Does social support affect depression in patients on antiretroviral treatment program in rural KwaZulu-Natal, South Africa?
Yeji, Francis Asepola
Good and quality social support has been positively associated with mental health and researchers and clinicians are increasingly recognising the important protective role it plays in people living with HIV/AIDS (PLWA). We investigated whether the mental health (depression) of patients receiving antiretroviral treatment (ART) in a public-sector treatment programme in the rural district of Umkhanyakude, KwaZulu-Natal, South Africa is influenced by social support and strategies to cope with HIV infection. Depression was assessed in a cross-section of 272 patients (mean age 38 years, age range 20-67 years) with the General Health Questionnaire 12 (GHQ12). A GHQ12 score of 4 or higher indicated mental health pathology (depression), while lower scores indicated normal mental health. We regressed depression on sex, age, marital status, education, household wealth, social support (instrumental and emotional social support), and 6 strategies to cope with HIV infection. Holding the other variables constant, “instrumental social support” was a significant predictor of mental health pathology (OR = 0.65 P<0.001, 95% CI 0.52 - 0.81). Using “avoidance of people” as a strategy to cope with HIV increased the odds of depression almost threefold (OR = 2.79 P=0.006, 95% CI 1.34 - 5.82), “trying to keep it from bothering” one reduced it by a factor two (OR = 0.45 P=0.068, 95% CI 0.20 - 1.06). 33% of patients were depressed indicating that depression is very common in patients on ART in rural South Africa. In addition to drug treatment, interventions improving instrumental social support and changes in the strategies to cope with HIV infection may be effective in reducing this disease burden among ART patients.
MSc (Med), Population-Based Field Epidemiology,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2009