Major Depressive Disorder: Longitudinal Analysis of Impact on Clinical and Behavioral Outcomes in Uganda. (1st June 2018)

• Record Type: Journal Article
• Authors: Kinyanda, Eugene; Levin, Jonathan; Nakasujja, Noeline; Birabwa, Harriet; Nakku, Juliet; Mpango, Richard; Grosskurth, Heiner; Seedat, Soraya; Araya, Ricardo; Shahmanesh, Maryam; Patel, Vikram
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 78:Number 2(2018)
• Publication Date: 2018-06-01
• Subjects: major depressive disorder -- HIV outcome measures -- ART adherence -- risky sexual behavior -- HIV disease progression -- health-seeking behavior -- Africa; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000001647
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Background: There is still wide variability in HIV disease course and other HIV-related outcomes, attributable in part to psychosocial factors such as major depressive disorder (MDD), a subject that has received little attention in sub-Saharan Africa. Methods: Using a longitudinal cohort of 1099 HIV-positive antiretroviral therapy–naive persons, we investigated the impact of MDD on 4 HIV-related negative outcome domains in Uganda. MDD was assessed using a Diagnostic Statistical Manual IV–based tool. Also collected were data on surrogate measures of the HIV-related outcome domains. Data were collected at the 3 time points of baseline, 6, and 12 months. Multiple regression and discrete time survival models were used to investigate the relationship between MDD and indices of the HIV outcomes. Results: MDD was a significant predictor of "missed antiretroviral therapy doses" [adjusted odds ratio (aOR) = 4.75, 95% confidence interval (CI): 1.87 to 12.04, P = 0.001], "time to first visit to healthy facility" (aOR = 1.71; 95% CI: 1.07 to 2.73; P = 0.024), "time to first self-reported risky sexual activity" (aOR = 2.11, 95% CI: 1.27 to 3.49; P = 0.004) but not of "CD4 counts at months 6 and 12" (estimated effect 29.0; 95% CI: −7.8 to 65.7; P = 0.12), and "time to new WHO stage 3 or 4 clinical event" (aOR = 0.52, 95% CI: 0.12 to 2.20, P = 0.37). Conclusions: MDD significantly impacted 3 of the 4 investigated outcome domains. These results by demonstrating the adverse consequences of an untreated mental health disorder (MDD) on HIV-related outcomes further strengthen the need to urgently act on WHO's call to integrate mental health care in general HIV care.