Amsterdam 2015
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| Abstract #2361 - No health without mental health | ||||
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Session: 40.2: No health without mental health (Parallel) on Thursday @ 16.30-18.00 in C103 Chaired by Mark Tomlinson, Tomas Campbell Authors: Presenting Author: Ms Malebogo Tlhajoane - Imperial College London, United Kingdom |
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| Additional Authors: | ||||
| Aim: By 2030, the World Health Organization predicts that depression will be the single highest contributor to the global burden of disease. Although, depressive and behavioural disorders have been found to be risk factors for HIV infection and poor adherence to antiretroviral therapy (ART) in high income settings, the nature and extent of this relationship in low and middle income (LMIC) settings remains largely unknown. We assess the prevalence of psychological distress (PD) in the general population in a low-income sub-Saharan African setting subject to a generalized HIV epidemic, and investigate (1) the risk factors for PD, (2) the effect of PD on sexual risk behaviours and (3) the effect of distress on progression through the HIV treatment cascade (including adherence). | ||||
| Method / Issue: Data were analysed from a cross sectional survey of 13219 adults (aged 15-54) conducted between January 2009 and August 2011 in Manicaland, Zimbabwe. Prevalence of depressive symptomology was determined through the Shona Symptom Questionnaire (SSQ), developed for use in Zimbabwe, and the standard WHO Self-reporting Questionnaire (SRQ). An index measure of psychological distress was created through principal components analysis using 25 variables derived from both the SSQ and the SRQ. Ordered logistic regression and binary logistic regression were used to assess associations between psychological distress, hypothesized risk factors including, illiteracy, low educational attainment, unemployment, not being in a committed relationship, HIV infection and STI infection, sexual risk behaviours, and reported HIV diagnosis, treatment initiation, and adherence. | ||||
| Results / Comments: The prevalence of psychological distress was 9.61% measured by the SSQ and 11.89% measured by the SRQ. Greater psychological distress was significantly correlated with female gender, unemployment, low levels of educational attainment, HIV infection, STI infection and not being in a long term committed relationship. Sexual risk factors associated with increasing severity of PD were STI infection and transactional sex in men, and among women, sex work, concurrent sexual relationships and intermittent condom use with a partner in a concurrent relationship. Individuals with severe PD were more likely to have tested for HIV at least once in their lifetime (AOR=1.36 95%CI: 1.13-1.64) but were more likely to occasionally or quite often forget to adhere to ART treatment (AOR=3.40 95%CI: 1.04-11.05). | ||||
| Discussion: Increasing severity of psychological distress amplifies certain sexual risk behaviours and is associated with non-adherence to ART in eastern Zimbabwe. Integrated services tackling mental health may be beneficial within the local community context, particularly among HIV infected women, as well as vocational interventions to improve access to employment in light of the country’s economic recovery. | ||||
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