RESEARCH PAPER
Evaluation of depression, anxiety and insomnia
in people living with HIV/AIDS in India
1
Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
Submission date: 2021-05-30
Final revision date: 2021-07-17
Acceptance date: 2021-07-19
Publication date: 2023-04-06
HIV & AIDS Review 2023;22(2):138-149
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Mental disorders are quite common in association with human immunodeficiency virus (HIV). Mental disorders are more prevalent in people living with HIV/AIDS (PLWHA) than the general population. The aim of this study was to evaluate depression, anxiety and insomnia in PLWHA and its correlation with socio-demographic factors and cluster of differentiation-4 (CD4) count.
Material and methods:
This was a cross sectional study conducted in Pt. BD Sharma PGIMS, Rohtak on 500 PLWHA in India. Hospital Anxiety and Depression Scale-Depression (HADS-D), Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and Pittsburgh Sleep Quality Index (PSQI) scale were used to assess depression, anxiety and insomnia respectively in PLWHA. Five groups were designed on the basis of CD4 count: Group A (< 100 cells/μl), Group B (100-199 cells/μl), Group C (200-349 cells/μl), Group D (350-499 cells/μl) and Group E (> 500 cells/μl).
Results:
Prevalence of anxiety, depression and insomnia was found to be 59.6%, 61.2% and 56.4% respectively. Males had higher prevalence of depression and insomnia which are 64.2% and 57.4% respectively, whereas female had higher prevalence of anxiety (63%). There was a positive correlation between each score i.e. HADS-A, HADS-D and PSQI scale. There was a weak negative correlation between CD4 and each score.
Conclusions:
Despite higher prevalence, psychiatric illnesses remains underdiagnosed most of the time. Thus clinicians at the anti-retroviral therapy centre should screen these patients for depression, anxiety and depression for improvement in morbidity and mortality in PLWHA.
Mental disorders are quite common in association with human immunodeficiency virus (HIV). Mental disorders are more prevalent in people living with HIV/AIDS (PLWHA) than the general population. The aim of this study was to evaluate depression, anxiety and insomnia in PLWHA and its correlation with socio-demographic factors and cluster of differentiation-4 (CD4) count.
Material and methods:
This was a cross sectional study conducted in Pt. BD Sharma PGIMS, Rohtak on 500 PLWHA in India. Hospital Anxiety and Depression Scale-Depression (HADS-D), Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and Pittsburgh Sleep Quality Index (PSQI) scale were used to assess depression, anxiety and insomnia respectively in PLWHA. Five groups were designed on the basis of CD4 count: Group A (< 100 cells/μl), Group B (100-199 cells/μl), Group C (200-349 cells/μl), Group D (350-499 cells/μl) and Group E (> 500 cells/μl).
Results:
Prevalence of anxiety, depression and insomnia was found to be 59.6%, 61.2% and 56.4% respectively. Males had higher prevalence of depression and insomnia which are 64.2% and 57.4% respectively, whereas female had higher prevalence of anxiety (63%). There was a positive correlation between each score i.e. HADS-A, HADS-D and PSQI scale. There was a weak negative correlation between CD4 and each score.
Conclusions:
Despite higher prevalence, psychiatric illnesses remains underdiagnosed most of the time. Thus clinicians at the anti-retroviral therapy centre should screen these patients for depression, anxiety and depression for improvement in morbidity and mortality in PLWHA.
REFERENCES (62)
1.
German Advisory Committee Blood (Arbeitskreis Blut), Subgroup ‘Assessment of Pathogens Transmissible by Blood’. Human immunodeficiency virus (HIV). Transfus Med Hemother 2016; 43: 203-222.
2.
Global Statistics [Internet]. HIV.gov. 2020 [cited 12 August 2020]. Available from: https://www.hiv.gov/hiv-basics....
3.
HIV Facts & Figures | National AIDS Control Organization | MoHFW | GoI [Internet]. Naco.gov.in. 2019 [accessed on 11 Jan 2019]. Available from: http://naco.gov.in/hiv-facts-f....
4.
Dube B, Benton T, Cruess DG, Evans DL. Neuropsychiatric manifestations of HIV infection and AIDS. J Psychiatry Neurosci 2005; 30: 237-246.
5.
Nedelcovych MT, Manning AA, Semenova S, Gamaldo C, Haughey NJ, Slusher BS. The psychiatric impact of HIV. ACS Chem Neurosci 2017; 8: 1432-1434.
6.
Chandra P, Jayarajan N. HIV and mental health: an overview of research from India. Indian J Psychiatry 2010; 52 (Suppl 1): S269-S273.
7.
Sagar R, Dandona R, Gururaj G, et al. The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990-2017. Lancet Psychiatry 2020; 7: 148-161.
8.
Cui R. Editorial: A systematic review of depression. Curr Neuropharmacol 2015; 13: 480. doi: 10.2174/1570159x1304150831123535.
9.
Chaudhury S, Bakhla AK, Saini R. Prevalence, impact, and management of depression and anxiety in patients with HIV: a review. Neurobehavioral HIV Med 2016; 7: 15-30.
10.
Crocq MA. A history of anxiety: from Hippocrates to DSM. Dialogues Clin Neurosci 2015; 17: 319-325.
11.
Barlow DH. Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. Am Psychol 2000; 55: 1247-1263.
12.
Goodwin GM. The overlap between anxiety, depression, and obsessive-compulsive disorder. Dialogues Clin Neurosci 2015; 17: 249-260.
13.
Kacanek D, Jacobson DL, Spiegelman D, Wanke C, Isaac R, Wilson IB. Incident depression symptoms are associated with poorer HAART adherence: a longitudinal analysis from the Nutrition for Healthy Living study. J Acquir Immune Defic Syndr 2010; 53: 266-272.
14.
Tegger MK, Crane HM, Tapia KA, Uldall KK, Holte SE, Kitahata MM. The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals. AIDS Patient Care STDS 2008; 22: 233-243.
15.
de Oliveira e Silva AC, Reis RK, Nogueira JA, Gir E. Quality of life, clinical characteristics and treatment adherence of people living with HIV/AIDS. Rev Lat Am Enfermagem 2014; 22: 994-1000.
16.
Trivedi JK, Gupta PK. An overview of Indian research in anxiety disorders. Indian J Psychiatry 2010; 52 (Suppl 1): S210-S218.
17.
Shacham E, Morgan JC, Önen NF, Taniguchi T, Overton ET. Screening anxiety in the HIV clinic. AIDS Behav 2012; 16: 2407-2413.
18.
Beer L, Tie Y, Padilla M, Shouse RL; Medical Monitoring Project. Generalized anxiety disorder symptoms among persons with diagnosed HIV in the United States. AIDS 2019; 33: 1781-1787.
19.
Doghramji K. The evaluation and management of insomnia. Clin Chest Med 2010; 31: 327-339.
20.
Wagner GJ, Ghosh-Dastidar B, Robinson E, et al. Effects of depression alleviation on work productivity and income among HIV patients in Uganda. Int J Behav Med 2017; 24: 628-633.
21.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 1983; 67: 361-370.
22.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
23.
Adewuya AO, Afolabi MO, Ola BA, Ogundele OA, Ajibare AO, Oladipo BF. Psychiatric disorders among the HIV-positive population in Nigeria: a control study. J Psychosom Res 2007; 63: 203-206.
24.
Tesfaye M, Hanlon C, Wondimagegn D, Alem A. Detecting postnatal common mental disorders in Addis Ababa, Ethiopia: validation of the Edinburgh Postnatal Depression Scale and Kessler Scales. J Affect Disord 2010; 122: 102-108.
25.
Abayomi O, Adelufosi A, Adebayo P, Ighoroje M, Ajogbon D, Ogunwale A. HIV risk behavior in persons with severe mental disorders in a Psychiatric Hospital in Ogun, Nigeria. Ann Med Health Sci Res 2013; 3: 380-384.
26.
Nanni M, Caruso R, Mitchell A, Meggiolaro E, Grassi L. Depression in HIV infected patients: a review. Curr Psychiatry Rep 2014; 17: 530. doi: 10.1007/s11920-014-0530-4.
27.
Rivera-Rivera Y, Vázquez-Santiago FJ, Albino E, Sánchez MD, Rivera-Amill V. Impact of depression and inflammation on the progression of HIV disease. J Clin Cell Immunol 2016; 7: 423. doi: 10.4172/2155-9899.1000423.
28.
Chand SP, Marwaha R. Anxiety. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2020.
29.
Kaur S, Singh R. Role of different neurotransmitters in anxiety: a systemic review. Int J Pharm Sci Res 2017; 8: 411-421.
30.
Nadjar A, Wigren H, Tremblay M. Roles of microglial phagocytosis and inflammatory mediators in the pathophysiology of sleep disorders. Front Cell Neurosci 2017; 11: 250. doi: 10.3389/fncel.2017.00250.
31.
Pappin M, Wouters E, Booysen FL. Anxiety and depression amongst patients enrolled in a public sector antiretroviral treatment programme in South Africa: a cross-sectional study. BMC Public Health 2012; 12: 244. doi: 10.1186/1471-2458-12-244.
32.
Wu HC, Lu PL, Lin WC, Yu CT, Feng MC. Sleep quality, depression, anxiety, and self-esteem in people living with HIV/AIDS (PLWHA). Hu Li Za Zhi 2017; 64: 34-44 [Article in Chinese].
33.
Rai P, Verma B. A study on depression in people living with HIV/AIDS in South-West part of Uttar Pradesh, India. South East Asia J Public Health 2015; 5: 12-17.
34.
Agrawal M, Srivastava K, Goyal S, Chaudhury S. Psychosocial correlates of human immunodeficiency virus infected patients. Ind Psychiatry J 2012; 21: 55-60.
35.
Kittner JM, Brokamp F, Thomaidis T, et al. Disclosure and experienced social support are not related to anxiety or depression in a German HIV patient cohort. Infect Chemother 2014; 46: 77-83.
36.
Asmare Eshetu D, Meseret S. Prevalence of depression and associated factors among HIV/AIDS patients attending ART clinic at Debrebirhan Referral Hospital, North Showa, Amhara Region, Ethiopia. Clin Psychiatry 2015; 1.
37.
Caballero-Suárez N, Rodríguez Estrada E, Candela-Iglesias M, Reyes-Terán G. Comparison of levels of anxiety and depression between women and men living with HIV of a Mexico City clinic. Salud Mental 2017; 40: 15-22.
38.
Sun W, Wu M, Qu P, Lu C, Wang L. Psychological well-being of people living with HIV/AIDS under the new epidemic characteristics in China and the risk factors: a population-based study. Int J Infect Dis 2014; 28: 147-152.
39.
Deshmukh N, Borkar A, Deshmukh J. Depression and its associated factors among people living with HIV/AIDS: can it affect their quality of life? J Family Med Prim Care 2017; 6: 549-553.
40.
Belete A, Andaregie G, Tareke M, Birhan T, Azale T. Prevalence of anxiety and associated factors among people living with HIV/AIDS at Debretabor General Hospital Anti Retro Viral Clinic Debretabor, Amhara, Ethiopia, 2014. Am J Psychiatry Neurosci 2014; 2: 109-114.
41.
Dar P, Kachroo V, Qureshi S. Prevalence of depression in HIV patients on antiretroviral therapy (ART). Int J Res Rev 2020; 7: 13-21.
42.
Tesfaw G, Ayano G, Awoke T, et al. Prevalence and correlates of depression and anxiety among patients with HIV on-follow up at Alert Hospital, Addis Ababa, Ethiopia. BMC Psychiatry 2016; 16: 368. doi: 10.1186/s12888-016-1037-9.
43.
Liu H, Zhao M, Ren J, et al. Identifying factors associated with depression among men living with HIV/AIDS and undergoing antiretroviral therapy: a cross-sectional study in Heilongjiang, China. Health Qual Life Outcomes 2018; 16: 190. doi: 10.1186/s12955-018-1020-x.
44.
Unnikrishnan B, Mithra P, Rekha T, Reshmi B. Awareness and attitude of the general public toward HIV/AIDS in coastal Karnataka. Indian J Community Med 2010; 35: 142-146.
45.
Liu J, Zhong X, Lu Z, et al. Anxiety and depression associated with anal sexual practices among HIV-negative men who have sex with men in Western China. Int J Environ Res Public Health 2020; 17: 464: doi: 10.3390/ijerph17020464.
46.
Yousuf A, Musa R, Isa MLM, Arifin SRM. Anxiety and depression among women living with HIV: prevalence and correlations. Clin Pract Epidemiol Ment Health 2020; 16: 59-66.
47.
Ogdie A, Pang W, Forde K, et al. Prevalence and risk factors for patient-reported joint pain among patients with HIV/Hepatitis C coinfection, Hepatitis C monoinfection, and HIV monoinfection. BMC Musculoskelet Disord 2015; 16: 93. doi: 10.1186/s12891-015-0552-z.
48.
Crowell TA, Gebo KA, Balagopal A, Fleishman JA, Agwu AL, Berry SA. Impact of hepatitis coinfection on hospitalization rates and causes in a multicenter cohort of persons living with HIV. J AIDS 2014; 65: 429-437.
49.
Bedaso A, Abraham Y, Temesgen A, Mekonnen N. Quality of sleep and associated factors among people living with HIV/AIDS attending ART clinic at Hawassa University comprehensive specialized Hospital, Hawassa, SNNPR, Ethiopia. PLoS One 2020; 15: e0233849. doi: 10.1371/journal.pone.0233849. .
50.
Lee K, Gay C, Portillo C, et al. Types of sleep problems in adults living with HIV/AIDS. J Clin Sleep Med 2012; 8: 67-75.
51.
Huang X, Li H, Meyers K, et al. Burden of sleep disturbances and associated risk factors: a cross-sectional survey among HIV-infected persons on antiretroviral therapy across China. Sci Rep 2017; 7: 3657. doi: 10.1038/s41598-017-03968-3.
52.
Gutierrez J, Tedaldi EM, Armon C, Patel V, Hart R, Buchacz K. Sleep disturbances in HIV-infected patients associated with depression and high risk of obstructive sleep apnea. SAGE Open Med 2019; 7: 2050312119842268. doi: 10.1177/2050312119842268.
53.
Jabbari F, Dabaghzadeh F, Khalili H, Abbasian L. Associated factors of sleep quality in HIV-positive individuals. Future Virology 2015; 10: 89-96.
54.
Adeoti AO, Dada MU, Ogundipe KO, Akolawole MA. Burden of insomnia and associated risk factors in people living with HIV/AIDS in a tertiary hospital in sub-Saharan Africa. J AIDS Clin Res Sex Transm Dis 2018; 5: 19.
55.
Ren J, Zhao M, Liu B, et al. Factors associated with sleep quality in HIV. J Assoc Nurses AIDS Care 2018; 29: 924-931.
56.
Downing MJ Jr, Houang ST, Scheinmann R, Yoon IS, Chiasson MA, Hirshfield S. Engagement in care, psychological distress, and resilience are associated with sleep quality among HIV-positive gay, bisexual, and other men who have sex with men. Sleep Health 2016; 2: 322-329.
57.
Anders MP, Breckenkamp J, Blettner M, Schlehofer B, Berg-Beckhoff G. Association between socioeconomic factors and sleep quality in an urban population-based sample in Germany. Eur J Public Health 2014; 24: 968-973.
58.
Dabaghzadeh F, Khalili H, Ghaeli P, Alimadadi A. Sleep quality and its correlates in HIV positive patients who are candidates for initiation of antiretroviral therapy. Iran J Psychiatry 2013; 8: 160-164.
59.
Adeoti AO, Dada MU, Fadare JO. Prevalence of depression and anxiety disorders in people living with HIV/AIDS in a tertiary hospital in South Western Nigeria. Med Rep Case Stud 2018; 3: 150.
60.
Rodriguez-Estrada E, Iglesias-Chiesa MC, Fresan-Orellana A, Reyes Teran G. Factors associated with poor sleep quality among HIV-positive individuals in Mexico City. Salud Mental 2018; 41: 123-129.
61.
Oshinaike O, Akinbam A, Ojelabi O, Dada A, Dosunmu A, Olabode SJ. Quality of sleep in an HIV population on antiretroviral therapy at an urban tertiary centre in Lagos, Nigeria. Neurol Res Int 2014; 2014: 298703.
62.
Agus DF, Effendy E, Camellia V. Screening of anxiety and depression related CD4 count of people living with HIV/AIDS with anti-retroviral in Medan, Indonesia. Open Access Maced J Med Sci 2019; 7: 2590-2594.
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