Prevalence and factors associated with depressive disorders in an HIV+ rural patient population in Southern Uganda
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Background: Depressive disorders are estimated to occur in nearly half of HIV-infected individuals worldwide. Aim: To examine the prevalence and cardinal demographic, psychosocial and clinical features associated with having any depressive disorder, sub-clinical depression, current and lifetime depressive disorders among patients with human immunodeficiency virus (HIV) in southern Uganda. Methods: Five hundred HIV+ individuals were screened for depression using a 20 item selfreporting questionnaire (SRQ-20) and evaluated with the mini neuropsychiatric interview (MINI) that assessed current and lifetime depressive disorders. Results: The prevalence estimates of any depressive disorder, subclinical depression, both current and lifetime major depression, and bipolar depression were 46.4%, 17.8%, 25% and 3.6% respectively. In comparison to non-depressed patients, those with sub-clinical depression were less likely to have high levels of self-efficacy, more likely to be using ART for less than one year, have advanced HIV disease and current alcohol use disorders (AUD's). Those with both current and lifetime depressive disorders were less likely to be 85% adherent to antiretroviral therapy (ART), have social support and high levels of self-efficacy, more likely to have tuberculosis and past manic episodes. Those with only lifetime depressive disorders were more likely to have current AUD's and past manic episodes. Limitations: Information concerning exposures and outcomes was collected simultaneously, thus causal relationships are difficult to establish. Conclusions: Sub-clinical depression, major depression and bipolar depression are widespread among HIV patients receiving ART. Integration of mental health services into HIV Care is desperately needed.