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Major Depressive Disorder: Longitudinal Analysis of Impact on Clinical and Behavioral Outcomes in Uganda

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. Green open access

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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
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
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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