Depression with pain co morbidity and factors associated among HIV positive patients

Abstract

This study aimed to determine the prevalence and associated factors of depression with pain co morbidity among HIV positive patients. Three-hundred and seventy three adult ambulatory HIV/AIDS patients were randomly recruited from a specialized HIV/AIDS outpatient clinic in Uganda. Symptom data for depression with pain co morbidity were collected using the Mini Mental Status Examination (MMSE), Patient Health Questionnaire (PHQ-9), Mini International Psychiatric Interview (MINI), International Association for the Study of Pain classification of chronic pain, modified version of the Standardized Evaluation of Pain (StEP); and the World Health Organization Quality of Life Instrument Brief Version (WHOQOL-BREF).

Five percent of the participants reported depression with pain co morbidity described as having both pain of more than two weeks duration and five or more depressive symptoms on the MINI. Depression with pain co morbidity was associated with depression severity, recurrent depression on the MINI, past depression diagnoses and worse scores on all domains of the WHOQOL-BREF. Depression with pain co morbidity was not associated with past pain diagnoses or treatment, past depression treatment, CD4 counts, HAART regimens, pain types, and chronic pain classifications according to the International Association for the Study of Pain.

This dissertation describes depression with pain co morbidity as a distinct syndrome which has more adverse outcomes than depression or pain alone in people with HIV/AIDS; especially in terms of quality of life. It also reports on the under-diagnosis and under-treatment of depression and pain possibly due to the somatisation of illnesses in people with HIV/AIDS. Finally it suggests that early diagnosis and treatment of depression may prevent pain and depression with pain co morbidity and calls for the integration of mental health services into HIV/AIDS care.