艾滋病与临床研究杂志

Investigating the Interaction between Disability and Depressive Symptoms in the Era of Widespread Access to ART

Abstract

Hellen Myezwa, Jill Hanass-Hancock, Nikolas Pautz, Rulaine Smith and Bradley Carpenter

Introduction: HIV has much comorbidity that includes depression. Additionally, disability has been found to manifest in HIV. However, the intersection between these co-morbidities is unknown. The primary aim is investigating the link between the onset of disability and depressive symptoms amongst a cohort of patients on antiretroviral treatment.

Materials and method: We conducted a cross sectional survey in an urban area of South Africa including measures for depressive symptoms, functional limitations/disability, adherence, HIV-related health symptoms, and livelihood. One thousand and fifty-five adult individuals (≥ 18 years old) were recruited from Themba Lethu HIV clinic in Johannesburg between August 2014–May 2015. Bivariate and logistic regression analysis was used to determine associations.

Results: Participants experiencing depressive symptoms had higher functional limitations on all sub-categories expect for one. The logistic regression model revealed that having depressive symptoms as a bivariate dependent variable and age, physical health, and disability as independent variables were statistically significantly associated, χ² (3)=199.63, p<0.001. The model explained 23.7% (Nagelkerke R²) of the variance in depressive symptom classification, with increases in age, physical health symptoms, and disability being associated with an increase in symptoms.

Conclusion: As reported in a related study functional limitations, age, and health symptoms were directly associated to an increase in depressive symptoms. Gender and ART adherence were not found to be significant contributing variables to depressive symptoms when controlling for other covariates (disability, age, physical health). Hence, the association between depressive symptoms, health, and disability is much more nuanced and complex than previously anticipated. Development of a comprehensive continuum of care needs to consider the importance of disability as both a driver of depression and an outcome. Rehabilitation interventions hold a key to addressing these new health-related needs now that people survive the acute stages of AIDS and can live a long life.