Major depressive disorder: Longitudinal analysis of impact on clinical and behavioural outcomes in Uganda.

BACKGROUND

There is still wide variability in HIV disease course and other HIV related outcomes, attributable in part to psychosocial factors such as major depressive disorder (MDD), a subject that has received little attention in sub-Saharan Africa.

METHODS

Using a longitudinal cohort of 1099 HIV positive antiretroviral therapy (ART) naïve persons, we investigated the impact of MDD on four HIV related negative outcome domains in Uganda. MDD was assessed using a Diagnostic Statistical Manual IV based tool. Also collected was data on surrogate measures of the HIV related outcome domains. Data was collected at the three time points of baseline, 6 and 12 months. Multiple regression and discrete time survival models were used to investigate the relationship between MDD and indices of the HIV outcomes.

RESULTS

MDD was a significant predictor of 'missed ART doses' (aOR=4.75, 95% CI, 1.87-12.04, p=0.001), 'time to first visit to healthy facility' (aOR=1.71; 95% CI, 1.07-2.73; p=0.024), 'time to first self-reported risky sexual activity' (aOR=2.11, 95% CI, 1.27-3.49; p=0.004) but not of 'CD4 counts at months 6 and 12' (estimated effect 29.0; 95% CI, -7.8-65.7; p=0.12) and 'time to new WHO stage 3 or 4 clinical event' (aOR=0.52, 95% CI, 0.12-2.20, p=0.37).

CONCLUSION

MDD significantly impacted three of the four investigated outcome domains. These results by demonstrating the adverse consequences of an untreated mental health disorder (MDD) on HIV related outcomes, further strengthen the need to urgently act on WHO's call to integrate mental health care in general HIV care.