Date Published: January 2, 2019
Author(s): Helina Abebe, Shegaye Shumet, Zebiba Nassir, Melkamu Agidew, Dessie Abebaw.
Depression is most frequently and highly occurring common mental disorder in HIV/AIDS patients especially youth living with HIV/AIDS. This study aimed to assess the prevalence and associated factors of depressive symptoms among youth living with Human Immunodeficiency Virus (HIV) attending Antiretroviral Therapy (ART) follow-up at public hospitals in Addis Ababa, Ethiopia. Objective. To assess the prevalence and associated factors of depressive symptoms among youth living with Human Immunodeficiency Virus (HIV) attending Antiretroviral Therapy (ART) follow-up at public hospitals Addis Ababa, Ethiopia, 2016. Method. In a cross sectional study, 507 HIV-positive young people from public health hospitals were recruited by systematic random sampling technique. Beck Depression Inventory-II was used to assess depressive symptoms. Morisky medication adherence rating scale, social support rating scale, and HIV stigma scale were the instruments used to assess the associated factors. Results. Prevalence of depressive symptoms among HIV-positive youth was 35.5% (95% CI:31.3, 39.6). In multivariate analysis, age range between 20 and 24 years with (AOR=2.22, 95% CI: 1.33,3.62), history of opportunistic infection (AOR=1.94, 95% CI:1.15,3.27), poor medication adherence (AOR=1.73, 95%CI:1.13,2.64, low social support (AOR=2.74, 95%CI:1.13,2.64), moderate social support (AOR=1.75 95% CI: 1.03,2.98), and stigma (AOR=2.06, 95% CI: 1.35,3.14) were associated with depressive symptoms. The results suggest that prevalence of depressive symptoms among HIV-positive youth was high. Prevention of opportunistic infection, stigma, and counseling for good medication adherence are necessary among HIV-positive youth.
According to DSM-5 depression is a common mental disorder that presents with depressed mood, loss of interest (pleasure), decreased energy, feeling of guilt, or low self-worth, disturbed sleep or appetite, and poor concentration . HIV/AIDS is a chronic infectious disease and first leading cause of mortality and morbidity worldwide from an infectious disease. An estimated 5 million young people aged 15-24 years are living with HIV, vast majority in sub-Saharan Africa . Depressive disorders were the third leading cause of global burden of disease in 2004 and will be the first by 2030. Globally depression is number one cause of illness and disability among youth [3–7].Youth and young adults account for a large percentage of all HIV/AIDS cases in Ethiopia . AIDS death has risen only among adolescents and young age group since 2001 [9, 10]. There is an evidence of significant comorbidity in people living with HIV/AIDS (PLWHA) including depression [4, 5].
A total of 507 participants out of 537 enrolled were included in the study making the response rate 94.4%. The mean age of participants was 18.6 years (±SD =3.024) and 272 (69.6%) were females. Concerning educational status, about 232 (45.8%) had attended primary education. From a total of participants 243 (47.9%) were living with father/mother (Table 1).
Prevalence of depressive symptoms among HIV-positive youth was 35.5% with 95% CI (31.3%, 39.6%) based on the Beck inventory scale. The rate is lower than reported rates in Zimbabwe 63% , Kenya 48% , and USA 52 % . The possible reason for this variation might be due to the difference in study design, sample size, and data collection tools. It might also be related to substance, stigmatization, and low social support. Substance use may increase risk of HIV infection and AIDS and interfere with their treatment, and conversely some mental disorders occur as a direct result of HIV infection. Youth with depression may have low in treatment service for HIV/AIDS. On the other hand, our rates are higher than the study done in Malawi, 18.9%  Kenya 17.8% , and Malaysia 18.5 % . The possible reason for this discrepancy might also be due to the study design and data collection tools. It might also be due to very poor medication adherence and presence of opportunistic infection in our study.
HIV-positive young people were at high risk of developing depression. Importantly this study demonstrates a high prevalence of depressive symptoms among HIV-positive youth attending ART follow-up at public hospitals. Age, history of opportunistic infection, HIV related stigma, poor medication adherence, and low and moderate social support were found to be independent predictor of depressive symptoms. Integration of mental health evaluation and treatment into the HIV care provided for youth can be beneficial. More studies to delineate factors associated with depressed youth with HIV may add value to the body of knowledge and overall improvement of care. The limitation of this study was social desirability bias.