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Depression and CD4 Cell Count Among Persons with HIV Infection in Uganda

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Abstract

Despite the importance of mental illness and the high prevalence of HIV in Africa, few studies have documented depressive symptoms among HIV-infected persons in Africa. We assessed factors associated with depression among HIV-infected adults undergoing anti-retroviral eligibility screening in Eastern Uganda. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Univariate and multiple regression analyses were conducted to identify socio-demographic characteristics and disease-related factors associated with depression. Among 1017 HIV-infected participants assessed for depression, 47% (476/1017) reported depressive symptoms (CES-D ≥ 23). Adjusting for age, gender, education, and source of income, patients with CD4 counts <50 cells/μl were more likely to be depressed (odds ratio 2.34, 95% confidence interval, 1.39–3.93, P = 0.001). Women, participants >50 years, and those without an income source were more likely to be depressed. Depression was common among HIV-infected persons in rural Uganda and was associated with low CD4 cell counts. Appropriate screening and treatment for depression should be considered for comprehensive HIV care.

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References

  • Bolton, P., Bass, J., Neugebauer, R., Verdeli, H., Clougherty, K. F., Wickramaratne, P., & Speelman, L. (2003). Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA, 289, 3117–3124.

    Article  PubMed  Google Scholar 

  • Bolton, P., Wilk, C. M., & Ndogoni, L. (2004). Assessment of depression prevalence in rural Uganda using symptom and function criteria. Social Psychiatry and Psychiatric Epidemiology, 39, 442–447.

    Article  PubMed  Google Scholar 

  • Breslau, N. (1985). Depressive symptoms, major depression, and generalized anxiety: a comparison of self-reports on CES-D and results from diagnostic interviews. Psychiatry Research, 15, 219–229.

    Article  PubMed  CAS  Google Scholar 

  • Bunnell, R., Ekwaru, J. P., Solberg, P., Wamai, N., Bikaako-Kajura, W., Were, W., Coutinho, A. (2006). Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS 20, 85–92.

    Article  PubMed  Google Scholar 

  • Burack, J. H., Barrett D. C., Stall R. D., Chesney M. A., Ekstrand M. L., & Coates T. J. (1993). Depressive symptoms and CD4 lymphocyte decline among HIV-infected men. JAMA, 270, 2568–2573.

    Article  PubMed  CAS  Google Scholar 

  • Cheng, S. T., & Chan, A. C. (2005). The Center for Epidemiologic Studies Depression Scale in older Chinese: Thresholds for long and short forms. International. Journal of Geriatric Psychiatry, 20, 465–470.

    Article  PubMed  Google Scholar 

  • Ciesla, J. A., & Roberts, J. E. (2001). Meta-analysis of the relationship between HIV infection and risk for depressive disorders. American Journal of Psychiatry, 158, 725–730.

    Article  PubMed  CAS  Google Scholar 

  • Cook, J. A., Grey, D., Burke, J., Cohen, M. H., Gurtman, A. C., Richardson, J. L., & Wilson, T. E. (2004). Depressive symptoms and AIDS-related mortality among a multisite cohort of HIV-positive women. American Journal of Public Health, 94, 1133–1140.

    Article  PubMed  Google Scholar 

  • Ickovics, J. R., Hamburger, M. E., Vlahov, D., Schoenbaum, E. E., Schuman, P., Boland, R. J., & Moore, J. (2001). Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA, 285, 1466–1474.

    Article  PubMed  CAS  Google Scholar 

  • Kalichman, S. C., Rompa, D., & Cage, M. (2000). Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. Journal of Nervous and Mental Diseases, 188, 662–670.

    Article  CAS  Google Scholar 

  • Leserman, J., Jackson, E. D., Petitto, J. M., Golden, R. N., Silva, S. G., Perkins, D. O., & Cai, J. (1999). Progression to AIDS: the effects of stress, depressive symptoms, and social support. Psychosomatic Medicine, 61, 397–406.

    PubMed  CAS  Google Scholar 

  • Linn, J. G., Poku, K. A., Cain, V. A., Holzapfel, K. M., & Crawford, D. F. (1995). Psychosocial outcomes of HIV illness in male and female African American clients. Social Work in Health Care, 21, 43–60.

    Article  PubMed  CAS  Google Scholar 

  • Lyketsos, C. G., Hoover, D. R., & Guccione, M. (1996a). Depression and survival among HIV-infected persons. JAMA, 275, 35–36.

    Article  CAS  Google Scholar 

  • Lyketsos, C. G., Hoover, D. R., Guccione, M., Dew, M. A., Wesch, J., Bing, E. G., & Treisman, G. J. (1996b). Depressive symptoms over the course of HIV infection before AIDS. Social Psychiatry and Psychiatric Epidemiology, 31, 212–219.

    Article  CAS  Google Scholar 

  • Lyketsos, C. G., Hoover, D. R., Guccione, M., Dew, M. A., Wesch, J. E., Bing, E. G., & Treisman, G. J. (1996c). Changes in depressive symptoms as AIDS develops. The Multicenter AIDS Cohort Study. American Journal of Psychiatry, 153, 1430–1437.

    CAS  Google Scholar 

  • Lyketsos, C. G., & Treisman, G. J. (1996). Depressive syndromes and causal associations. Psychosomatics, 37, 407–412.

    PubMed  CAS  Google Scholar 

  • Maj, M., Janssen, R., Satz, P., Zaudig, M., Starace, F., Boor, D., & Sughondhabirom, B. (1991). The World Health Organization’s cross-cultural study on neuropsychiatric aspects of infection with the human immunodeficiency virus 1 (HIV−1). Preparation and pilot phase. British Journal of Psychiatry, 159, 351–356.

    Article  PubMed  CAS  Google Scholar 

  • Mills, T. C., Paul, J., Stall, R., Pollack, L., Canchola, J., Chang, Y. J., & Moskowitz, J. T. (2004). Distress and depression in men who have sex with men: The Urban Men’s Health Study. American Journal of Psychiatry, 161, 278–285.

    Article  PubMed  Google Scholar 

  • Moneyham, L., Sowell, R., Seals, B., & Demi, A. (2000). Depressive symptoms among African American women with HIV disease. Nursing Practice, 14, 9–39.

    CAS  Google Scholar 

  • Moore, J., Schuman, P., Schoenbaum, E., Boland, B., Solomon, L., & Smith, D. (1999). Severe adverse life events and depressive symptoms among women with, or at risk for, HIV infection in four cities in the United States of America. AIDS, 13, 2459–2468.

    Article  PubMed  CAS  Google Scholar 

  • Myers, J. K., & Weissman, M. M. (1980). Use of a self-report symptom scale to detect depression in a community sample. American .Journal of .Psychiatry, 137, 1081–1084.

    PubMed  CAS  Google Scholar 

  • Okun, A., Stein, R. E., Bauman, L. J., & Silver, E. J. (1996). Content validity of the Psychiatric Symptom Index, CES-depression Scale, and State-Trait Anxiety Inventory from the perspective of DSM-IV. Psychological Reports, 79, 1059–1069.

    PubMed  CAS  Google Scholar 

  • Olley, B. O., Gxamza, F., Seedat, S., Theron, H., Taljaard, J., Reid, E., Reuter, H. (2003). Psychopathology and coping in recently diagnosed HIV/AIDS patients--the role of gender. South African Journal of Medical Sciences, 93, 928–931.

    Google Scholar 

  • Olley, B. O., Seedat, S., Nei, D. G., & Stein, D. J. (2004). Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa. AIDS Patient Care and STDS, 18, 481–487.

    Article  PubMed  CAS  Google Scholar 

  • Page-Shafer, K., Delorenze, G. N., Satariano, W. A., & Winkelstein, W., (1996). Comorbidity and survival in HIV-infected men in the San Francisco Men’s Health Survey. Annals of Epidemiology, 6, 420–430.

    Article  PubMed  CAS  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  • Richardson, J., Barkan, S., Cohen, M., Back, S., FitzGerald, G., Feldman, J., & Young, M. (2001). Experience and covariates of depressive symptoms among a cohort of HIV infected women. Social Work in Health Care, 32, 93–111.

    Article  PubMed  CAS  Google Scholar 

  • UNAIDS (2004). Report on the global HIV/AIDS epidemic: 4th global report. [Retrieved from: http://www.unaids.org/bangkok2004/GAR2004_pdf/UNAIDSGlobalReport2004_en.pdf].

  • Wilk, C. M., & Bolton, P. (2002). Local perceptions of the mental health effects of the Uganda acquired immunodeficiency syndrome epidemic. Journal of Nervous and Mental Diseases, 190, 394–397.

    Article  Google Scholar 

  • Yang, H. J., Soong, W. T., Kuo, P. H., Chang, H. L., & Chen, W. J. (2004). Using the CES-D in a two-phase survey for depressive disorders among nonreferred adolescents in Taipei: A stratum-specific likelihood ratio analysis . Journal of Affective Disorders, 82, 419–430.

    PubMed  Google Scholar 

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Acknowledgements

We thank the interviewers and staff of TASO and of CDC-Uganda, especially Anne Stangl, Anna Awor, and Sylvia Nakayiwa for their input and dedication. We are greatly indebted to the study participants for their support.

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Authors and Affiliations

  1. Centers for Disease Control and Prevention (CDC), Entebbe, Uganda

    Frank M. Kaharuza, Rebecca Bunnell, Susan Moss, Winnie Bikaako-Kajura, Nafuna Wamai, Robert Downing & Jonathan Mermin

  2. Global AIDS Program, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA

    David W. Purcell

  3. Institute of Global Health, University of California, San Francisco, USA

    Peter Solberg

  4. The AIDS Support Organization, Kampala, Uganda

    Alex Coutinho

  5. CDC-Uganda, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda

    Rebecca Bunnell

Authors
  1. Frank M. Kaharuza
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  2. Rebecca Bunnell
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  3. Susan Moss
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  4. David W. Purcell
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  5. Winnie Bikaako-Kajura
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  6. Nafuna Wamai
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  7. Robert Downing
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  8. Peter Solberg
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  9. Alex Coutinho
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  10. Jonathan Mermin
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Corresponding author

Correspondence to Rebecca Bunnell.

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The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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Kaharuza, F.M., Bunnell, R., Moss, S. et al. Depression and CD4 Cell Count Among Persons with HIV Infection in Uganda. AIDS Behav 10 (Suppl 1), 105–111 (2006). https://doi.org/10.1007/s10461-006-9142-2

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