Depression and HIV in Botswana: A Population-Based Study on Gender-Specific Socioeconomic and Behavioral Correlates

Abstract

BackgroundDepression is a leading contributor to the burden of disease worldwide, a critical barrier to HIV prevention and a common serious HIV co-morbidity. However, depression screening and treatment are limited in sub-Saharan Africa, and there are few population-level studies examining the prevalence and gender-specific factors associated with depression.MethodsWe conducted a cross-sectional population-based study of 18–49 year-old adults from five districts in Botswana with the highest prevalence of HIV-infection. We examined the prevalence of depressive symptoms, using a Hopkins Symptom Checklist for Depression (HSCL-D) score of ≥1.75 to define depression, and correlates of depression using multivariate logistic regression stratified by sex.ResultsOf 1,268 participants surveyed, 25.3% of women and 31.4% of men had depression. Among women, lower education (adjusted odds ratio [AOR] 2.07, 95% confidence interval [1.30–3.32]), higher income (1.77 [1.09–2.86]), and lack of control in sexual decision-making (2.35 [1.46–3.81]) were positively associated with depression. Among men, being single (1.95 [1.02–3.74]), living in a rural area (1.63 [1.02–2.65]), having frequent visits to a health provider (3.29 [1.88–5.74]), anticipated HIV stigma (fearing discrimination if HIV status was revealed) (2.04 [1.27–3.29]), and intergenerational sex (2.28 [1.17–4.41]) were independently associated with depression.DiscussionDepression is highly prevalent in Botswana, and its correlates are gender-specific. Our findings suggest multiple targets for screening and prevention of depression and highlight the need to integrate mental health counseling and treatment into primary health care to decrease morbidity and improve HIV management efforts.

Correlates of depression among internally displaced persons after post-election violence in Kaduna, North Western Nigeria

“…Individuals with total score 4 1.75 were considered to have probable depression. The HSCL-25 has widely been used in studies among refugees in many countries including Nigeria (Gupta et al, 2010;Aniebue and Onyema, 2008;Kleijn et al, 2001).…”

HIV-Related Disability in HIV Hyper-Endemic Countries: A Scoping Review

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How community physical, structural, and social stressors relate to mental health in the urban slums of Accra, Ghana

“…Numerous studies and reports have uncovered that these poor urban communities experience high rates of communicable (e.g., HIV) and, non-communicable diseases (e.g., respiratory disease, waterborne diseases, diabetes, stroke), injuries, and premature death (Ali, 2010;Butala et al, 2010;Kyobutungi et al, 2008;Sverdlik, 2011). The growing awareness that mental illness, particularly depression, is a tremendous contributor to the growing burden of disease worldwide, and especially in developing regions (Bird et al, 2010;Gupta et al, 2010;Izutsu et al, 2006;Lund et al, 2010;Prince et al 2007), suggests that improving wellbeing among slum dwellers, a charge of the Millennium Development Goals (MDGs), requires significantly more attention to mental health outcomes than the few existing studies have given.…”