Depression and anxiety in HIV infected individuals attending HIV treatment facilities at various sites in South Africa: occurrence and related factors. A descriptive-analytic study

Abstract

International literature, most of which originates from First-world countries where HIV predominantly affects socially marginalised minority populations, has well-described the burden of mental disorder, particularly depressive and anxiety disorders in HIV-infected individuals. The few studies conducted in developing countries show contradictory results. This study aimed to describe the occurrence of mental disorders; particularly depressive and anxiety disorders, in a population of HIV-infected individuals attending HIV-treatment sites in Gauteng and Mpumalanga in South Africa from November 2004 to November 2005. A cross-sectional descriptive-analytic study, it included a clinical diagnostic interview and a semi-structured interview to explore postulated risk and protective factors, including demographic, clinical and psychosocial variables, for depressive and anxiety disorders in HIV-infected individuals. Three hundred and two (302) individuals were interviewed at the Perinatal HIV Research Unit’s associated Wellness clinics and at the Chris Hani Baragwanath Hospital’s Nthabiseng HIV clinic. Just over thirty percent of participants had a current mental disorder and the lifetime prevalence of mental disorder was 40%. Almost 17% of participants had a current depressive disorder and almost 16% had a lifetime depressive disorder. The occurrence of major depressive disorder, current and lifetime, was 3.64% and 10.26% respectively. Sixty percent of participants with lifetime major depressive disorder had their first onset after diagnosis of HIV status. The occurrence of current and lifetime anxiety disorder was almost 4%. Substance use disorders were common, affecting 7.6% of the participants at time of interview. Lifetime prevalence of substance use disorders was 18.9%, suggesting that knowledge of HIV status or other interventions may have resulted in this significant decrease. Identified significant risk factors for depressive disorder included a history of a lifetime depressive disorder, moderate or severe psychosocial stress and feelings of isolation. Being in a support group was found to be a protective factor against depressive disorder. While the results in this study are conservative compared to those of other similar South African studies in HIV-infected individuals, there was a statistically significantly increased occurrence of depressive and anxiety disorders (combined) compared to general population prevalence studies of these disorders in South Africa. Ways of improving access to mental healthcare for HIV-infected individuals and the general population, are discussed