Understanding the influence of depression on social, economic and health-related outcomes among HIV patients in Uganda

Background: Depression can play a key role in the socioeconomic well-being and quality of life of persons living with HIV/AIDS (PLHA). We examined the relationship of depression to physical health, social and economic well-being, and psychosocial adjustment among new HIV clinic clients in Uganda. Methods: 602 participants were enrolled in a longitudinal prospective cohort study designed to examine the impact of HIV Antiretroviral Therapy on multiple dimensions of health. Baseline data were analyzed to determine the association of depression, measured by PHQ-9, with variables from each of the following domains: demographics, physical health, economic well-being, social support/environment and psychosocial adjustment to HIV. Significant bi-variate correlates of depression were included in domain-specific regression models, from which significant predictors were included in an overall regression model. Results: Two thirds of participants were female (68%); 13% had PHQ-9 > 10, which signifies clinical depression. Correlates of greater depression (PHQ-9 total score) from the overall regression model included subscales of the MOS-HIV (lower physical functioning, lower cognitive functioning, more health-related distress, recent worsening of health), as well as internalized HIV stigma, and more disclosure of HIV to friends (all p values < .01). In the logistic model for clinical depression, only cognitive functioning, recent worsening of health and internalized stigma were significant correlates (p values < .05). Conclusions: Depression may play a key role in the socioeconomic well-being and quality of life of PLHA in Sub-Saharan Africa. Effective diagnosis and treatment of depression may be critical to maximizing the downstream benefits of HIV care.