Exploring depression among people living with HIV/AIDS and attending a primary health care centre in Kigali, Rwanda : a descriptive, cross-sectional study.

Abstract

HIV is major public problem in the world and in Sub-Saharan Region in particular. The literature has shown that mental disorders and particularly depression are common among people living with HIV/AIDS, but that little is known about the prevalence of depression and factors associated with it, among people living with HIV/AIDS in Rwanda. A descriptive, cross-sectional study was done to assess the prevalence of depression, the clinical profile and the factors associated with depression among people living with HIV and attending a primary health care centre in Kigali-Rwanda. This study was informed by the stress and vulnerability framework. A questionnaire was used to collect socio-demographic and HIV related medical information, while depression was assessed using the Beck Depression Inventory Scale, with a cut off of less than 10 for no depression and above 10 scoring positive for depression. Respondents were randomly selected from the patient appointment list for patients who were scheduled during the period of data collection and according to the sample selection criteria. The sample consisted of 96 people living with HIV. Permission to conduct the study was requested and obtained from the University of Kwazulu-Natal Ethics Committee, from the CNLS Research and Ethics Committee in Rwanda and from the management of the health care centre to consult patients' files. Data was analyzed using the Statistical Package for the Social Sciences (SPSS for window, 15). Descriptive data was analyzed by means of frequencies, mean and standard deviation. Cross tabulation using Pearson' chi-square test was performed to test the association between sociodemographic factors and HIV related medical information and depression for categorical variables, while t-test for independent simple test was performed for continuous variable. Multi logistic regression analysis was performed to test further association between the above mentioned factors with depression, while controlling for confounders. The results were presented by means of tables, histograms and graphs. The findings of the study revealed that depression is very high among HIV-infected patients attending a primary health care centre in Kigali, with a prevalence of 41.7%. The most frequent depressive symptoms presented were pessimism, fatigability, sad mood; lack of satisfaction, somatic preoccupation, loss of libido, crying spells, work inhibition, irritability, social v withdrawal and loss of appetite. The majority of respondents scored mild to moderate depression, whereas few had moderate to severe depression and only very few scored severe depression. Having considered all other socio-demographic and HIV related medical factors that were studied, being a female, having presented many HIV-related symptoms in the month prior to data collection, and having less than 250 CD4 counts were statistically associated with depression. On the other hand, having high social and family support was a protector factor to depression. Although the results of this study are not generalizable to the Rwandan population living with HIV, they underscore the importance of integrating mental health in HIV/AIDS services for the care of those who present mental problems related to HIV such as depression.