Depression, alcohol use and adherence to antiretroviral therapy in sub-saharan Africa: a systematic review.
ABSTRACT This study evaluated estimates of depression symptoms, major depression, alcohol use or disorders and their association with ART adherence in sub-Saharan Africa. Studies published between January 1, 2006 and July 31, 2011 that documented rates of these mental health problems were identified through electronic databases. A pooled analysis of 23 studies reporting rates of depression symptoms and six studies reporting rates of major depression indicated a pooled estimate of 31.2% (95% CI 25.5-38.2%, Tau(2) = 0.23) and 18% (95% CI 12.3-25.8%, Tau(2) = 0.19) respectively. Few studies reported rates of alcohol use or disorders, and so we did not pool their estimates. Likelihood of achieving good adherence was 55% lower among those with depression symptoms compared to those without (pooled OR = 0.45 (95% CI 0.31-0.66, Tau(2) = 0.20, P value = 0.000). Interventions to improve mental health of HIV-positive individuals and to support adherence are desperately needed in sub-Saharan Africa.
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ABSTRACT: OBJECTIVES: This study examined the relationship between depression and functional status among a community-dwelling older population of 65 years and older in South Africa. METHOD: Data from the first wave of the South African National Income Dynamics Study were used, this being the first longitudinal panel survey of a nationally representative sample of households. The study focused on the data for resident adults 65 years and older (n = 1,429). Depression was assessed using the 10-item version of the Center for Epidemiologic Studies Depression Scale. Functional status, pertaining to both difficulty and dependence in activities of daily living (ADL), instrumental activities of daily living (IADL), and physical functioning and mobility (PFM), were assessed using 11 items. RESULTS: Functional challenges were generally higher in the older age group. There was a significant association between depression and functional dependence in ADL (adjusted OR = 2.57 [CI: 1.03-6.41]), IADL (adjusted OR = 2.76 [CI: 1.89-4.04]), and PFM (adjusted OR = 1.66 [CI: 1.18-2.33]), but the relationship between depression and functional status, particularly PFM, appeared weaker in older age. CONCLUSION: The relationship between depression symptoms and function is complex. Functional characteristics between older and younger old populations are diverse, and caution is indicated against overgeneralizing the challenges related to depression and function among this target population. Copyright © 2013 John Wiley & Sons, Ltd.International Journal of Geriatric Psychiatry 03/2013; · 3.09 Impact Factor
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ABSTRACT: BACKGROUND: In high-income countries, depression is prevalent in HIV patients and is associated with lower medication adherence and clinical outcomes. Emerging evidence from low-income countries supports similar relationships. Yet little research has validated rapid depression screening tools integrated into routine HIV clinical care. METHODS: Using qualitative methods, we adapted the Patient Health Questionnaire-9 (PHQ-9) depression screening instrument for use with Cameroonian patients. We then conducted a cross-sectional validity study comparing an interviewer-administered PHQ-9 to the reference standard Composite International Diagnostic Interview in 400 patients on antiretroviral therapy attending a regional HIV treatment center in Bamenda, Cameroon. RESULTS: The prevalence of major depressive disorder (MDD) in the past month was 3% (n=11 cases). Using a standard cutoff score of ≥10as a positive depression screen, the PHQ-9 had estimated sensitivity of 27% (95% confidence interval: 6-61%) and specificity of 94% (91-96%), corresponding to positive and negative likelihood ratios of 4.5 and 0.8. There was little evidence of variation in specificity by gender, number of HIV symptoms, or result of a dementia screen. LIMITATIONS: The low prevalence of MDD yielded very imprecise sensitivity estimates. Although the PHQ-9 was developed as a self-administered tool, we assessed an interviewer-administered version due to the literacy level of the target population. CONCLUSION: The PHQ-9 demonstrated high specificity but apparently low sensitivity for detecting MDD in this sample of HIV patients in Cameroon. Formative work to define the performance of proven screening tools in new settings remains important as research on mental health expands in low-income countries.Journal of affective disorders 07/2012; · 3.76 Impact Factor
- Health 01/2013; Vol.5(No.3A):557-566. · 2.10 Impact Factor