Prevalence and factors associated with severe depressive symptoms in older west African people living with HIV

Abstract

Background Depression is one of the most common psychiatric disorders in people living with HIV (PLHIV). Depression has a negative impact on both mental and physical health and is mainly associated with suboptimal HIV treatment outcomes. To encourage successful aging and the achievement of the 3 × 90 objectives in older PLHIV, the psychological domain must not be neglected. In this context and as data are scarce in West Africa, this study aimed to evaluate the prevalence and the factors associated with severe depressive symptoms in older PLHIV living in this region of the world. Methods Data from PLHIV aged ≥50 years and on ART since ≥6 months were collected in three clinics (two in Côte d’Ivoire, one in Senegal) participating in the West Africa International epidemiological Databases to Evaluate AIDS (IeDEA) collaboration. The severity of depressive symptoms was measured using the Center for Epidemiological Studies Depression scale (CES-D), and associated factors were identified using logistic regressions. Results The median age of the 334 PLHIV included in the study was 56.7 (53.5–61.1), 57.8% were female, and 87.1% had an undetectable viral load. The prevalence of severe depressive symptoms was 17.9% [95% Confidence Interval (95% CI): 13.8–22.0]. PLHIV with severe depressive symptoms were more likely to be unemployed (adjusted Odd Ratio (aOR) = 2.8; 95% CI: 1.4–5.7), and to be current or former tobacco smokers (aOR = 2.6; 95% CI: 1.3–5.4) but were less likely to be overweight or obese (aOR = 0.4; 95% CI: 0.2–0.8). Conclusions The prevalence of severe depressive symptoms is high among older PLHIV living in West Africa. Unemployed PLHIV and tobacco smokers should be seen as vulnerable and in need of additional support. Further studies are needed to describe in more details the reality of the aging experience for PLHIV living in SSA. The integration of screening and management of depression in the standard of care of PLHIV is crucial.

Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review

“…However, in some studies, household wealth quintile, education levels, 51 and age 25 were not significant correlates of depression. In other studies, being a current/former smoker, 46 increasing disability scores, decreasing mean handgrip strength, reported back pain, not having hypertension, 55 HIV stigma 48 and caregiving (for adult children) 58 were significantly associated with elevated levels of depression. On the other hand, receiving a government grant 58 and resilience 48 were significantly associated with reduced levels of depression.…”

“…Correlates of depression among PLWH50 + were reported only in eight studies. 27 28 46 48 51 54 55 58 Among sociodemographic variables, older age, 27 54 declining socioeconomic status, 55 being unemployed, 46 being female, 28 58 HIV status disclosure 48 and urban residency 58 were associated with an elevated risk of depression while being married, employed (full-time or part-time work), 54 old age, 51 higher educational attainment 48 and belonging to the highest wealth quintile 28 were associated with reduced levels of depression. However, in some studies, household wealth quintile, education levels, 51 and age 25 were not significant correlates of depression.…”

Navigating life with HIV as an older adult on the Kenyan coast: perceived health challenges seen through the biopsychosocial model

“…Our results are also partly corroborated by findings from other settings in SSA. For instance, Charlotte and colleagues reported a high prevalence of severe depression among OALWH in West Africa, especially among those who were unemployed, current or former smokers (44). In other studies, OALWH have been noted to have lower rates of common mental disorders than uninfected age peers or younger PLWH (45).…”

Determinants of Depressive Symptoms in People Living with HIV: Findings from a Population-Based Study with a Gender Perspective

“…The multiple factors associated with the high prevalence of depression in this population point to a complex and multicausal relationship. These include demographic and economic factors (e.g., female sex) [ 16 , 17 ], low level of education [ 17 , 18 ], and financial instability [ 19 ]. Additional, overlapping risk factors include pre-existing mood disorders and harmful alcohol consumption [ 20 , 21 ], substance abuse [ 22 ], nicotine dependence [ 19 ], poor adherence to ART [ 18 ], risky sexual behaviors [ 22 ], structural barriers such as internalized stigma [ 18 ], experiences of discrimination [ 18 , 23 ], and social isolation [ 21 , 23 ].…”