Kinyanda, E;
Levin, J;
Nakasujja, N;
Birabwa, H;
Nakku, J;
Mpango, R;
Grosskurth, H;
... Patel, V; + view all
(2018)
Major Depressive Disorder: Longitudinal Analysis of Impact on Clinical and Behavioral Outcomes in Uganda.
Journal of Acquired Immune Deficiency Syndromes (JAIDS)
, 78
(2)
pp. 136-143.
10.1097/QAI.0000000000001647.
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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.
| Type: | Article |
|---|---|
| Title: | Major Depressive Disorder: Longitudinal Analysis of Impact on Clinical and Behavioral Outcomes in Uganda |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1097/QAI.0000000000001647 |
| Publisher version: | https://doi.org/10.1097/QAI.0000000000001647 |
| Language: | English |
| Additional information: | This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10054669 |
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