/fncel.2023.1130938] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/07/2023] [Indexed: 05/21/2023] Open
Abstract
Depression and neurocognitive disorder continue to be the major neuropsychiatric disorders affecting persons with HIV (PWH). The prevalence of major depressive disorder is two to fourfold higher among PWH than the general population (∼6.7%). Prevalence estimates of neurocognitive disorder among PWH range from 25 to over 47% - depending upon the definition used (which is currently evolving), the size of the test battery employed, and the demographic and HIV disease characteristics of the participants included, such as age range and sex distribution. Both major depressive disorder and neurocognitive disorder also result in substantial morbidity and premature mortality. However, though anticipated to be relatively common, the comorbidity of these two disorders in PWH has not been formally studied. This is partly due to the clinical overlap of the neurocognitive symptoms of these two disorders. Both also share neurobehavioral aspects - particularly apathy - as well as an increased risk for non-adherence to antiretroviral therapy. Shared pathophysiological mechanisms potentially explain these intersecting phenotypes, including neuroinflammatory, vascular, and microbiomic, as well as neuroendocrine/neurotransmitter dynamic mechanisms. Treatment of either disorder affects the other with respect to symptom reduction as well as medication toxicity. We present a unified model for the comorbidity based upon deficits in dopaminergic transmission that occur in both major depressive disorder and HIV-associated neurocognitive disorder. Specific treatments for the comorbidity that decrease neuroinflammation and/or restore associated deficits in dopaminergic transmission may be indicated and merit study.
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Affiliation(s)
- Karl Goodkin
- Department of Psychiatry, School of Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, United States
- Institute of Neuroscience, School of Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, United States
| | - Teresa H. Evering
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Albert M. Anderson
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Ann Ragin
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia L. Monaco
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Del Monte Institute of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Christina Gavegnano
- Department of Pathology, Emory School of Medicine, Emory University, Atlanta, GA, United States
- Department of Pharmacology, Emory School of Medicine, Emory University, Atlanta, GA, United States
- Department of Chemical Biology, Emory School of Medicine, Emory University, Atlanta, GA, United States
- Center for the Study of Human Health, Emory College of Arts and Sciences, Emory University, Atlanta, GA, United States
- Atlanta Veteran’s Affairs Medical Center, Atlanta, GA, United States
- Center for Bioethics, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Ryan J. Avery
- Division of Nuclear Medicine, Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sean B. Rourke
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lucette A. Cysique
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
| | - Bruce J. Brew
- Department of Neurology, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, Faculty of Medicine, University of Notre Dame, Sydney, NSW, Australia
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12
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Beltran-Najera I, Mustafa A, Warren D, Salling Z, Misiura M, Woods SP, Dotson VM. Elevated frequency and everyday functioning implications of vascular depression in persons with HIV disease. J Psychiatr Res 2023; 160:78-85. [PMID: 36780803 PMCID: PMC10123762 DOI: 10.1016/j.jpsychires.2023.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/24/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023]
Abstract
Depression and cardiovascular disease are common and associated with one another in HIV disease. This study aimed to determine the frequency and everyday functioning implications of the clinical syndrome of vascular depression among people living with HIV (PLWH). Participants in this cross-sectional study included 536 PLWH and 272 seronegative individuals who completed a biomedical and psychiatric research evaluation. Vascular depression was operationalized as the current presence of: 1) two or more vascular conditions; and 2) depression as determined by a normative elevation on the Depression/Dejection subscale of the Profile of Mood States or a diagnosis of Major Depressive Disorder per the Composite International Diagnostic Interview. Everyday functioning was measured by both self- and clinician-rated activities of daily living. A logistic regression model showed that HIV was associated with a three-fold increased risk of vascular depression, independent of potential confounding factors. A second logistic regression model within the PLWH sample showed that PLWH with vascular depression had significantly greater odds of dependence in everyday functioning as compared to PLWH with either vascular disease or depression alone. The elevated frequency of vascular depression in PLWH is consistent with the vascular depression hypothesis from the late-life depression literature. The high rate of functional dependence among PLWH with vascular depression highlights the clinical importance of prospective work on this syndrome in the context of HIV disease.
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Affiliation(s)
- Ilex Beltran-Najera
- Department of Psychology, University of Houston, 126 Heyne Bldg., Houston, TX, 77204, USA
| | - Andrea Mustafa
- Department of Psychology, University of Houston, 126 Heyne Bldg., Houston, TX, 77204, USA
| | - Desmond Warren
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302, USA
| | - Zach Salling
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302, USA
| | - Maria Misiura
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302, USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, 126 Heyne Bldg., Houston, TX, 77204, USA
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302, USA; Gerontology Institute, Georgia State University, P.O. Box 3984, Atlanta, GA, 30302, USA.
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13
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Rafiei S, Raoofi S, Pashazadeh Kan F, Masoumi M, Doustmehraban M, Biparva AJ, Ashari A, Vali N, Khani S, Abdollahi B, Vaziri Shahrebabak ESV, Heydari M, Momeni Z, Kasaie ZA, Beliad M, Ghashghaee A. Global prevalence of suicide in patients living with HIV/AIDS: A systematic review and meta-analysis. J Affect Disord 2023; 323:400-408. [PMID: 36455715 DOI: 10.1016/j.jad.2022.11.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/05/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In fact, people living with HIV are at a greater risk of mental health disorders. Based on lack of necessary information in this area the present systematic review and meta-analysis study was conducted to determine the magnitude of committed suicides among HIV/AIDS people as well as their associated factors in a global setting. METHOD Firstly we registered the protocol of study in PROSPRO. Then the publications were searched in the 4 main databases from January 2000 to April 2022. After removing duplication and inappropriate studies we applied inclusion and exclusion criteria. Finally 60 studies were included for analysis. Comprehensive meta-analysis software were used for analyzing. RESULTS After reviewing 60 articles published from January 2000 to April 2021 in 24 countries, the total prevalence rate of suicide among 61,904 patients was estimated at 0.249 (95 % CI, 0.2-0.306). Findings indicated that the highest suicide prevalence was related to single patients estimated at 0.257 (95 % CI, 0.184-0.347). A gender-based meta-analysis depicted that the prevalence of suicide/ suicidal ideation was higher among females estimated at 0.22 (95 % CI, 0.15-0.29) compared with men at 0.17 (95 % CI, 0.11-0.23). CONCLUSION Health planners and policymakers should develop suicide-prevention strategies aimed at female patients in younger age groups who live alone and are deprived of social support to effectively promote their self-efficacy in successful management of the disease. Integrating mental health services into anti-retroviral therapy for HIV/AIDS patients is also suggested in order to effectively design integrated programs for the management of individuals living with HIV/AIDS.
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Affiliation(s)
- Sima Rafiei
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Samira Raoofi
- Student Research Committee, Faculty of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran; Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Pashazadeh Kan
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Masoumi
- Clinical Research and Development Center, Qom University of Medical Sciences
| | - Maryam Doustmehraban
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Akbar Javan Biparva
- Student Research Committee, School of Health Management and Medical Informatics, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezou Ashari
- Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Negin Vali
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Saghar Khani
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahare Abdollahi
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohadeseh Heydari
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Momeni
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Zeynab Alsadat Kasaie
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ahmad Ghashghaee
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
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14
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Crowe M, Manuel J, Carlyle D, Lacey C. Experiences of psilocybin treatment for clinical conditions: A qualitative meta-synthesis. Int J Ment Health Nurs 2023. [PMID: 36779424 DOI: 10.1111/inm.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/14/2023]
Abstract
There is increasing clinical interest in the use of psilocybin. There is emerging evidence of the efficacy of psilocybin for the treatment of a range of clinical conditions. Mental health nurses have a unique set of skills for caring for people who are hallucinating. To expand these skills to meet the developing clinical interest in the therapeutic use of psilocybin, it is helpful to understand the experience from the perspective of the person being treated with psilocybin. A qualitative meta-synthesis was conducted to examine how those with psilocybin described their experiences to identify whether its effects are similar across different health conditions. Ten studies were included in the review. The health conditions studied were cancer, depression, HIV, substance use disorder, smoking cessation and trauma. The synthesis of findings identified three themes that were common across the studies despite the health condition: acceptance, connection and transformation. The review provides helpful insights into how people experience psilocybin and its effects on their health condition.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jenni Manuel
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Dave Carlyle
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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15
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Comparative efficacy and acceptability of non-pharmacological interventions for depression in people living with HIV: A systematic review and network meta-analysis. Int J Nurs Stud 2023; 140:104452. [PMID: 36821952 DOI: 10.1016/j.ijnurstu.2023.104452] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment for depression in people living with HIV has increasingly turned to non-pharmacological treatments due to the adverse reactions of pharmacotherapy. However, it remains unclear which non-pharmacological treatment is the most effective and acceptable for depression in people living with HIV. OBJECTIVE To compare and rank the efficacy and acceptability of different non-pharmacological treatments for depression in people living with HIV. DESIGN A systematic review and Bayesian network meta-analysis. METHODS We systematically searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, PsycArticles, CINAHL, ProQuest, OpenGrey, and international trial registers for published and unpublished studies from their inception to September 1, 2022, and searched key conference proceedings from January 1, 2020, to September 25, 2022. We searched for randomized controlled trials of any non-pharmacological treatments for depression in adults living with HIV (≥18 years old). Primary outcomes were efficacy (mean change scores in depression) and acceptability (all-cause discontinuation). We used a random-effects network meta-analysis model to synthesize all available evidence. The methodological quality of the included studies was assessed using the Cochrane Collaboration Risk of Bias Tool. We registered this study in PROSPERO, number CRD42021244230. RESULTS A total of 53 randomized controlled trials were included in this network meta-analysis involving seven non-pharmacological treatments for depression in people living with HIV. For efficacy, mind-body therapy, interpersonal psychotherapy, cognitive-behavioral therapy, supportive therapy, and education were significantly more effective than most control conditions (standardized mean differences ranged from -0.96 to -0.36). Rankings probabilities indicated that mind-body therapy (79%), interpersonal psychotherapy (71%), cognitive-behavioral therapy (62%), supportive therapy (57%), and education (57%) might be the top five most significantly effective treatments for depression in people living with HIV, in that order. For acceptability, only supportive therapy and interpersonal psychotherapy were significantly less acceptable than most control conditions (odds ratios ranged from 1.92 to 3.43). Rankings probabilities indicated that education might be the most acceptable treatment for people living with HIV (66%), while supportive therapy (26%) and interpersonal psychotherapy (10%) might rank the worst. The GRADE assessment results suggested that most results were rated as "moderate" to "very low" for the confidence of evidence. CONCLUSIONS Our study confirmed the efficacy and acceptability of several non-pharmacological treatments for depression in people living with HIV. These results should inform future guidelines and clinical decisions for depression treatment in people living with HIV.
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16
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Tibebu NS, Kassie BA, Anteneh TA, Rade BK. Depression, anxiety and stress among HIV-positive pregnant women in Ethiopia during the COVID-19 pandemic. Trans R Soc Trop Med Hyg 2022; 117:317-325. [PMID: 36579933 DOI: 10.1093/trstmh/trac126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 09/19/2022] [Accepted: 12/13/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Assessing the maternal mental health status during the coronavirus disease 2019 (COVID-19) pandemic is necessary to prevent the occurrence of severe mental disorders. Prenatal depression, anxiety and stress disorders are prominent in pregnant women living with human immunodeficiency virus (HIV) and highly associated with poor maternal and neonatal outcomes. Therefore this study aimed to assess the level of depression, anxiety, and stress among HIV-positive pregnant women in Ethiopia during the COVID-19 pandemic. METHODS An institution-based cross-sectional study was conducted in Amhara region referral hospitals from 17 October 2020 to 1 March 2021. A systematic random sampling technique was used to select 423 eligible women. A structured, pretested and interviewer-administered questionnaire was employed to collect the data. A multivariable logistic regression analysis was implemented to identify factors associated with women's depression, anxiety and stress. Statistical association was certain based on the adjusted odds ratio (AOR) with its 95% confidence interval (CI) and p-values ≤0.05. RESULTS Prenatal depression, anxiety and stress among HIV-positive pregnant women were 37.6% (95% CI 33 to 42.3), 42.1 (95% CI 37.7 to 46.7) and 34.8% (95% CI 30.3 to 39.2), respectively. Having an HIV-negative sexual partner (AOR 1.91 [95% CI 1.16 to 3.15]) and being on antiretroviral therapy >1 year (AOR 2.18 [95% CI 1.41 to 3.36]) were found to be statistically significant with women's antenatal depression, while unplanned pregnancy (AOR 1.09 [95% CI 1.02 to 2.33]) and did not discuss with the sexual partner about HIV (AOR 3.21 [95% CI 2.12 to 7.07]) were the factors associated with prenatal anxiety. CONCLUSIONS In this study, more than one in three HIV-positive pregnant women had depression and anxiety. Thus, implementing strategies to prevent unplanned pregnancy and advocating open discussion with sexual partners about HIV will play a large role in reducing pregnancy-related depression and anxiety.
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Affiliation(s)
- Nebiyu Solomon Tibebu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Ayanaw Kassie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tazeb Alemu Anteneh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bayew Kelkay Rade
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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17
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Kagee A, Saal W. Persistent depressive disorder among persons receiving an HIV test: an understudied phenomenon. AIDS Care 2022; 34:1530-1533. [PMID: 35914113 DOI: 10.1080/09540121.2022.2105797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Persistent depressive disorder is under-studied in HIV settings. We recruited 500 persons seeking an HIV test in South Africa and administered the major depression and persistent depression modules of the Structured Clinical Interview for the DSM-5, the Beck Depression Inventory (BDI), Beck Anxiety Inventory, Alcohol Use and Drug Use Disorders Identification Tests and the PTSD Symptom Scale. Of the total sample, 7.2% met the criteria for persistent depression and 14.4% had major depression; 3.6% had both Major Depression and Persistent Depression; 3.6% had Persistent Depression and no Major Depression; 10.8% had Major Depression and no Persistent Depression; and 82.0% had neither Major Depression nor Persistent Depression. We found a significant relationship between major and persistent depression (X2 (1, N = 500) = 39.89; p < .00; 95% CI). Persons with PDD were over 7 times more likely to have major depression than those without PDD (OR = 7.59; 95% CI: 3.72-15.48). Income level and BDI scores were significant predictors of persistent depression (p < 0.05), but not anxiety, traumatisation, and harmful alcohol and drug use. Many people may experience diagnosable mood disturbance prior to receipt of their HIV test results, suggesting the need to integrate mental health services with HIV testing.
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Affiliation(s)
- Ashraf Kagee
- Stellenbosch University, Stellenbosch, South Africa
| | - Wylene Saal
- Stellenbosch University, Stellenbosch, South Africa
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18
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Can a linking crosswalk table be applied to a different population? An independent validation study for a crosswalk between BSI depression and PROMIS depression scales. PLoS One 2022; 17:e0278232. [PMID: 36441806 PMCID: PMC9704687 DOI: 10.1371/journal.pone.0278232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022] Open
Abstract
A linking procedure establishes a "bridge" between the scores from different patient-reported outcome (PRO) instruments that measure similar constructs. After developing a linking relationship however, it is critical to evaluate whether this relationship can be generalized to different groups. Our study aims to validate a published crosswalk for score conversion between the Brief Symptom Inventory Depression subscale and the Patient-Reported Outcomes Measurement Information System Depression 8a using an independent sample. Data were from a sample of young men who have sex with men (MSM), which differs in terms of participant age, race, and ethnicity from the sample used to develop the existing crosswalk. The validity of the newly derived crosswalk was evaluated in terms of the correlation, mean difference and standard deviation between the observed and the linked scores. The two crosswalks were further compared to evaluate if the difference was within an acceptable range. More than half of the item parameters obtained from the two samples were found to overlap in their confidence intervals. Differences between each pair of scores in the two crosswalks was within three T-score points, well within the range of each crosswalk score's standard error. This study concludes that an existing crosswalk is replicable on a sample that differs from that used for crosswalk development, but future research should continue to examine the generalizability of the linked parameters and evaluate the reproducibility of this crosswalk to other populations.
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19
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Benfante A, Romeo A. Alexithymia Among People Living with HIV: A Scoping Review. AIDS Behav 2022; 27:1926-1941. [PMID: 36367612 DOI: 10.1007/s10461-022-03926-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
The present scoping review aimed to identify studies that investigated alexithymia, defined as a difficulty in identifying and describing one's own emotions, in people living with HIV (PLWH).A literature search, in line with the guidelines of PRISMA-ScR, was conducted in the following bibliographic databases: PubMed, PsycINFO, and Web of Science. The databases were queried using the following strings (using Boolean operators): ("alexithymia" OR "alexithymic") AND ("HIV" OR "Human Immunodeficiency Virus"). In line with the eligibility criteria, fourteen articles were found.Ten studies showed the involvement of alexithymia in disease severity (e.g., viral load levels), and adherence to antiretroviral therapy. Three studies revealed an association between alexithymia and cardiovascular disease, and three studies highlighted the implication of alexithymia in cognitive impairment.This review revealed the complex role of alexithymia in HIV disease. A careful clinical assessment of the emotional regulation process of PLWH can provide useful prognostic information.
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Affiliation(s)
- Agata Benfante
- Department of Psychology, University of Turin, Via Verdi 10, 10124, Turin, Italy
| | - Annunziata Romeo
- Department of Psychology, University of Turin, Via Verdi 10, 10124, Turin, Italy.
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20
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Mudra Rakshasa-Loots A, Whalley HC, Vera JH, Cox SR. Neuroinflammation in HIV-associated depression: evidence and future perspectives. Mol Psychiatry 2022; 27:3619-3632. [PMID: 35618889 PMCID: PMC9708589 DOI: 10.1038/s41380-022-01619-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 02/08/2023]
Abstract
People living with HIV face a high risk of mental illness, especially depression. We do not yet know the precise neurobiological mechanisms underlying HIV-associated depression. Depression severity in the general population has been linked to acute and chronic markers of systemic inflammation. Given the associations between depression and peripheral inflammation, and since HIV infection in the brain elicits a neuroinflammatory response, it is possible that neuroinflammation contributes to the high prevalence of depression amongst people living with HIV. The purpose of this review was to synthesise existing evidence for associations between inflammation, depression, and HIV. While there is strong evidence for independent associations between these three conditions, few preclinical or clinical studies have attempted to characterise their interrelationship, representing a major gap in the literature. This review identifies key areas of debate in the field and offers perspectives for future investigations of the pathophysiology of HIV-associated depression. Reproducing findings across diverse populations will be crucial in obtaining robust and generalisable results to elucidate the precise role of neuroinflammation in this pathophysiology.
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Affiliation(s)
- Arish Mudra Rakshasa-Loots
- Edinburgh Neuroscience, School of Biomedical Sciences, The University of Edinburgh, Edinburgh, UK.
- Lothian Birth Cohorts Group, Department of Psychology, The University of Edinburgh, Edinburgh, UK.
| | - Heather C Whalley
- Division of Psychiatry, Centre for Clinical Brain Sciences, Royal Edinburgh Hospital, The University of Edinburgh, Edinburgh, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Simon R Cox
- Lothian Birth Cohorts Group, Department of Psychology, The University of Edinburgh, Edinburgh, UK
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21
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Desalegn SY, Asaye MM, Temesgan WZ, Badi MB. Antenatal depression and associated factors among HIV-positive pregnant women in South Gondar zone public health facilities, northwest Ethiopia, a cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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22
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Perry EW, Culbreth R, Self-Brown S, Gilmore AK, Kasirye R, Musuya T, Ndetei D, Swahn MH. Violence Exposure, Self-Reported Mental Health Concerns and Use of Alcohol and Drugs for Coping among Youth in the Slums of Kampala, Uganda. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022; 53:83-110. [PMID: 38577222 PMCID: PMC10989775 DOI: 10.1080/00207411.2022.2073755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to a) compute the prevalence of violence exposure types, polyvictimization, and self-reported depression, anxiety, and using substances to cope among youth ages 12 to 18 years living on the streets or in the slums of Kampala, Uganda, (b) examine the independent associations among orphan status, violence exposure types, and self-reported mental health concerns, and c) explore the association between polyvictimization and mental health concerns. Data are from a 2014 cross-sectional survey of service-seeking youth ages 12 to 18 years (N = 1134) in Kampala, Uganda. Violence exposure types explored in this study were: witnessing family physical violence, direct physical abuse by a parent, any rape history, and physical dating violence. We used descriptive statistics and multivariable logistic regression to test study objectives. Over half of the sample (60.5%) reported experiencing at least one type of violence exposure; many youth endorsed self-reported depression (57.8%), anxiety (76.8%), and substance use to cope (37.0%). Exposure to violence was associated with higher odds for self-reported depression, anxiety, and using substances to cope. These findings underscore the urgent need to implement evidence-based interventions among this young, underserved population and their families to prevent violence, improve mental health outcomes, and promote resilience.
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Affiliation(s)
| | - Rachel Culbreth
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA USA
| | | | - Amanda K Gilmore
- School of Public Health, National Center for Sexual Violence Prevention, Georgia State University, Atlanta, GA USA
| | | | - Tina Musuya
- Center for Domestic Violence Prevention, Kampala, Uganda
| | - David Ndetei
- Department of Psychiatry, University of Nairobi, Africa Mental Health Foundation, Nairobi, Kenya
| | - Monica H Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA USA, School of Public Health, Georgia State University, Atlanta, GA USA
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Qu S, Wang A, Wang X, Yang Y, Pan X, Zhang T. Health-Related Quality of Life of HIV-Positive and HIV-Negative Pregnant Women in an Impoverished Area: Cross-sectional Study. JMIR Public Health Surveill 2022; 8:e29906. [PMID: 35380543 PMCID: PMC9019641 DOI: 10.2196/29906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/13/2021] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Liangshan prefecture of Sichuan province was an impoverished mountainous area in China, where the annual number of HIV-positive pregnant women accounted for approximately 10% of China’s total population in the decades before 2020. In general, pregnant women living here are likely to be physically and mentally different from those in other places. Objective This study aims to explore the health-related quality of life (HRQoL) of pregnant women living with HIV in an impoverished area. Methods From December 2018 to January 2019, HIV-positive and HIV-negative parturients within 18 months after delivery were recruited in Liangshan Prefecture, Sichuan Province. Questionnaires were designed to collect their demographic data, while the EuroQol 5-Dimension, 3-Level questionnaire was used to measure their HRQoL when they were in the second trimester from 4 to 6 months of pregnancy, and their quantitative health scores were converted to corresponding healthy utility values by using the Chinese Utility Value Integral System (time trade-off coefficient). Results A total of 250 pregnant women (133 HIV-positive and 117 HIV-negative) were enrolled in the study. Among them, 55 (41.35%) and 75 (64.10%) of HIV-positive and HIV-negative pregnant women self-reported full health (healthy state 11111), respectively. The median health utility value of the 250 pregnant women was 0.961 (IQR –0.046 to 0.961), and those of the HIV-positive and HIV-negative pregnant women were 0.875 (0.424-0.961) and 0.961 (IQR –0.046 to 0.961), respectively. We observed a significant difference only in the dimension of anxiety or depression between the two groups (P=.002) and no significant difference in the distribution of health utility indices between the two groups in terms of maternal age, education level, occupation, annual household income, prenatal care visits, family size, and medical insurance category. Multivariate ordinal logistic regression analysis showed that age (odds ratio [OR] 0.62, P<.05) and prenatal care visit (OR 0.29, P<.01) were independent risk factors for health status. Conclusions Most pregnant women self-reported satisfactory HRQoL in this impoverished mountainous area. HIV-negative pregnant women had an edge over HIV-positive pregnant women, and there were significant differences in anxiety or depression dimensions between the two groups.
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Affiliation(s)
- Shuiling Qu
- Chinese Center for Disease Control and Prevention, Beijing, China.,National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ailing Wang
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoyan Wang
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yehuan Yang
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoping Pan
- National Center for Women and Children's Health Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tong Zhang
- Capital Institute of Pediatrics, Beijing, China
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24
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Yen YF, Lai HH, Kuo YC, Chan SY, Chen LY, Chen CC, Wang TH, Wang CC, Chen M, Yen TF, Kuo LL, Kuo ST, Chuang PH. Association of depression and antidepressant therapy with antiretroviral therapy adherence and health-related quality of life in men who have sex with men. PLoS One 2022; 17:e0264503. [PMID: 35213633 PMCID: PMC8880848 DOI: 10.1371/journal.pone.0264503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
UNAIDS’ HIV treatment targets require that 90% of people living with HIV/AIDS (PLWHA) receiving antiretroviral treatment (ART) achieve viral suppression and 90% of people with viral suppression have good health-related quality of life (HRQOL). This study aimed to examine the association of depression and antidepressant therapy with ART adherence and HRQOL in HIV-infected men who have sex with men (MSM). From 2018 through 2020, HIV-infected MSMs were consecutively recruited (N = 565) for the evaluation of ART adherence and HRQOL at Taipei City Hospital HIV clinics. Non-adherence to ART was defined as a Medication Adherence Report Scale score of < 23. HRQOL in PLWHHA was evaluated using WHOQOL-BREF, Taiwan version. Overall, 14.0% had depression and 12.4% exhibited non-adherence to ART. The nonadherence proportion was 21.8% and 10.5% in depressed and nondepressed HIV-infected MSM, respectively. After adjusting for other covariates, depression was associated with a higher risk of nonadherence to ART (adjusted odds ratio = 2.02; 95% confidence interval: 1.02–4.00). Physical, psychological, social, and environmental HRQOL were significantly negatively associated with depression. Considering antidepressant therapy, ART nonadherence was significantly associated with depression without antidepressant therapy but not with antidepressant therapy. The depressed HIV-infected MSM without antidepressant therapy had worse psychological, social, and environmental HRQOL than those with antidepressant therapy. Our study suggests that depression is associated with poor ART adherence and HRQOL, particularly in those without antidepressant therapy. Adequate diagnosis and treatment of depression should be provided for PLWHA to improve their ART adherence and HRQOL.
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Affiliation(s)
- Yung-Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- * E-mail:
| | - Hsin-Hao Lai
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Chun Kuo
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Shang-Yih Chan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Department of Internal Medicine, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
| | - Lian-Yu Chen
- Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Teng-Ho Wang
- Section of Infectious Diseases, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Chien Chun Wang
- Section of Infectious Diseases, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Tsen-Fang Yen
- Department of Nursing, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Li-Lan Kuo
- Department of Nursing, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Shu-Ting Kuo
- Department of Nursing, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Pei-Hung Chuang
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
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25
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Boateng GO, Workman CL, Miller JD, Onono M, Neilands TB, Young SL. The syndemic effects of food insecurity, water insecurity, and HIV on depressive symptomatology among Kenyan women. Soc Sci Med 2022; 295:113043. [PMID: 32482382 PMCID: PMC8869838 DOI: 10.1016/j.socscimed.2020.113043] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/28/2020] [Accepted: 05/09/2020] [Indexed: 02/06/2023]
Abstract
Depression is a leading cause of disability worldwide and a major contributor to the overall global burden of disease, especially for women of childbearing age. Social science scholarship has demonstrated significant relationships between mental health, food insecurity (FI), water insecurity (WI), and HIV. Little is known, however, about the temporal relationships between food and water insecurity or the mechanisms through which these multiple stressors may operate or interact to impact depression. We therefore used syndemic theory to explore the complex relationships between FI, WI, and HIV on depressive symptomatology among Kenyan women of mixed HIV status (n=183, NCT02979418). We sought to 1) understand the temporal relationships between time-variant risk factors for depression, i.e. FI and WI, and 2) assess how these factors potentially interacted with HIV to impact depressive symptomatology. We first assessed the bidirectional relationship between WI and FI using a cross-lagged three-wave, two-variable panel model. Next, we modeled depressive symptomatology at 21 months as a linear function of the potentially syndemic interaction between FI, WI, and HIV status, adjusting for household wealth. WI had a predominant predictive effect on FI (Bayesian posterior predictive p-value=0.13); there was no reverse causality for the influence of FI on WI. The interaction effect of FI, WI, and HIV was significantly associated with greater depressive symptomatology (β=0.06) at 21 months postpartum. These data suggest that water insecurity may be an important determinant of food insecurity. Further, the co-occurrence of FI, WI, and HIV increases the likelihood of maternal depressive symptomatology, i.e. there is a syndemic relationship. These findings suggest that the role of household WI in other adverse health outcomes beyond mental well-being should be examined, and that interventions to improve mental health will be more effective if they also consider concurrent resource insecurities, regardless of HIV status.
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Affiliation(s)
- Godfred O Boateng
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, 76019, USA; Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | - Cassandra L Workman
- Department of Anthropology, University of North Carolina at Greensboro, Greensboro, NC, 27412, USA
| | - Joshua D Miller
- Department of Anthropology, Northwestern University, Evanston, IL, 60208, USA
| | | | - Torsten B Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Sera L Young
- Department of Anthropology & Global Health, Faculty Fellow, Institute for Policy Research, Northwestern University, Evanston, IL, 60208, USA.
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26
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Moseholm E, Aho I, Mellgren Å, Pedersen G, Katzenstein TL, Johansen IS, Bach D, Storgaard M, Weis N. Psychosocial health in pregnancy and postpartum among women living with - and without HIV and non-pregnant women living with HIV living in the Nordic countries - Results from a longitudinal survey study. BMC Pregnancy Childbirth 2022; 22:20. [PMID: 34996383 PMCID: PMC8740861 DOI: 10.1186/s12884-021-04357-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The success of antiretroviral therapy has normalized pregnancy among women living with HIV (WWH) with a very low risk of perinatal transmission of HIV. Despite these advances, WWH still face complex medical and psychosocial issues during pregnancy and postpartum. The aim of this study was to assess differences in psychosocial health outcomes between pregnant WWH, non-pregnant WWH, and pregnant women without HIV, and further identify factors associated with probable depression in the third trimester and postpartum. METHODS In a longitudinal survey study, participants were included from sites in Denmark, Finland, and Sweden during 2019-2020. Data was collected in the 3rd trimester, 3 and 6 months postpartum using standardized questionnaires assessing depression, perceived stress, loneliness, and social support. Mixed regression models were used to assess changes over time within and between groups. Logistic regression models were used to identify factors associated with depression in pregnancy and postpartum. RESULTS A total of 47 pregnant WWH, 75 non-pregnant WWH, and 147 pregnant women without HIV were included. The prevalence of depression was high among both pregnant and non-pregnant WWH. There was no significant difference between pregnant and non-pregnant WWH in depression scores, perceived stress scores, or social support scores at any time point. Compared to pregnant women without HIV, pregnant WWH reported worse outcomes on all psychosocial scales. Social support and loneliness were associated with an increased odds of depressive symptoms in the adjusted analysis. CONCLUSIONS A high burden of adverse psychosocial outcomes was observed in both pregnant and non-pregnant women living with HIV compared to pregnant women without HIV. Loneliness and inadequate social support were associated with increased odds of depression in pregnancy and should be a focus in future support interventions.
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Affiliation(s)
- Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Hvidovre, Denmark. .,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Inka Aho
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Åsa Mellgren
- Department of Infectious Diseases, Region Vestra Gotland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Diana Bach
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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27
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Relationship of the balloon analog risk task to neurocognitive impairment differs by HIV serostatus and history of major depressive disorder. J Neurovirol 2022; 28:248-264. [PMID: 34981438 PMCID: PMC9187559 DOI: 10.1007/s13365-021-01046-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/11/2021] [Accepted: 12/16/2021] [Indexed: 12/27/2022]
Abstract
HIV and major depressive disorder (MDD) commonly co-occur and are both linked to greater risk-taking behavior, possibly due to neurocognitive impairment (NCI). The present study examined the concordance of the Balloon Analog Risk Task (BART), a gold standard measure of risk-taking propensity, with NCI and real-world sexual risk behaviors in PWH with comorbid MDD. Participants included 259 adults, stratified by HIV serostatus (HIV + /HIV −) and lifetime MDD (MDD + /MDD −), who completed neuropsychological testing, the BART, and sexual risk behavior questionnaires. Logistic regression, stratified by HIV serostatus, examined joint effects of MDD and BART (linear and quadratic) on NCI. Follow-up linear regressions examined sexual risk behavior and neurocognitive domain T-scores as correlates of the BART. NCI prevalence was lowest in HIV − /MDD − , but BART scores did not differ by HIV/MDD status. In the HIV + group, BART performance predicted NCI such that high and low BART scores related to greater odds of NCI, but only in dual-risk HIV + /MDD + individuals. HIV + /MDD + individuals with both low and high BART scores exhibited poorer learning and recall, whereas processing speed and executive function were only poor in low BART risk-taking HIV + /MDD + . Higher BART scores linearly related to higher sexual risk behaviors only in MDD + individuals, independent of HIV serostatus. Low and high risk-taking on the BART may reflect discrete neurocognitive profiles in HIV + /MDD + individuals, with differential implications for real-world sexual risk behavior. HIV and comorbid MDD may disturb corticostriatal circuits responsible for integrating affective and neurocognitive components of decision-making, thereby contributing to risk-averse and risk-taking phenotypes.
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28
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Chen S, Hong H, Xu G. Prevalence and related factors of depressive symptoms among HIV/AIDS in Ningbo, China: A cross-sectional study. Front Psychiatry 2022; 13:1004318. [PMID: 36299546 PMCID: PMC9592111 DOI: 10.3389/fpsyt.2022.1004318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depressive symptoms were common among HIV/AIDS patients. Previous studies had shown that HIV-infected patients were twice as likely to be diagnosed with depression as the general population. However, only few studies have explored the prevalence and related factors of depressive symptoms among HIV/AIDS in China. MATERIALS AND METHODS A cross-sectional study was conducted to study the prevalence of depressive symptoms among HIV/AIDS from January to December 2021 through the database of HIV/AIDS antiretroviral therapy and psychological evaluation system in Ningbo, China. The Patient Health Questionnaire-2 (PHQ-2) was used to screen for depressive symptoms (PHQ-2 > 0), the Patient Health Questionnaire-9 (PHQ-9) was used to diagnose depressive symptoms, and multivariate Logistic regression model was carried on to evaluate the related factors. RESULTS A total of 3,939 HIV/AIDS patients were enrolled, and the age of initiation of antiretroviral therapy was 37.15 (IQR = 28.41-48.73) years. Among them, 3,230 (82.00%) were male, 3,844 (97.59%) were Han nationality, 1,391 (35.49%) were unmarried, 1,665 (42.27%) were homosexual transmission, and 2,194 (55.70%) were HIV-infected patients. There were 265 patients (6.73%) with depressive symptoms, and the proportion of mild, moderate, moderate and severe depressive symptoms was 4.01% (158/3939), 1.65% (65/3939), 0.76% (30/3939), and 0.30% (12/3939), respectively. Multivariate analysis showed that married [odds ratio (OR) = 0.675, 95% CI = 0.501-0.908], divorced or widowed (OR = 0.571, 95% CI = 0.380-0.860), homosexual transmission (OR = 1.793, 95% CI = 1.349-2.396) were associated with depressive symptoms among HIV/AIDS. CONCLUSION The prevalence of depressive symptoms among HIV/AIDS patients was 6.73% in Ningbo, China. More attention should be paid to the psychological status of unmarried and homosexual HIV/AIDS patients in Ningbo and timely psychological intervention or treatment should be given to those patients with depressive symptoms.
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Affiliation(s)
- Suting Chen
- School of Medicine, Ningbo University, Ningbo, China
| | - Hang Hong
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Guozhang Xu
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
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29
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Osborn L, Ronen K, Larsen AM, Richardson B, Khasimwa B, Chohan B, Matemo D, Unger J, Drake AL, Kinuthia J, John-Stewart G. Antenatal depressive symptoms in Kenyan women living with HIV: contributions of recent HIV diagnosis, stigma, and partner violence. AIDS Care 2022; 34:69-77. [PMID: 34579601 PMCID: PMC8758509 DOI: 10.1080/09540121.2021.1981216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Depression among pregnant women living with HIV (WLWH) in sub-Saharan Africa leads to poor pregnancy and HIV outcomes. This cross-sectional analysis utilized enrollment data from a randomized trial (Mobile WAChX, NCT02400671) in six Kenyan public maternal and child health clinics. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), stigma with the Stigma Scale for Chronic Illness, and intimate partner violence (IPV) with the Abuse Assessment Screen. Correlates of moderate-to-severe depressive symptoms ("depression", PHQ-9 score ≥10) were assessed using generalized estimating equation models clustered by facility. Among 824 pregnant WLWH, 9% had depression; these women had more recent HIV diagnosis than those without depression (median 0.4 vs. 2.0 years since diagnosis, p = .008). Depression was associated with HIV-related stigma (adjusted Prevalence Ratio [aPR]:2.36, p = .025), IPV (aPR:2.93, p = .002), and lower social support score (aPR:0.99, p = .023). Using population-attributable risk percent to estimate contributors to maternal depression, 81% were attributable to stigma (27%), recent diagnosis (24%), and IPV (20%). Integrating depression screening and treatment in prevention of mother-to-child HIV transmission programs may be beneficial, particularly in women recently diagnosed or reporting stigma and IPV.
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Affiliation(s)
| | | | | | | | | | - Bhavna Chohan
- University of Washington, Seattle, WA, USA,Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | - John Kinuthia
- Kenyatta National Hospital, Nairobi, Kenya,University of Nairobi, Nairobi, Kenya
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30
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Hong N, Park JS, Kim HJ. Synapto-protective effect of lithium on HIV-1 Tat-induced synapse loss in rat hippocampal cultures. Anim Cells Syst (Seoul) 2021; 26:1-9. [PMID: 35308128 PMCID: PMC8928815 DOI: 10.1080/19768354.2021.2018044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
Abstract
Human immunodeficiency virus type I (HIV-1) infection of the CNS produces synapse loss which correlates with cognitive decline in patients with HIV-associated neurocognitive disorders (HAND). Lithium is mood stabilizer of unknown mechanism used to treat bipolar disorder and is known to exhibit neuroprotective properties. Here, we studied the effects of lithium on HIV-1 Tat-induced synapses between rat hippocampal neurons. The number of synapses was quantified to detect clusters of the scaffold protein postsynaptic density 95 (PSD95) which is clustered at glutamatergic synapses on cultured rat hippocampal neurons in vitro. Lithium protected synapses from HIV-1 Tat-induced synapse loss and subsequent neuronal death. This synaptic protection was prevented by both the activation of NMDA receptor leading to intracellular signaling and the regulatory pathway of lithium including inositol depletion and glycogen synthase kinase-3β (GSK-3β). These results suggest that mood stabilizers might be effective drugs to treat neurodegenerative disorders including HAND.
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Affiliation(s)
- Namgue Hong
- Department of Physiology, College of Medicine, Dankook University, Cheonan, Republic of Korea
- Department of Medical Laser, Graduate School, Dankook University, Cheonan, Republic of Korea
- Medical Laser Research Center, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Jeong-Soo Park
- Department of Biochemistry, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Hee Jung Kim
- Department of Physiology, College of Medicine, Dankook University, Cheonan, Republic of Korea
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31
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Matt SM. Targeting neurotransmitter-mediated inflammatory mechanisms of psychiatric drugs to mitigate the double burden of multimorbidity and polypharmacy. Brain Behav Immun Health 2021; 18:100353. [PMID: 34647105 PMCID: PMC8495104 DOI: 10.1016/j.bbih.2021.100353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 12/12/2022] Open
Abstract
The increased incidence of multimorbidities and polypharmacy is a major concern, particularly in the growing aging population. While polypharmacy can be beneficial, in many cases it can be more harmful than no treatment, especially in individuals suffering from psychiatric disorders, who have elevated risks of multimorbidity and polypharmacy. Age-related chronic inflammation and immunopathologies might contribute to these increased risks in this population, but the optimal clinical management of drug-drug interactions and the neuro-immune mechanisms that are involved warrants further investigation. Given that neurotransmitter systems, which psychiatric medications predominantly act on, can influence the development of inflammation and the regulation of immune function, it is important to better understand these interactions to develop more successful strategies to manage these comorbidities and complicated polypharmacy. I propose that expanding upon research in translationally relevant human in vitro models, in tandem with other preclinical models, is critical to defining the neurotransmitter-mediated mechanisms by which psychiatric drugs alter immune function. This will define more precisely the interactions of psychiatric drugs and other immunomodulatory drugs, used in combination, enabling identification of novel targets to be translated into more efficacious diagnostic, preventive, and therapeutic interventions. This interdisciplinary approach will aid in better precision polypharmacy for combating adverse events associated with multimorbidity and polypharmacy in the future.
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Affiliation(s)
- Stephanie M. Matt
- Drexel University College of Medicine, Department of Pharmacology and Physiology, Philadelphia, PA, USA
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32
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Abstract
After participating in this activity, learners should be better able to:• Assess strategies for diagnosing depressive disorders in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)• Identify factors that contribute to the development of depressive disorders in HIV/AIDS• Evaluate strategies for managing depressive disorders in HIV/AIDS ABSTRACT: Depressive disorders and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are associated with major socioeconomic burdens. The negative impact of depressive disorders on HIV/AIDS is well known, including on treatment outcomes. Unfortunately, depressive disorders are underdiagnosed and undertreated in seropositive persons. This review summarizes clinically useful information on depressive disorders in HIV/AIDS. More specifically, we address assessment, differential diagnosis, contributing factors, management, and common challenges in the treatment of depressive disorders in seropositive individuals. Assessment and diagnosis of depression may be challenging in seropositive persons because of several biopsychosocial particularities associated with HIV/AIDS. One of the difficulties is the overlap between depression and HIV/AIDS symptoms, particularly in individuals with advanced AIDS, requiring consideration of a broad differential diagnosis. Several factors related to HIV/AIDS status contribute to the higher rates of depressive disorders, including infectious-immunological, psychosocial, and exogenous factors. The treatment of depressive disorders in HIV/AIDS involves three groups of interventions: (1) pharmacological interventions, (2) psychotherapeutic interventions, and (3) management of other contributing factors. Challenges in management include poor adherence to treatment and the risk of suicide. We provide evidence-based recommendations to improve assessment and management of depressive disorders in seropositive persons.
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Swahn MH, Culbreth R, Masyn KE, Salazar LF, Wagman J, Kasirye R. The Intersection of Alcohol Use, Gender Based Violence and HIV: Empirical Findings among Disadvantaged Service-Seeking Youth in Kampala, Uganda. AIDS Behav 2021; 25:3106-3114. [PMID: 33988783 PMCID: PMC8120497 DOI: 10.1007/s10461-021-03301-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
The SAVA syndemic is frequently used to describe the co-occurrence of HIV, gender-based violence (GBV), and substance use. In this study we determine the extent to which the typologies of the SAVA syndemic can be described and utilized for intervention strategies among youth living in the slums of Kampala, Uganda. We analyzed the “Kampala Youth Survey 2014,” a cross-sectional survey conducted in the spring of 2014, consisting of a convenience sample (N = 1134) of urban youth (12–18 years of age). Descriptive statistics were computed for hypothesized risk factors and demographic variables among the 8 typologies of GBV, HIV, and alcohol use. Multinomial logistic regression was conducted to determine statistically significant correlates with each typology. The overall prevalence of GBV was 31.7%, whereas the overall prevalence of alcohol use in the past 12 months was 31.2%. HIV-Positive youth comprised 10.5% of the total sample. Females comprised the majority of the typology with no SAVA components compared to males (55% vs. 45%, respectively), as well as the SAVA syndemic typology (GBV + HIV + ALC +) (58% vs. 42%, respectively). Engaging in commercial sex work (36%), witnessing parental abuse (61%), and depression/suicidality (81%) were all highly prevalent among youth in the SAVA syndemic typology (GBV, HIV, and alcohol use). Sex work and observing parental abuse were associated with the SAVA syndemic typology in the multivariable model. In our study, alcohol rarely coexisted without GBV among the typologies. Therefore, prevention efforts including structural interventions may be particularly warranted in vulnerable populations to address alcohol use, which may directly or indirectly impact GBV and HIV.
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Affiliation(s)
- Monica H. Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, 520 Parliament Garden Way, Kennesaw, GA 30144 USA
| | - Rachel Culbreth
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, P.O. Box 4019, Atlanta, GA 30302-4019 USA
| | - Katherine E. Masyn
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995 USA
| | - Laura F. Salazar
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995 USA
| | - Jennifer Wagman
- Fielding School of Public Health, University of California, P.O. Box 951772, Los Angeles, CA 90095-1772 USA
| | - Rogers Kasirye
- Uganda Youth Developmental Link, P.O. Box 12659, Kampala, Uganda, USA
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Lebanese People Living with HIV: Psychiatric Co-morbidities and Psycho-Social Environment. Community Ment Health J 2021; 57:1400-1408. [PMID: 34057660 DOI: 10.1007/s10597-021-00834-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/05/2021] [Indexed: 12/12/2022]
Abstract
Data are lacking on the psychiatric and psycho-social profiles of Middle-Eastern people living with HIV (PLHIV). Our study aimed to establish the prevalence and correlates of mental illness in a sample of Lebanese PLHIV, and to delineate their socio-cultural reality. PLHIV, either attending a private ID clinic or a non-governmental organization, were interviewed. A total of 94 patients were included. Sixty-nine (73.4%) were found to have at least one psychiatric disorder. Only nine participants were currently receiving psychotropic medications. The most common diagnosis was major depression, occurring in half of the subjects. Homosexual or bisexual orientation predicted the presence of a current depression (p = 0.024), and ART status was negatively associated with current depression (p = 0.028). The rate of psychiatric disorders is clearly higher than that of the general population. PLHIV with a homosexual or bisexual orientation face a double stigma, perhaps making them more vulnerable to depression. Our findings need to be replicated in larger studies with more representative samples.
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Lin RF, Cheng SH, Liu YP, Chen CP, Wang YJ, Chang SY. Predicting Emotional Valence of People Living with the Human Immunodeficiency Virus Using Daily Voice Clips: A Preliminary Study. Healthcare (Basel) 2021; 9:1148. [PMID: 34574921 PMCID: PMC8466484 DOI: 10.3390/healthcare9091148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
To detect depression in people living with the human immunodeficiency virus (PLHIV), this preliminary study developed an artificial intelligence (AI) model aimed at discriminating the emotional valence of PLHIV. Sixteen PLHIV recruited from the Taoyuan General Hospital, Ministry of Health and Welfare, participated in this study from 2019 to 2020. A self-developed mobile application (app) was installed on sixteen participants' mobile phones and recorded their daily voice clips and emotional valence values. After data preprocessing of the collected voice clips was conducted, an open-source software, openSMILE, was applied to extract 384 voice features. These features were then tested with statistical methods to screen critical modeling features. Several decision-tree models were built based on various data combinations to test the effectiveness of feature selection methods. The developed model performed very well for individuals who reported an adequate amount of data with widely distributed valence values. The effectiveness of feature selection methods, limitations of collected data, and future research were discussed.
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Affiliation(s)
- Ray F. Lin
- Department of Industrial Engineering and Management, Yuan Ze University, Taoyuan 32003, Taiwan; (R.F.L.); (Y.-J.W.)
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 33004, Taiwan; (S.-H.C.); (C.-P.C.); (S.-Y.C.)
- School of Public Health, Taipei Medical University, Taipei 110301, Taiwan
| | - Yung-Ping Liu
- Department of Industrial Engineering and Management, Chaoyang University of Technology, Taichung 413310, Taiwan
| | - Cheng-Pin Chen
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 33004, Taiwan; (S.-H.C.); (C.-P.C.); (S.-Y.C.)
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Yi-Jyun Wang
- Department of Industrial Engineering and Management, Yuan Ze University, Taoyuan 32003, Taiwan; (R.F.L.); (Y.-J.W.)
| | - Shu-Ying Chang
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 33004, Taiwan; (S.-H.C.); (C.-P.C.); (S.-Y.C.)
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Bronshteyn M, Yang FN, Shattuck KF, Dawson M, Kumar P, Moore DJ, Ellis RJ, Jiang X. Depression is associated with hippocampal volume loss in adults with HIV. Hum Brain Mapp 2021; 42:3750-3759. [PMID: 34089276 PMCID: PMC8288081 DOI: 10.1002/hbm.25451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/15/2021] [Accepted: 04/08/2021] [Indexed: 12/15/2022] Open
Abstract
Depressive symptoms are more prevalent in persons with HIV (PWH) than HIV-uninfected individuals. In HIV-uninfected individuals, depression has been associated with atrophy in the hippocampus and other brain regions. In the present study, we investigated the impact of depression on brain structure in PWH. One hundred PWH participated in a cross-sectional study (56.6 ± 6.4 yrs, range 41-70 yrs, 24 females, 63 African Americans). The Beck's Depression Inventory-II (BDI-II) was used to assess depressive symptoms. Structural MRI images were collected. Both the voxel-based morphometry (VBM) technique and a region of interest (ROI) based approach were used to examine the relationship between hippocampal gray matter volume (GMv) and depressive symptoms. The impact of HIV CD4 nadir and antidepressants was also investigated. Both VBM and ROI approaches revealed that higher BDI-II scores (implicating more severe depressive symptoms) were associated with loss of hippocampal GMv, especially in the right hippocampus and the right entorhinal cortex. Low CD4 nadir predicted additional hippocampal volume loss independent of depressive symptoms. Taking antidepressants did not have a detectable effect on hippocampal volume. In summary, having more depressive symptoms is associated with smaller hippocampal volume in PWH, and a history of severe immunosuppression (i.e., low CD4 nadir) correlates with additional hippocampal volume reduction. However, the impact of depression on hippocampal volume may be independent of HIV-disease severity such as low CD4 nadir.
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Affiliation(s)
- Margarita Bronshteyn
- Department of NeuroscienceGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Fan Nils Yang
- Department of NeuroscienceGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Kyle F. Shattuck
- Department of NeuroscienceGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Matthew Dawson
- Department of PsychiatryUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
| | - Princy Kumar
- Department of MedicineGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - David J. Moore
- Department of PsychiatryUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
| | - Ronald J. Ellis
- Department of PsychiatryUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
- Department of NeurosciencesUniversity of CaliforniaSan Diego, La JollaCaliforniaUSA
| | - Xiong Jiang
- Department of NeuroscienceGeorgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
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The pregnancy factor: the prevalence of depression among women living with HIV enrolled in the African Cohort Study (AFRICOS) by pregnancy status. Arch Womens Ment Health 2021; 24:649-658. [PMID: 33683462 DOI: 10.1007/s00737-021-01117-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
Among Sub-Saharan African women living with HIV (WLWH), pregnancy creates unique stressors that may cause depression. We describe the prevalence of depression among WLWH enrolled in the African Cohort Study (AFRICOS) by pregnancy status and describe factors associated with depression. WLWH < 45 years of age underwent six-monthly visits with depression diagnosed using the Center for Epidemiological Studies-Depression scale. Visits were categorized as "pregnant;" "postpartum" (the first visit made after the last pregnancy visit), and "non-pregnant." The prevalence of depression was calculated for each visit type and compared using prevalence odds ratios (POR) with 95% confidence intervals (CI). Logistic regression with generalized estimating equations was used to evaluate sociodemographic factors associated with depression. From January 2013 to March 1, 2020, 1333 WLWH were enrolled, and 214 had pregnancies during follow-up. As compared to the prevalence of depression during "non-pregnant" visits (9.1%), depression was less common at "pregnant" (6.3%; POR = 0.68 [CI: 0.42, 1.09]) and "postpartum" (3.4%; POR = 0.36 [CI: 0.17, 0.76]) visits. When controlling for other factors, the visit category was not independently associated with depression. Visit number, study site, employment status, and food security were independently associated with decreased odds of depression. We observed a lower prevalence of depression during pregnancy and the postpartum period than has been previously described among WLWH during similar time points. We observed protective factors against depression which highlight the impact that holistic and consistent health care at HIV-centered clinics may have on the well-being of WLWH in AFRICOS.
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Vader K, Carusone SC, Aubry R, Ahluwalia P, Murray C, Baxter L, Robinson G, Ibáñez-Carrasco F, Stewart A, Solomon P, O'Brien KK. Strengths and Challenges of Implementing Physiotherapy in an HIV Community-Based Care Setting: A Qualitative Study of Perspectives of People Living with HIV and Healthcare Providers. J Int Assoc Provid AIDS Care 2021; 20:23259582211005628. [PMID: 33779374 PMCID: PMC8010811 DOI: 10.1177/23259582211005628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The needs of people living with HIV (PLWH) who have access to antiretroviral therapy have shifted from hospital to community care; however, little is known about physiotherapy within HIV community-based care. Our aim was to understand strengths and challenges of implementing physiotherapy within an interprofessional HIV day health program in Toronto, Ontario, Canada. We conducted a qualitative descriptive study using semi-structured interviews. Data were analyzed using inductive content analysis. Fifteen PLWH and 5 healthcare providers participated. Strengths included improved access to physiotherapy and fulfilling an unmet need for rehabilitation; a tailored approach to physiotherapy; co-location improved communication, coordination, and engagement in care; and improved health outcomes for PLWH (i.e. function, psychosocial outcomes, and quality of life). Challenges related to managing expectations; variable attendance at visits; and managing complex and diverse needs of PLWH. Results may be transferable to other community-based care settings that provide care for PLWH and complex multi-morbidity.
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Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | | | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Ann Stewart
- St. Michael's Academic Family Health Team, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
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Parro-Torres C, Hernández-Huerta D, Ochoa-Mangado E, Pérez-Elías MJ, Baca-García E, Madoz-Gúrpide A. Antiretroviral treatment adherence and mental disorders: observational case-control study in people living with HIV in Spain. AIDS Care 2021; 34:1064-1072. [PMID: 34165358 DOI: 10.1080/09540121.2021.1944598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mental disorders hamper immunological control of HIV infection by exerting a negative influence on antiretroviral therapy (ART) adherence. We sought to address the possible relationship between non-adherence to antiretroviral treatment (ART), mental disorders and substance use in people living with HIV/AIDS (PLWHA) in Spain, which presents a high prevalence of intravenously transmitted HIV infection. We assessed 125 PLWHA attending regular outpatient follow-up. The main adherence measure was pill collection from the Hospital Pharmacy. We included sociodemographic variables, mental disorders diagnosis, and substance use in the 12 months prior to the assessment. Harmful alcohol consumption (OR: 6.834; 95% CI: 2.008-23.257; p = 0.002), suffering from depression (OR: 5.851; 95% CI: 1.470-23.283; p = 0.012) and being at risk of suicide (OR: 3.495; 95% CI: 1.136-10.757; p = 0.029) increased the likelihood of non-adherence. 29.6% of the sample had been infected via blood contact. HCV co-infection was present in 46.4% of the study sample, increasing the likelihood of non-adherence (OR: 3.223; 95% CI: 1.119-9.286; p = 0.030). Harmful alcohol use and some serious mental disorders (especially depression and suicide risk) are consistently associated with non-adherence to ART. HCV co-infection could be an important risk marker of non-adherence among PLWHA with a high prevalence of intravenous drug use.
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Affiliation(s)
- Carlos Parro-Torres
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Enriqueta Ochoa-Mangado
- Department of Psychiatry, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.,Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, Madrid, Spain
| | - María Jesús Pérez-Elías
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Enrique Baca-García
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain.,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain.,Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain.,Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, Nimes, France.,Department of Psychiatry, Madrid Autonomous University, Madrid, Spain.,CIBERSAM (Centro de Investigacion en Salud Mental), Carlos III Institute of Health, Madrid, Spain.,Department of Medicine, Universidad Catolica del Maule, Talca, Chile
| | - Agustín Madoz-Gúrpide
- Department of Psychiatry, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.,Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, Madrid, Spain
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40
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Trang K, Ly AT, Lam LX, Brown CA, To MQ, Sullivan PS, Worthman CM, Giang LM, Jovanovic T. Mental health in HIV prevention and care: A qualitative study of challenges and facilitators to integration in Vietnam. Soc Sci Med 2021; 279:113978. [PMID: 34000583 PMCID: PMC8684791 DOI: 10.1016/j.socscimed.2021.113978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Globally, men who have sex with men (MSM) experience a disproportionate burden of mental health issues. While HIV service providers may possess the skills and relationships to provision mental health and psychosocial support (MHPSS) to this population, task-sharing models that integrate MHPSS into HIV contexts remain limited. The aim of this study was to explore the sociodemographic, psychological, and structural factors operant at the client and HIV service provider levels that shape MHPSS access and burden among MSM and opportunities for integration in Vietnam. METHODS Between June and August 2018, semi-structured interviews were conducted with 20 MSM and 13 service providers at out-patient clinics (OPCs) and community-based organizations (CBOs) in Hanoi, Vietnam. Interviews explored participants' understandings of and experiences with the signs, causes, and appropriate treatments for mental health concerns; and perceived barriers to MHPSS integration in HIV contexts. Data were coded thematically and analyzed in MAXQDA. RESULTS Most MSM did not view their mental distress as constituting illness or as warranting clinical attention. Specifically, terms like "mental illness" were often associated with being "crazy" or immoral, while symptoms of distress were interpreted as having to do with everyday difficulties associated with being MSM and/or HIV-positive. Due to mental health stigma, MSM were reluctant to access services while service providers were similarly reluctant to query about needs. Few service providers knew where to refer patients for MHPSS, and none had done so previously. Most service providers reported lacking the human capital, expertise, and funding to address MHPSS needs. CONCLUSIONS Our findings suggest that aside from mental health stigma, future integration strategies must address competing demands and incentivization structures, limitations in existing mental health infrastructure and funding, misperceptions around MHPSS needs and symptoms, and opportunities to streamline MHPSS with existing CBO activities to strengthen community wellbeing.
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Affiliation(s)
- Kathy Trang
- Institute of Human Development and Social Change, New York University, New York, NY, United States.
| | - An Thanh Ly
- Australian Research Center in Sex, Health and Society, LaTrobe University, Melbourne, Australia; Department of Global Health, School of Preventive Medicine and Public Health, Hanoi Medical University, Viet Nam
| | - Le Xuan Lam
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Ha Noi, Viet Nam
| | - Carolyn A Brown
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Margaret Q To
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Carol M Worthman
- Department of Anthropology, Emory University, Atlanta, GA, United States
| | - Le Minh Giang
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Ha Noi, Viet Nam
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Wayne State, University, Detroit, MI, United States
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Kohn JN, Loop MS, Kim-Chang JJ, Garvie PA, Sleasman JW, Fischer B, Rendina HJ, Woods SP, Nichols SL, Hong S. Trajectories of Depressive Symptoms, Neurocognitive Function, and Viral Suppression With Antiretroviral Therapy Among Youth With HIV Over 36 months. J Acquir Immune Defic Syndr 2021; 87:851-859. [PMID: 33587499 PMCID: PMC8131211 DOI: 10.1097/qai.0000000000002653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/30/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Depression and neurocognitive impairment are highly prevalent among persons living with HIV and associated with poorer clinical outcomes; however, longitudinal studies of depression-neurocognition relationships in youth living with HIV (YLWH), and the role of antiretroviral therapy (ART), are lacking. This study tested whether (1) depressive symptomatology, across somatic, cognitive, and affective symptom domains, improved with ART and (2) more severe depressive symptoms at baseline were associated with poorer neurocognitive function and poorer HIV suppression. SETTING Data were collected from 181 YLWH (18-24 years) who were treatment-naive, a subset of whom (n = 116) initiated ART. METHODS Participants were categorized into elevated (DS) or nonelevated (non-DS) depressive symptom groups at entry (Beck Depression Inventory-II ≥14) and followed for 36 months. Neurocognition (5-domain battery) and depressive symptoms were repeatedly assessed. Longitudinal models examined depressive symptomatology, neurocognition, and odds of HIV nonsuppression by group. RESULTS Greater improvements in depressive symptoms were observed in the DS group over 36 months [beta = -0.14, (-0.24 to -0.03)], particularly within cognitive and affective domains. Verbal learning performance increased in the DS group [beta = 0.13, (0.01 to 0.24)], whereas psychomotor function improved somewhat in the non-DS group [beta = -0.10, (-0.22 to 0.00)]. Adjusted for ART adherence, odds of HIV nonsuppression did not significantly differ by group [odds ratio = 0.22, (0.04 to 1.23)]; however, greater somatic symptoms at study entry were associated with an increased risk of nonsuppression over time [odds ratio = 2.33 (1.07 to 5.68)]. CONCLUSION Depressive symptoms were associated with differential neurocognitive trajectories, and somatic depressive symptoms at baseline may predict poorer subsequent HIV suppression. Identifying and treating depressive symptoms at ART initiation may benefit neurocognitive and clinical outcomes in YLWH.
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Affiliation(s)
- Jordan N. Kohn
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Matthew Shane Loop
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Julie J. Kim-Chang
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | - John W. Sleasman
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Bernard Fischer
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | | | - Sharon L. Nichols
- Department of Neurosciences, University of California San Diego, La Jolla, CA
| | - Suzi Hong
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA
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Denton AR, Mactutus CF, Lateef AU, Harrod SB, Booze RM. Chronic SSRI treatment reverses HIV-1 protein-mediated synaptodendritic damage. J Neurovirol 2021; 27:403-421. [PMID: 34003469 PMCID: PMC8504184 DOI: 10.1007/s13365-021-00960-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/11/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
HIV-1 infection affects approximately 37 million individuals, and approximately 50% of seropositive individuals will develop symptoms of clinical depression and/or apathy. Dysfunctions of both serotonergic and dopaminergic neurotransmission have been implicated in the pathogenesis of motivational alterations. The present study evaluated the efficacy of a SSRI (escitalopram) in the HIV-1 transgenic (Tg) rat. Behavioral, neurochemical, and neuroanatomical outcomes with respect to HIV-1 and sex were evaluated to determine the efficacy of chronic escitalopram treatment. Escitalopram treatment restored function in each of the behavioral tasks that were sensitive to HIV-1-induced impairments. Further, escitalopram treatment restored HIV-1-mediated synaptodendritic damage in the nucleus accumbens; treatment with escitalopram significantly increased dendritic proliferation in HIV-1 Tg rats. However, restoration did not consistently occur with the neurochemical analysis in the HIV-1 rat. Taken together, these results suggest a role for SSRI therapies in repairing long-term HIV-1 protein-mediated neuronal damage and restoring function.
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Affiliation(s)
- Adam R Denton
- Behavioral Neuroscience Laboratory, Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Charles F Mactutus
- Behavioral Neuroscience Laboratory, Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Almeera U Lateef
- Behavioral Neuroscience Laboratory, Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Steven B Harrod
- Behavioral Neuroscience Laboratory, Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Rosemarie M Booze
- Behavioral Neuroscience Laboratory, Department of Psychology, University of South Carolina, Columbia, South Carolina, USA.
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43
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Valdelamar-Jiménez J, Lins-Kusterer L, de Jesus STG, Netto EM, Brites C. Comparison of Three Health-Related Quality of Life Instruments to Evaluate Symptoms of Depression in HIV Patients in Brazil. J Clin Psychol Med Settings 2021; 27:643-650. [PMID: 31456126 DOI: 10.1007/s10880-019-09657-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The evaluation of quality of life could be a useful indicator of depression in HIV patients. We compared the performance of three health-related quality of life (HRQoL) instruments for detecting depression. This nested case-control study included 200 HIV patients attended at an AIDS referral center. Depression was measured by Beck Depression Inventory (BDI). We accessed HRQoL by SF-36v2, HAT-QoL, and WHOQOL-HIV Bref. The depression diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curve analysis. SF-36v2 presented negative correlation with BDI score (- 0.72 to - 0.40), and HAT-QoL (- 0.66 to 0.05) and WHOQoL-HIV Bref (- 0.67 to 0.32) domains presented negative and positive correlations. Mental Health (r = - .71) and Mental Component Summary (r = - .72) showed high negative correlation with BDI. SF-36v2 showed excellent measure by the ROC curve analysis in four factors, and high correlation in Mental Health and MCS. Sf-36 may represent a useful tool for screening of depressive symptoms in HIV patients.
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Affiliation(s)
- Juliet Valdelamar-Jiménez
- LAPI - Infectious Diseases Research Laboratory, Edgard Santos Federal University Hospital, Rua Augusto Viana, S/n, Canela, Salvador, Bahia, CEP-40110060, Brazil
| | - Liliane Lins-Kusterer
- LAPI - Infectious Diseases Research Laboratory, Edgard Santos Federal University Hospital, Rua Augusto Viana, S/n, Canela, Salvador, Bahia, CEP-40110060, Brazil.
| | | | - Eduardo Martins Netto
- LAPI - Infectious Diseases Research Laboratory, Edgard Santos Federal University Hospital, Rua Augusto Viana, S/n, Canela, Salvador, Bahia, CEP-40110060, Brazil
| | - Carlos Brites
- LAPI - Infectious Diseases Research Laboratory, Edgard Santos Federal University Hospital, Rua Augusto Viana, S/n, Canela, Salvador, Bahia, CEP-40110060, Brazil
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Pampaka D, Pantavou K, Giallouros G, Pavlitina E, Williams LD, Piovani D, Bonovas S, Nikolopoulos GK. Mental Health and Perceived Access to Care among People Who Inject Drugs in Athens, Greece. J Clin Med 2021; 10:jcm10061181. [PMID: 33808991 PMCID: PMC8002050 DOI: 10.3390/jcm10061181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022] Open
Abstract
Poor mental health among human immunodeficiency virus (HIV)-positive people who inject drugs (PWID) may contribute to stigma, and together they act as barriers to medical care. This analysis aims to examine factors associated with the mental health of PWID and their network contacts, and the association of poor mental health with the experience of HIV-related stigmatizing events, with HIV-related social support, and with perceived access to care. Data were collected during the Transmission Reduction Intervention Project (TRIP) conducted in Athens, Greece (2013-2015). PWID (n = 292; n = 122 HIV-positive) were interviewed both at baseline and follow-up. Items of depression, anxiety, and general positive affect subscales of the Mental Health Inventory were used to explore the psychological distress and well-being of participants at follow-up. Items of the Access to Care Scale were used to evaluate perceived access to medical care at baseline and follow-up. Linear regression showed that unemployment was positively related to depression (β = 1.49, p = 0.019), while injecting drug use was a risk factor for a low general positive affect score (β = -3.21, p = 0.015). Poor mental health was not linked to HIV-related stigma or social support. Positive perception of access to care was associated in multivariable analyses with low depression (β = -0.22, p = 0.049). The perceived access to care score improved from baseline to follow-up (p = 0.019) and HIV-positive participants had a higher score than HIV-negative participants. Future interventions should include targets to improve the mental well-being of participants, reduce psychosocial distress, and minimize perceived barriers to accessing medical care.
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Affiliation(s)
- Despina Pampaka
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus;
| | - Katerina Pantavou
- Medical School, University of Cyprus, Nicosia 2029, Cyprus; (K.P.); (G.G.)
| | - George Giallouros
- Medical School, University of Cyprus, Nicosia 2029, Cyprus; (K.P.); (G.G.)
- Department of Business and Public Administration, University of Cyprus, Nicosia 1678, Cyprus
| | - Eirini Pavlitina
- Transmission Reduction Intervention Project, Athens Site, 11527 Athens, Greece;
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA;
- National Development and Research Institutes, New York, NY 10010, USA
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Georgios K. Nikolopoulos
- Medical School, University of Cyprus, Nicosia 2029, Cyprus; (K.P.); (G.G.)
- Correspondence: ; Tel.: +357-228-952-23
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Binagwaho A, Remera E, Bayingana AU, Gishoma D, Scott KW, Goosman M, Campbell E, Agbonyitor M, Kayiteshonga Y, Nsanzimana S. Addressing the mental health needs of children affected by HIV in Rwanda: validation of a rapid depression screening tool for children 7-14 years old. BMC Pediatr 2021; 21:59. [PMID: 33514343 PMCID: PMC7844907 DOI: 10.1186/s12887-020-02475-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/16/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Depression in children presents a significant health burden to society and often co-exists with chronic illnesses, such as human immunodeficiency virus (HIV). Research has demonstrated that 10-37% of children and adolescents living with HIV also suffer from depression. Low-and-middle income countries (LMICs) shoulder a disproportionate burden of HIV among other health challenges, but reliable estimates of co-morbid depression are lacking in these settings. Prior studies in Rwanda, a LMIC of 12 million people in East Africa, found that 25% of children living with HIV met criteria for depression. Though depression may negatively affect adherence to HIV treatment among children and adolescents, most LMICs fail to routinely screen children for mental health problems due to a shortage of trained health care providers. While some screening tools exist, they can be costly to implement in resource-constrained settings and are often lacking a contextual appropriateness. METHODS Relying on international guidelines for diagnosing depression, Rwandan health experts developed a freely available, open-access Child Depression Screening Tool (CDST). To validate this tool in Rwanda, a sample of 296 children with a known diagnosis of HIV between ages 7-14 years were recruited as study participants. In addition to completing the CDST, all participants were evaluated by a mental health professional using a structured clinical interview. The validity of the CDST was assessed in terms of sensitivity, specificity, and a receiver operating characteristic (ROC) curve. RESULTS This analysis found that depression continues to be a co-morbid condition among children living with HIV in Rwanda. For identifying these at-risk children, the CDST had a sensitivity of 88.1% and specificity of 96.5% in identifying risk for depression among children living with HIV at a cutoff score of 6 points. This corresponded with an area under the ROC curve of 92.3%. CONCLUSIONS This study provides evidence that the CDST is a valid tool for screening depression among children affected by HIV in a resource-constrained setting. As an open-access and freely available tool in LMICs, the CDST can allow any health practitioner to identify children at risk of depression and refer them in a timely manner to more specialized mental health services. Future work can show if and how this tool has the potential to be useful in screening depression in children suffering from other chronic illnesses.
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Affiliation(s)
- Agnes Binagwaho
- University of Global Health Equity, Kigali, Rwanda
- Harvard Medical School, Boston, MA, USA
- Dartmouth College Geisel School of Medicine, Hanover, NH, USA
| | - Eric Remera
- University of Global Health Equity, Kigali, Rwanda
- Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Darius Gishoma
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | | | | | | | | | - Sabin Nsanzimana
- University of Global Health Equity, Kigali, Rwanda
- Rwanda Biomedical Center, Kigali, Rwanda
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Necho M, Tsehay M, Zenebe Y. Suicidal ideation, attempt, and its associated factors among HIV/AIDS patients in Africa: a systematic review and meta-analysis study. Int J Ment Health Syst 2021; 15:13. [PMID: 33485362 PMCID: PMC7825170 DOI: 10.1186/s13033-021-00437-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/12/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Suicidal ideation and suicidal attempt are warning signs for and determine the prognosis of completed suicide. These suicidal behaviors are much more pronounced in people living with HIV/AIDS. Despite this, there is a scarcity of aggregate evidence in Africa. This study was therefore aimed to fill this gap. METHODS we extensively searched Psych-info, PubMed, Scopus, and EMBASE to obtain eligible studies. Further screening for a reference list of articles was also done. Meta XL package was used to extract data and the Stata-11 was also employed. Cochran's Q- and the Higgs I2 test were engaged to check heterogeneity. Sensitivity and subgroup analysis were implemented. Egger's test and funnel plots were used in detecting publication bias. RESULTS The pooled prevalence of suicidal ideation was 21.7% (95% CI 16.80, 26.63). The pooled prevalence of suicidal ideation in Ethiopia, Nigeria, Uganda, and South Africa was 22.7%, 25.3%, 9.8%, and 18.05% respectively. The pooled prevalence of suicidal ideation was larger; 27.7% in studies that used Composite International Diagnostic Interview (CIDI) than Mini-international Neuropsychiatric Interview (MINI); 16.96%. Moreover, the prevalence of suicidal ideation in studies with a sample size of < 400 was 23.42% whereas it was 18.3% in studies with a sample size ≥ of 400 participants. The pooled prevalence of suicidal attempts in this study was 11.06% (95% CI 6.21, 15.92). A suicidal attempt was higher in Ethiopia (16.97%) and Nigeria (16.20%) than Uganda (3.51%). This pooled prevalence of suicidal attempt was higher among studies that used a smaller sample (< 400 participants) (15.5%) than studies that used a larger sample size (≥ 400 participants) (8.4%). The pooled prevalence of suicidal attempt was 3.75%, and 16.97% in studies that used MINI and CIDI respectively. Our narrative synthesis revealed that advanced stages of AIDS, co-morbid depression, perceived HIV stigma, and poor social support was among the factors strongly associated with suicidal ideation and attempt. CONCLUSION The pooled magnitude of suicidal ideation and attempt was high and factors like advanced stages of AIDS, co-morbid depression, perceived stigma, and poor social support were related to it. Clinicians should be geared towards this mental health problem of HIV patients during management.
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Affiliation(s)
- Mogesie Necho
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Mekonnen Tsehay
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yosef Zenebe
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Abela IA, Scherrer AU, Böni J, Yerly S, Klimkait T, Perreau M, Hirsch HH, Furrer H, Calmy A, Schmid P, Cavassini M, Bernasconi E, Günthard HF. Emergence of Drug Resistance in the Swiss HIV Cohort Study Under Potent Antiretroviral Therapy Is Observed in Socially Disadvantaged Patients. Clin Infect Dis 2021; 70:297-303. [PMID: 30843028 DOI: 10.1093/cid/ciz178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/28/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The rate of acquired human immunodeficiency virus type 1 (HIV-1) drug resistance (ADR) has fallen dramatically since introduction of combined antiretroviral therapy (cART) in Switzerland. However, clinical experience indicates that there are still patients at risk of newly acquiring drug resistance despite having access to cART. Here, we characterized risk factors for ADR, to improve patient care and prevent emergence of drug resistance and treatment failure. METHODS We performed a case-control study to identify risk factors for ADR in all patients starting their first cART in the Swiss HIV Cohort Study (SHCS) since 1996. The SHCS is highly representative and includes >75% of patients receiving ART in Switzerland. To this end, we implemented a systematic medical chart review to obtain more detailed information on additional parameters, which are not routinely collected in the SHCS. The collected data were analyzed using univariable and multivariable conditional logistic regression. RESULTS We included in our study 115 cases and 115 matched controls. Unemployment (multivariable odds ratio [mOR], 2.9 [95% confidence interval {CI}, 1.3-6.4]; P = .008), African origin (mOR, 3.0 [95% CI, 1.0-9.2]; P = .047), comedication with anti-infectives (mOR, 3.7 [95% CI, 1.0-12.6]; P = .045), and symptoms of mental illness (mOR, 2.6 [95% CI, 1.2-5.5]; P = .012) were associated with ADR in the multivariable model. CONCLUSIONS Although ADR has become very rare with cART due to new potent therapies, patients in socially challenging life situations or presenting with mental health issues are at higher risk for drug resistance. Prompt identification and adequate support of these patients before ADR will prevent treatment failure and HIV-1 transmission.
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Affiliation(s)
- Irene A Abela
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich.,Institute of Medical Virology, University of Zurich
| | - Alexandra U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich.,Institute of Medical Virology, University of Zurich
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich
| | - Sabine Yerly
- Laboratory of Virology, Division of Infectious Diseases, Geneva University Hospitals
| | | | - Matthieu Perreau
- Division of Immunology and Allergy, University Hospital Lausanne
| | - Hans H Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern
| | - Alexandra Calmy
- HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospitals
| | - Patrick Schmid
- Division of Infectious Diseases, Cantonal Hospital St Gallen
| | | | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich.,Institute of Medical Virology, University of Zurich
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Cumulative Burden of Depression and Neurocognitive Decline Among Persons With HIV: A Longitudinal Study. J Acquir Immune Defic Syndr 2021; 84:304-312. [PMID: 32195746 DOI: 10.1097/qai.0000000000002346] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Higher cumulative burden of depression among people with HIV (PWH) is associated with poorer health outcomes; however, longitudinal relationships with neurocognition are unclear. This study examined hypotheses that among PWH, (1) higher cumulative burden of depression would relate to steeper declines in neurocognition, and (2) visit-to-visit depression severity would relate to fluctuations in neurocognition within persons. SETTING Data were collected at a university-based research center from 2002 to 2016. METHODS Participants included 448 PWH followed longitudinally. All participants had >1 visit (M = 4.97; SD = 3.53) capturing depression severity (Beck Depression Inventory-II) and neurocognition (comprehensive test battery). Cumulative burden of depression was calculated using an established method that derives weighted depression severity scores by time between visits and total time on study. Participants were categorized into low (67%), medium (15%), and high (18%) depression burden. Multilevel modeling examined between- and within-person associations between cumulative depression burden and neurocognition over time. RESULTS The high depression burden group demonstrated steeper global neurocognitive decline compared with the low depression burden group (b = -0.100, P = 0.001); this was driven by declines in executive functioning, delayed recall, and verbal fluency. Within-person results showed that compared with visits when participants reported minimal depressive symptoms, their neurocognition was worse when they reported mild (b = -0.12, P = 0.04) or moderate-to-severe (b = -0.15, P = 0.03) symptoms; this was driven by worsened motor skills and processing speed. CONCLUSIONS High cumulative burden of depression is associated with worsening neurocognition among PWH, which may relate to poor HIV-related treatment outcomes. Intensive interventions among severely depressed PWH may benefit physical, mental, and cognitive health.
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A Systematic Review and Meta-Analysis on Depression and Associated Factors among Adult HIV/AIDS-Positive Patients Attending ART Clinics of Ethiopia: 2021. DEPRESSION RESEARCH AND TREATMENT 2021; 2021:8545934. [PMID: 34721902 PMCID: PMC8550854 DOI: 10.1155/2021/8545934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/18/2021] [Accepted: 10/04/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Depression is the most common mental health problem in people living with the human immune virus. It ranges from 11% to 63% in low- and middle-income countries. Depression was high in people living with HIV/AIDS in developing countries, especially in the Ethiopian context. Even though depression has negative consequences on HIV-positive patients, the care given for depression in resource-limited countries like Ethiopia is below the standard in their HIV care programs. METHOD International databases (Google Scholar, PubMed, Hinari, Embase, and Scopus) and Ethiopian university repository online have been covered in this review. Data were extracted using Microsoft Excel and analyzed by using the Stata version 14 software program. We detected the heterogeneity between studies using the I 2 test. We checked publication bias using a funnel plot test. RESULTS The overall pooled depression prevalence among adult HIV/AIDS patients attending antiretroviral therapy in Ethiopia was 36.3% (95% CI: 28.4%, 44.2%) based on the random effect analysis. Adult HIV/AIDS patients having CD4count < 200(AOR = 5.1; 95% CI: 2.89, 8.99), widowed marital status (AOR = 3.7; 95% CI: 2.394, 5.789), medication nonadherence (AOR = 2.3; 95% CI: 1.63, 3.15), poor social support (2.986) (95% CI: 2.139, 4.169), perceived social stigma (2.938) (2.305, 3.743), opportunistic infections (3.010) (2.182, 4.151), and adverse drug reactions (4.013) (1.971, 8.167) were significantly associated with depression among adult HIV/AIDS patients on antiretroviral therapy, in Ethiopia. Conclusion and Recommendation. The pooled depression prevalence among adult HIV/AIDS patients attending antiretroviral therapy in Ethiopia was higher than the general population and is alarming for the government to take special consideration for HIV-positive patients. Depression assessment for all HIV-positive patients and integrating with mental health should be incorporated to ensure early detection, prevention, and treatment. Community-based and longitudinal study designs mainly focusing on the incidence and determinants of depression among adult HIV/AIDS patients should be done in the future.
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Namuli JD, Nalugya JS, Bangirana P, Nakimuli-Mpungu E. Prevalence and Factors Associated With Suicidal Ideation Among Children and Adolescents Attending a Pediatric HIV Clinic in Uganda. FRONTIERS IN SOCIOLOGY 2021; 6:656739. [PMID: 34212027 PMCID: PMC8239397 DOI: 10.3389/fsoc.2021.656739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/25/2021] [Indexed: 05/15/2023]
Abstract
Background: Suicidal behavior and HIV/AIDS are vital public health challenges especially in low and middle-income countries. As suicide in adults is perturbing for those closest to them, this sentiment is much more intense and generalized in the case of a child or adolescent. Knowledge of factors associated with suicidal ideation in HIV infected children and adolescents may inform suicide prevention strategies needed to improve their quality of life. This study aimed to assess the prevalence and factors associated with suicidal ideation among HIV infected children and adolescents attending a pediatric HIV clinic in Uganda. Methods: Data from a sample of 271 children and adolescents aged 6-18 years living with HIV/AIDS attending a pediatric HIV clinic was analyzed. Child characteristics and clinical variables were assessed using a socio-demographic questionnaire and medical records respectively. Suicidal ideation and depression were assessed using the Child Depression Inventory. The types of behavioral problems and the parent-child relationship were assessed using Child Behavioral Check List (6-18 years) and the Parent Child Relationship Scale respectively. Child exposure to different stressful life events was assessed with a series of standardized questions. Logistic regression models were used to explore factors independently associated with suicidal ideation. Results: The prevalence of suicidal ideation was 17%. In the multivariate analysis; Child exposure to family or friend's death (prevalence rate ratio (PRR = 2.02; 95% CI, 1.01-4.03), p = 0.046), HIV wasting syndrome (PRR = 0.39; 95% CI, 0.21-0.75, p = 0.04), Depression (PRR = 1.08; 95% CI, 1.03-1.12, p = 0.001), Anxiety symptoms (PRR = 1.10; 95% CI, 1.01-1.20, p = 0.024) and Rule breaking behavior (PRR = 1.06; 95% CI, 0.99-1.13, p = 0.051) were independently associated with suicidal ideations. Conclusion: The prevalence of suicidal ideation among children and adolescents living with HIV/AIDS is substantial. Children and adolescents with exposure to family or friend's death, those with higher depression scores, anxiety symptoms and rule breaking behavior are more likely to report suicidal ideation. Those with HIV wasting syndrome were less likely to report suicidal ideation. There is urgent need for HIV care providers to screen for suicide and link to mental health services.
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Affiliation(s)
- Justine Diana Namuli
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
- *Correspondence: Justine Diana Namuli,
| | | | - Paul Bangirana
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
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