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Depression Increases the Risk of Disease Progression and Death in HIV-positive Women

visitor reported talking to or seeing her.

About two months after enrolment, every six months until 2001, and every twelve months thereafter, a psychosocial questionnaire was administered to assess depression /anxiety symptoms based on eight out of the 25-item scale of the Hopkins Symptoms Checklist (HSCL-25). A previous study in this population validated the usefulness of the eight point sub-scale for assessing depression. A social support scale, based on a ten-item questionnaire on emotional or affective (six) and material or instrumental (four) support, was used to assess social support among the patients.

A psychiatric nurse provided individual counseling in the clinic and facilitated a weekly peer support group for women who needed or required counseling for depressive or anxiety symptoms. Women were encouraged to visit the study clinic if they were ill or required counseling.

Depression is not only common but is an independent predictor of disease progression and death among HIV-infected African women, the authors conclude. This brings into sharp relief the urgent need for additional studies to assess the effectiveness of psychosocial interventions in preventing or delaying disease progression.

The policy implication is that, alongside antiretroviral drug treatment, management of depression and psychiatric disorders must be an integral part of the health care package provided to all HIV-infected patients.

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