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Keynejad RC, Bitew T, Sorsdahl K, Myers B, Honikman S, Mulushoa A, Demissie M, Deyessa N, Howard LM, Hanlon C. Adapting brief problem-solving therapy for pregnant women experiencing depressive symptoms and intimate partner violence in rural Ethiopia. Psychother Res 2024; 34:538-554. [PMID: 37384929 DOI: 10.1080/10503307.2023.2222899] [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: 02/14/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE To adapt an evidence-based psychological intervention for pregnant women experiencing depressive symptoms and intimate partner violence (IPV) in rural Ethiopia. METHOD We conducted a desk review of contextual factors in Sodo, Ethiopia, followed by qualitative interviews with 16 pregnant women and 12 antenatal care (ANC) providers. We engaged stakeholders through participatory theory of change (ToC) workshops, to select the intervention and articulate a programme theory. We used "ADAPT" guidance to adapt the intervention to the context, before mapping potential harms in a "dark logic model". RESULTS Brief problem-solving therapy developed for South Africa was the most contextually relevant model. We adapted the delivery format (participants prioritised confidentiality and brevity) and training and supervision (addressing IPV). Consensus long-term outcomes in our ToC were ANC providers skilled in detecting and responding to emotional difficulties and IPV, women receiving appropriate support, and emotional difficulties improving. Our dark logic model highlighted the risk of more severe IPV and mental health symptoms not being referred appropriately. CONCLUSION Although intervention adaptation is recommended, the process is rarely reported in depth. We comprehensively describe how contextual considerations, stakeholder engagement, programme theory, and adaptation can tailor psychological interventions for the target population in a low-income, rural setting.
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Affiliation(s)
- Roxanne C Keynejad
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Tesera Bitew
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychology, College of Education and Behavioural Sciences, Injibara University
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Division of Addiction Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, South Africa
- Curtin enAble Institute, Curtin University, Bentley, Western Australia
- Mental health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Simone Honikman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Adiyam Mulushoa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekdes Demissie
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Bernard C, Mané I, Ziadeh S, Tine JM, Diaw A, Benzekri N, Ndiaye I, Samba O, Font H, Bottai T, Jacquesy L, Verdeli H, Ngom NF, Dabis F, Seydi M, de Rekeneire N. Perceptions, facilitators and barriers to the implementation of interpersonal group therapy to treat depression among people living with HIV in Senegal: a qualitative study. Front Public Health 2024; 12:1295181. [PMID: 38327573 PMCID: PMC10848853 DOI: 10.3389/fpubh.2024.1295181] [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: 09/15/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
Background Depression is highly prevalent in people living with HIV (PLWH) but remains under treated in Sub-Saharan Africa. In this context, we conducted the first study of Group Interpersonal Therapy (IPT) to treat depression in PLWH in Senegal. We assessed the perceptions and experiences of patients and group facilitators, as well as barriers to implementation. Methods This study was conducted at the Fann National University Hospital Center in Dakar, the urban capital of Senegal. Qualitative data were collected during the implementation phase (February to June 2020 and then from January to February 2021), with a 6-month pause due to the COVID-19 pandemic. Twenty-five patients and three group facilitators were individually interviewed by a socio-anthropologist. Qualitative data were analyzed thematically. Results Group IPT was perceived as successful and beneficial by patients and facilitators. Patients reported positive experiences with group IPT and sustained outcomes. Beyond improving depressive symptoms, patients reported improvements in their social and professional lives, and the development of skills to prevent relapse. Group facilitators noted the benefits of therapy for their patients and for their professional skills, reporting greater clinical competence and improved supportive skills. Challenges to intervention implementation included confidentiality and patient privacy concerns, healthcare accessibility issues, and time demands. Conclusion In this first qualitative study of group IPT for depression in PLWH in Senegal, participants described both positive experiences with the intervention and challenges to its implementation. Future studies, conducted in suburban and rural communities outside of Dakar, would further inform the implementation of IPT in Senegal.
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Affiliation(s)
- Charlotte Bernard
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | - Idrissa Mané
- CNRS, Université de Pau et des Pays de l’Adour, Pau, France
| | - Salaheddine Ziadeh
- Université Libanaise, Faculté de Santé Publique, Sidon, Lebanon
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | | | - Abibatou Diaw
- Centre de Traitement ambulatoire, CHNU de Fann, Dakar, Senegal
| | - Noëlle Benzekri
- Department of Medicine-Infectious Diseases, University of Washington, Seattle, WA, United States
| | | | - Oumar Samba
- Service de psychiatrie, CHNU de Fann, Dakar, Senegal
| | - Hélène Font
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | | | | | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | | | - François Dabis
- National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, University of Bordeaux, Bordeaux, France
| | - Moussa Seydi
- Service des maladies infectieuses et tropicales, CHNU de Fann, Dakar, Senegal
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Effectiveness and implementation outcomes for peer-delivered mental health interventions in low- and middle-income countries: a mixed-methods systematic review. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1731-1747. [PMID: 35484436 DOI: 10.1007/s00127-022-02294-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This review aimed to evaluate interventions led by peer counselors (PCs) for adults with common mental disorders in low- and middle-income countries (LMICs) along indices of overall effectiveness and key implementation outcomes (acceptability, feasibility, cost, fidelity, sustainability). METHODS This review followed a mixed-methods systematic review design. MEDLINE/PubMed, Embase, PsycINFO, and Global Health databases were searched for PC-led interventions for adults in LMICs targeting depressive and/or anxiety disorders or PTSD. Quantitative data was narratively synthesized, and qualitative data was thematically synthesized separately. The results from the qualitative and quantitative syntheses were then combined in a cross-study synthesis. RESULTS Twenty-four papers describing thirteen PC-led interventions were included for review. Narrative synthesis results indicated mixed effectiveness of PC-led interventions in reducing depressive, anxiety, PTSD symptoms and high PC competency. Thematic synthesis revealed five descriptive themes: (1) Preferred PC characteristics; (2) Incentives and motivation for PCs; (3) Barriers to PC-led intervention implementation; (4) Helpful supervision/training practices; and (5) Overall high acceptability of PC-led interventions. Cross-study synthesis revealed high acceptability, feasibility, and fidelity, but cost and sustainability outcomes were underreported in included papers. CONCLUSION PC-led interventions seem to show initial promise in terms of effectiveness, acceptability, feasibility, cost, fidelity, and sustainability. Future research should focus on standardizing measurements of implementation outcomes to facilitate cross-study analysis. Additional empirical attention should be paid to underrepresented implementation outcomes (e.g., cost, sustainability). Finally, researchers should adopt a participatory approach that elevates the perspectives of PCs throughout all stages of the implementation process.
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Yator O, Khasakhala L, Stewart GJ, Kumar M. Acceptability and impact of group interpersonal therapy (IPT-G) on Kenyan adolescent mothers living with human immunodeficiency virus (HIV): a qualitative analysis. BMC Womens Health 2022; 22:240. [PMID: 35717156 PMCID: PMC9206094 DOI: 10.1186/s12905-022-01807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Task shifting is a well-tested implementation strategy within low- and middle-income countries that addresses the shortage of trained mental health personnel. Task shifting can increase access to care for patients with mental illnesses. In Kenya, community health workers (CHWs) are a combination of community health assistants and community health volunteers and have played a crucial role on this front. In our study, we seek to assess the acceptability and feasibility of Group Interpersonal Psychotherapy (IPT-G) delivered by CHWs among depressed postpartum adolescents (PPAs) living with human immunodeficiency virus (HIV). Method The study used theoretical framework of behaviour change including: Capability, Opportunity and Motivation (COM-B model) to help understand behavioural changes due to IPT-G intervention delivered by the CHWs. 24 PPAs were administered IPT-G by trained CHWs from two health centres. A two-arm study design (IPT-G intervention and treatment as usual) with an intent to treat was used to assess the acceptability and feasibility of IPT-G. With purposeful sampling, participants who scored > 10 on the Edinburgh postnatal depression scale and who were 6–12 weeks postpartum were eligible for the study. Participants were equally distributed into two groups: one group for intervention and another as a wait-listed group. This was achieved by randomly allocating numerical numbers and separating those with odd numbers (intervention group) and even numbers (wait-listed group). Focus group discussions and in-depth interviews ascertained the experiences and perceptions of the PPAs and the CHWs during IP-G delivery process. In addition to weekly face-to-face continuous supportive supervision for the CHWs, the researchers also utilized phone calls, short messages services and WhatsApp instant messaging services. Results The CHWs found the intervention useful for their own knowledge and skill-set. With regards to participation, 21 out of the 24 adolescents attended all sessions. Most of the adolescents reported an improvement in their interpersonal relationships with reduced distress and lessening of HIV-related stigma. Primary healthcare workers embraced the intervention by accommodating the sessions in their routine clinic activities. Conclusion Our study demonstrates the possible benefits of task shifting in addressing mental health problems within low-resource settings in Kenya, and IPT-G is demonstrated to be both acceptable and feasible by health workers and adolescents receiving care. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01807-w.
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Affiliation(s)
- Obadia Yator
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, P. O. Box 799-00517, Nairobi, Kenya.
| | - Lincoln Khasakhala
- Department of Psychiatry, University of Nairobi, P. O. Box 30197-00100, Nairobi, Kenya
| | - Grace-John Stewart
- University of Washington, 325 9th Avenue, Box 359909, Seattle, WA, 98104, USA
| | - Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O. Box 47074-00100, Nairobi, Kenya.,Department of Psychology, University College London, London, UK
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Stonbraker S, Sanabria G, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Rowell-Cunsolo T, Halpern M, Bakken S, Schnall R, George M. "If They Give Their Mind to HIV, They Don't Last as Long": An Explanatory Model of HIV Infection in a Limited-Resource Setting Informs Person-Centered Care. Glob Qual Nurs Res 2022; 9:23333936221097112. [PMID: 35719278 PMCID: PMC9203948 DOI: 10.1177/23333936221097112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 03/04/2022] [Accepted: 03/19/2022] [Indexed: 11/18/2022] Open
Abstract
Explanatory models describe individuals’ perceptions of their illness experiences, which can guide culturally relevant care. We constructed an explanatory model of the experience of living with human immunodeficiency virus (HIV) in the Dominican Republic. Following qualitative descriptive methodology, we conducted interviews in Spanish using a semi-structured interview guide developed using Kleinman’s explanatory model framework. Two bilingual researchers coded interview transcripts following conventional content analysis. We used deductive codes from Kleinman’s framework and inductive codes external to the framework to construct the codebook. We arranged codes by shared meaning into categories and constructed themes that reflected shared findings from inductive categories and deductive codes. Twenty-six persons living with HIV participated. They provided rich descriptions of their experiences represented by four cross-cutting themes, which informed the explanatory model. By incorporating this in-depth understanding of patients’ illness experiences into care delivery, nurses can cultivate culturally meaningful and trusting patient-centered partnerships that improve health.
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Affiliation(s)
- Samantha Stonbraker
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, USA
| | | | | | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
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Asrat B, Lund C, Ambaw F, Schneider M. Acceptability and feasibility of peer-administered group interpersonal therapy for depression for people living with HIV/AIDS-a pilot study in Northwest Ethiopia. Pilot Feasibility Stud 2021; 7:147. [PMID: 34321104 PMCID: PMC8317371 DOI: 10.1186/s40814-021-00889-x] [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: 01/14/2021] [Accepted: 07/16/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Psychological treatments are widely tested and have been effective in treating depressive symptoms. However, implementation of psychological treatments in the real world and in diverse populations remains difficult due to several interacting barriers. In this study, we assessed the acceptability and feasibility of peer-administered group interpersonal therapy for depressive symptoms among people living with HIV/AIDS in Northwest Ethiopia. METHOD We conducted a single-arm, peer-administered, group interpersonal therapy intervention with eight weekly sessions from 15 August to 15 December 2019 among people living with HIV/AIDS in Northwest Ethiopia. Four interpersonal therapy groups were formed for the intervention with a total of 31 participants. RESULTS Of the 31 recruited participants, 29 completed the intervention providing a retention rate of 93.5%. The process of the intervention and its outcomes were highly acceptable as most participants expressed success in resolving their psychosocial problems, adjusting to life changes and coping with stigma. The intervention was also reported to be feasible despite anticipated barriers such as access to transportation, perceived stigma and confidentiality concerns. The post-intervention assessment revealed significant reduction in depressive symptoms (mean difference (MD) = 9.92; t = - 7.82; 95% CI, - 12.54, - 7.31; p < 0.001), improvement in perceived social support (MD = 0.79; t = 2.84; 95% CI, 0.22, 1.37; p = 0.009) and quality of life (MD = 0.39; t = 4.58; 95% CI, 0.21, 0.56; p < 0.001). CONCLUSION Group interpersonal therapy is feasible and acceptable, and people living with HIV/AIDS can benefit from group interpersonal therapy in managing depressive symptoms and in improving perceived social support and quality of life. Future studies should examine the effectiveness of group interpersonal therapy in this setting.
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Affiliation(s)
- Biksegn Asrat
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, King's Global Health Institute, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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A cross-cultural interpersonal model of adolescent depression: A qualitative study in rural Nepal. Soc Sci Med 2021; 270:113623. [PMID: 33461033 PMCID: PMC7895817 DOI: 10.1016/j.socscimed.2020.113623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/25/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Abstract
Most cross-cultural qualitative research on depression has been descriptive, documenting symptoms and explanatory models. There is a lack of qualitative research testing theoretical models of depression. The interpersonal model conceptualises grief, interpersonal disputes, role transitions and social isolation as the context in which depression develops and is the basis of interpersonal therapy (IPT), which is increasingly used in cross-cultural settings to treat depression. We aimed to qualitatively evaluate to what extent the interpersonal model can explain adolescent depression in Nepal. Data were collected between December 2018 and April 2019 and comprised transcripts from 126 participants: 25 semi-structured interviews with depressed adolescents aged 13–18; four focus group discussions with adolescents (N = 38), four with parents/caregivers (N = 39), and two with teachers (N = 17); and seven semi-structured interviews with health and non-governmental organisation workers. We coded data using an analytical framework comprising deductive codes representing key concepts from the interpersonal model of depression and IPT, including principles, techniques and strategies. Participants mainly related depression to interpersonal problem areas of grief, dispute, role transition and social isolation. Interpersonal disputes were common, and for many adolescents this involved parental physical and emotional abuse. Although role transitions were common few adolescents grieved loss of the prior role. Distress related to social isolation was evident despite close physical proximity and extensive social interaction with family and community members. Adolescents described coping strategies that were similar to strategies central to IPT, e.g. identifying helpful and unhelpful relationships and generating options and ways of managing problems. In conclusion, interpersonal problems are relevant to this population and conceptualisations align with core principles of the interpersonal model of depression. The findings highlight the importance of addressing abuse and maltreatment in depression aetiology. They also inform future cultural adaptations of IPT in Nepal and beyond, including the opportunity to integrate local coping strategies. Testing psychological models cross-culturally is important for adapting therapies. Interpersonal problems trigger depression among adolescents in Nepal. Experiences of depression align with core principles of interpersonal therapy (IPT). Few adolescents use IPT strategies to address interpersonal problems. Models of depression must incorporate poverty, migration and abuse as risk factors.
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Asrat B, Lund C, Ambaw F, Garman EC, Schneider M. Major depressive disorder and its association with adherence to antiretroviral therapy and quality of life: cross-sectional survey of people living with HIV/AIDS in Northwest Ethiopia. BMC Psychiatry 2020; 20:462. [PMID: 32972394 PMCID: PMC7513286 DOI: 10.1186/s12888-020-02865-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/10/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Major depression is believed to affect treatment adherence and overall quality of life (QoL) of people living with HIV/AIDS (PLWHA). Comorbid major depression contributes to a two-fold higher risk of mortality among PLWHA. Understanding the relationships of major depression, adherence to antiretroviral therapy (ART) and QoL is important to identify areas for intervention. The aim of this study is to examine relationship of major depressive disorder (MDD) and adherence to ART with QoL, and to investigate socio-demographic and clinical factors associated with MDD, adherence and QoL among PLWHA in Northwest Ethiopia. METHOD A cross-sectional study was conducted in the ART clinic of Felege-Hiwot referral hospital in Northwest Ethiopia from July to October 2019. Adult PLWHA were selected using a systematic random sampling technique. Data were collected using interview administered questionnaires and chart reviews. Mini International Neuropsychiatric Interview and WHOQOL-HIV-BREF-Eth instruments were used to measure MDD and QoL respectively. Adherence to ART was assessed using pill count data from patients' adherence monitoring chart. Univariate and multivariate Poisson regressions were used to assess associations of socio-demographic and clinical factors with MDD and adherence to ART. A multivariate linear regression was used to examine the associations of both MDD and adherence with overall QoL. RESULT Of the total of 393 invited participants, 391 (99.5%) completed the interviews. MDD was negatively associated with overall QoL: participants with MDD had a lower QoL score of 0.17 points compared to those with no MDD. MDD was associated with reduced adherence to ART when functional disability was controlled (RR = 1.43; 95%CI = 1.05, 1.96; p = 0.025). However, there was no statistical association between adherence to ART and overall QoL. Functional disability was associated with both MDD (RR = 5.07; 95%CI = 3.27,7.86; p < 0.001) and overall QoL (β = 0.29; 95%CI = 0.21,0.36; p < 0.001). CONCLUSION The relationship between MDD and QoL indicates the need for feasible, acceptable and evidence-based mental health interventions to reduce depression and improve overall QoL of PLWHA. We recommend future studies investigate causal relationships of MDD, adherence to ART and QoL of PLWHA to better understand priority areas for intervention.
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Affiliation(s)
- Biksegn Asrat
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, Department of Health Services and Population Research, King's Global Health Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Fentie Ambaw
- School of Public Health, College of medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Emily Claire Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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