Depression: a ‘serious public health hazard’ for people with HIV in Sub-Saharan Africa

10 October 2017

Untreated depression could seriously compromise treatment outcomes for people living with HIV, warn critics. 

father comforting son

Depression is one of the most common psychiatric disorders among people living with HIV. They are, according to statistics from western countries, two to three times more likely to develop symptoms compared to the general population.

However, critics suggest that ‘insufficient attention’ is being placed on mental health issues in sub-Saharan Africa (SSA) where the majority of people living with HIV live and are in care. 

Published in the journal, PLoS ONE, a recent meta-analysis and review of studies investigating the link between HIV and depression has now revealed that prevalence ranges from a low of 3% among people on antiretroviral treatment (ART) to a high of 34% among treatment-naïve individuals across SSA countries.

On average this means, among those living with HIV, that 1 in 8 people on ART, and 1 in 5 not currently accessing ART, are likely to be diagnosed with a major depressive disorder (MDD) in their lifetime. 

Factors associated with an elevated risk of depression include being a woman, having a disability, unemployment, a low socioeconomic background, additional opportunistic infection or co-morbidities, or the experience of HIV-related stigma. 

Despite World Health Organization (WHO) guidelines indicating the need to screen and manage depression alongside HIV care, the authors admit that in clinical practice, depression is still usually underdiagnosed in SSA and the provision of follow-up care is varied. 

As a result, untreated depression in people living with HIV can be debilitating – with evidence suggesting that its symptoms can have severe consequences on clinical outcomes and ART adherence. 

In fact, this latest review makes clear that depression is consistently associated with poorer health status overall including low CD4 progression, weight loss and faster disease progression, increasing the risk of AIDS-related mortality.

Such findings highlight the critical importance of psychiatric screening and the integration of mental health care alongside HIV services. Since depression is a modifiable condition, the authors suggest that adequate diagnosis, appropriate counselling, and follow-up care should be prioritised. Without it, people living with HIV and depression are at increased risk of developing viral resistance and other poor outcomes because of low level ART adherence.

In their commentary, the authors conclude that a lack of integration could risk burdening both healthcare systems and human resources as well as the individuals, warning: 

“This may become a significant public health hazard, deserving preventive and corrective measures to assure people living with HIV better quality of life and outcomes in SSA… depression could seriously compromise ART outcomes at individual and population levels.”

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Written by Christine Humphrey

Content Editor