Wagner G.J., Ghosh-Dastidar B., Garnett J., Kityo C., Mugyenyi P.
RAND Corporation, 1776 Main St, Santa Monica, CA 90407, United States; Joint Clinical Research Centre, Kampala, Uganda
Wagner, G.J., RAND Corporation, 1776 Main St, Santa Monica, CA 90407, United States; Ghosh-Dastidar, B., RAND Corporation, 1776 Main St, Santa Monica, CA 90407, United States; Garnett, J., RAND Corporation, 1776 Main St, Santa Monica, CA 90407, United States; Kityo, C., Joint Clinical Research Centre, Kampala, Uganda; Mugyenyi, P., Joint Clinical Research Centre, Kampala, Uganda
Objective: With wide-reaching harmful effects of depression, and the absence of psychiatric treatment in most HIV care programs in sub-Saharan Africa, we examined the effects of antiretroviral therapy (ART) on depression and other mental health indicators. Methods: 602 patients (302 non-ART, 300 ART) were followed for the first 12 months of HIV care in Uganda, with assessments at entry into care and Months 6 and 12. Mental health was assessed with measures of depression, hopelessness, and internalized HIV stigma; physical health functioning was assessed as an explanatory variable. Results: Thirteen percent had clinical depression, 57% had elevated depressive symptoms, and CD4 cell count was negatively correlated with measures of depression at baseline. Significant reductions in elevated depressive symptoms (time: odds ratio [95% confidence interval] = 0.53 [0.43-0.64]) and hopelessness (time: β =-0.12, p <.001) were observed in both the ART and non-ART groups, but the drop in depression was greater among ART patients in intention-to-treat multivariate analysis (ART × time: p <.001). When added to the regression models, change in physical health functioning predicted positive longitudinal change on measures of depression, hopelessness, and internalized stigma (all p values <.001), yet ART status remained a significant independent predictor of each (ART × time: p values ranged from <.05 to <.001). Most mental health benefits of ART were experienced in the first 6 months of care. Conclusions: These findings demonstrate the mental health benefits of HIV care and ART. However, in some people, mental health problems persist once physical health is stabilized, in which case mental health treatment may be needed. © 2012 by the American Psychosomatic Society.
anti human immunodeficiency virus agent; adult; article; CD4 lymphocyte count; controlled study; depression; female; follow up; highly active antiretroviral therapy; hopelessness; human; Human immunodeficiency virus infection; longitudinal study; major clinical study; male; mental health; physical activity; predictor variable; priority journal; psychologic assessment; stigma; Uganda; Acquired Immunodeficiency Syndrome; Adult; Anti-HIV Agents; Cohort Studies; Depressive Disorder, Major; Developing Countries; Female; Follow-Up Studies; Health Services Accessibility; Health Status; HIV Infections; Humans; Internal-External Control; Male; Motivation; Prospective Studies; Quality of Life; Social Stigma; Uganda