Prevalence, impact, and management of depression and anxiety in patients with HIV: a review

Figures & data

Table 1 Prevalence rate of depression in patients with HIV

Location, reference	Scale used	Sample size	Depression prevalence, %	Associated findings
Nigeria, Sale and Gadanya^Citation25	HADS, ICD 10	162	39.9	Depression was associated with the stage of HIV illness, CD4^+ count level, poverty, low social support, and inability to tolerate ART
People’s Republic of China, Lu et al^Citation26	SRDS	102	67.65	Depression and anxiety were associated with low CD4^+ T-lymphocyte counts
Kenya, Musisi and Kinyanda^Citation27	ICD 10	82	40.8	Other comorbid disorders included anxiety, somatization, seizures, mania, and HIV-associated progressive encephalopathy
Thailand, Nüesch et al^Citation28	HADS	251	7.2	ART improved mental health and QoL
Tanzania, Marwick and Kaaya^Citation29	CIS-R	220	15.5	During HIV care, co-morbid psychiatric disorders should be identified and managed
Jamaica, Clarke et al, (2010)^Citation30	PHQ-9	63	43	Age, gender, marital status, major stress, living conditions, ART, and CD4^+ count were not associated with depression
India, Sivasubramanian et al^Citation31	M.I.N.I.; DSM–IV	150	29	Depression was associated with low self-esteem and low levels of social support
Albania, Morrison et al^Citation32	Semistructured interview	79	62.3	Depression was significantly associated with anxiety, greater number of barriers to care, and greater medical and social needs
USA, Bhatia et al^Citation33	CES-D	180	67	Multivariate analysis revealed the association of depression with female gender, low income, history of psychoactive substance abuse, and low access to medical care
Uganda, Kinyanda et al^Citation34	M.I.N.I.	618	8.1	Depression was associated with psychosocial impairment, adverse life events, PTSD, GAD, and past history of deliberate self-harm
India, Agarwal et al^Citation35	HADS	50	30	46% of PLWHA had low psychological well-being
South Africa, Pappin et al^Citation36	HADS	716	25.4	Depression was associated with stigma
Cameroon, L’akoa et al^Citation37	PHQ-9	100	63	Newly diagnosed HIV-infected patients had higher prevalence of depression, severe immunosuppression, and harmful use of alcohol associated with depression
People’s Republic of China, Su et al^Citation38	BDI	258	71.9	Depression was associated with less income and high perceived stress
India, Talukdar et al^Citation39	BDI	175	56	Poor QoL was associated with depression and high neuroticism score
Nigeria, Olagunju et al^Citation40	SCID-NP	295	14.9	Compared to the general population, PLWHA suffer from more psychiatric disorders
South Korea, Song et al^Citation41	BDI	82	21	Depression was associated with poor adherence and anxiety. Comorbidities and unemployment were risk factors for depression.
People’s Republic of China, Liu et al^Citation42	CES-D	320	66.3	Depression and anxiety in PLWHA could be reduced by high social support
India, Chauhan et al^Citation43	HADS	I00	39	Asymptomatic PLWHA had significantly higher prevalence of alcohol dependence, adjustment disorder, and sexual dysfunction compared to control subjects
Israel, Levy et al^Citation44	PHQ-9	57	24	Neurocognitive disturbances and psychiatric illnesses were common in asymptomatic PLWHA, but were independent of the time of being positive, immunological status, viral load, or treatment received
South Africa, Nel and Kagee^Citation45	BDI II	I0I	40.4	ART adherence was significantly related to depressive symptoms on biserial correlations and logistic regression analysis
Romania, Largu et al^Citation46	BDI II	146	41 (moderate in 14%; mild in 27%)	PLWHA were afraid (of death, complications, other people’s reaction to the diagnosis), confused (in terms of diagnosis, the mode of infection, the future), angry (against the source of infection, themselves, God), felt guilty and blamed themselves
Malawi, Kim et al^Citation47	CDRS-R	562	18.9	7.1% of PLWHA had suicidal ideation
Germany, Kittner et al^Citation48	HADS	80	30 (male) and 47 (female)	Guilt for the HIV infection was present in 36% of PLWHA
India, Bhatia and Munjal^Citation49	CES-D	160	58.7	Depression was associated with low family income, unemployment, low education, not married, migration, poor relationship with spouse, poor social support, and visiting commercial sex workers
People’s Republic of China, Sun et al^Citation50	CES-D	772	73.1	Depression was associated with health status, perceived social support, job, and gender
People’s Republic of China, Qiu et al^Citation51	PHQ-9	370	40.3	Depression was associated with employment status, sexual orientation, resident status, emergence of HIV-related symptoms, stress, and social support
Haitian females in USA, Glémaud et al^Citation52		96	49	12.5% of subjects gave a history of abuse; 34% of subjects had PTSD
Lowther et al^Citation53	Systematic review	66 original studies	33.60	Low- and middle-income countries had a higher prevalence of depression (41.36%) compared to high-income countries (25.81%)
Western Europe and Canada, Robertson et al^Citation5	HADS	2,863	15.7 (14.3% of male and 17.9% of female)	Depression occurred significantly more often in females compared to males
South Korea, Kee et al^Citation54	BDI	840	36	Both anxiety and depression were associated with persistent symptoms, alcohol and tobacco use, and marital status
Brazil, Nomoto et al^Citation55	BDI	59	61	Depression was significantly associated with low income, low social class, and poor QoL
Denmark, Slot et al^Citation56	BDI	212	35	Depression was associated with stress, poor health, dissatisfaction with life situation, ART nonadherence, and past history of alcohol abuse or psychiatric treatment

Abbreviations: AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; BDI, Beck Depression Inventory; CDRS-R, Children’s Depression Rating Scale-Revised; CES-D, Center for Epidemiologic Studies Depression Scale; CIS-R, Clinical Interview Schedule-Revised; DSM, Diagnostic and Statistical Manual of Mental Disorders; GAD, generalized anxiety disorder; HADS, Hospital Anxiety and Depression Scale; HIV, human immunodeficiency virus; ICD, International Classification of Diseases; M.I.N.I., Mini International Neuropsychiatric Interview; PHQ-9, Patient Health Questionnaire; PLWHA, persons living with HIV/AIDS; PTSD, post-traumatic stress disorder; QoL, quality of life; SCID-NP, Structured Clinical Interview for DSM-IV non-patient; SRDS, Self-rating depression scale.

Table 2 Prevalence of anxiety in patients with HIV

Location, reference	Scale	Sample size	Anxiety prevalence, %	Associated findings
People’s Republic of China, Lu et al^Citation26	SRAS	102	43.13	Anxiety and depression were associated with low CD4^+ T-lymphocyte counts
Kenya, Musisi and Kinyanda^Citation27	ICD 10 criteria	82	45.6	Other comorbid disorders included depression, somatization, seizures, mania, and HIV-associated progressive encephalopathy
Thailand, Nüesch et al^Citation28	HADS	251	16.3	ART improved mental health and QoL
Tanzania, Marwick and Kaaya^Citation29	CISR	220	4.5	During HIV care, comorbid psychiatric disorders should be identified and managed
India, Sivasubramanian et al^Citation31	M.I.N.I.; DSM-IV	150	24	Anxiety associated with low levels of social support
Albania, Morrison et al^Citation32	Semistructured interview	79	82.3	Anxiety significantly associated with depression, first-line ART, recent HIV diagnosis, and greater medical and social needs
Nigeria, Olagunju et al^Citation57	SCAN	4,000	21.7	Anxiety was associated with low family support, lack of employment, and being unmarried
Canada, Ivanova et al^Citation58	HADS (HADS-A ≥11)	361	37 had high anxiety	Anxiety was associated with stigma, ART, and worries about reproductive health
India, Agarwal et al^Citation35	HADS	50	54	46% of PLWHA had low psychological well-being
South Africa, Pappin et al^Citation36	HADS	716	30.6	Anxiety was associated with ART side effects, avoidant coping, and stigma
India, Chauhan et al^Citation43	HADS	100	19	Asymptomatic PLWHA had significantly higher prevalence of alcohol dependence, adjustment disorder, and sexual dysfunction compared to control subjects
Italy, Celesia et al^Citation59	SRAS	251	47	Anxiety was associated with a high number of ART switches
Nigeria, Olagunju et al^Citation40	SCID-NP	295	8.1	Compared to the general population, PLWHA suffer from more psychiatric disorders
USA, Parhami et al^Citation60	NA	7,834	16	53% of the patients had a psychiatric condition, including mood disorder (23%) and substance-related disorder (19%)
People’s Republic of China, Liu et al^Citation42	SRAS	320	45.6	Depression and anxiety in PLWHA could be reduced by high social support
Israel, Levy^Citation44	STAI	57	18	Neurocognitive disturbances and psychiatric illnesses are common in asymptomatic PLWHA, independent of the time of being positive, immunological status, viral load, or treatment received
South Africa, Nel and Kagee^Citation45	BAI	101	28.7	–
Western Europe and Canada, Robertson et al^Citation5	HADS	2,863	33.3	No significant difference was found between those receiving combination ART and those not receiving it
Romania, Largu et al^Citation46	HAS	146	71 (54% mild, 14% severe, and 3% very severe anxiety)	PLWHA were afraid (of death, complications, other people’s reaction to the diagnosis), confused (in terms of diagnosis, the mode of infection, the future), angry (against the source of infection, themselves, God), felt guilty and blamed themselves
Germany, Kittner et al^Citation48	HADS	80	40 (male) and 73 (female)	Guilt for the HIV infection was present in 36% of PLWHA
People’s Republic of China, Sun et al^Citation50	SRAS	772	49	Anxiety was associated with health status, social support, alcohol consumption, and condom use at the last sexual contact
People’s Republic of China, Qiu et al^Citation51	GAD-7	370	30.5	Anxiety associated with employment status, sexual orientation, resident status, emergence of HIV-related symptoms, and stress
Ethiopia, Belete et al^Citation22	BAI	436	22.2	Being female, perceived stigma, started ART, and divorced were significantly associated with anxiety
Haitian females in USA, Glémaud et al^Citation52	NA	96	43	12.5% of subjects gave a history of abuse; 34% of subjects had PTSD
Lowther et al^Citation53	Systematic review	66 original studies	28.38	Low- and middle-income countries had a higher prevalence (33.92%) compared to high-income countries (25.53%)
South Korea, Kee et al^Citation54	STAI	840	32	Both anxiety and depression were associated with persistent symptoms, alcohol and tobacco use, and marital status

Abbreviations: AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; BAI, Beck Anxiety Inventory; CISR, Clinical Interview Schedule-Revised; DSM, Diagnostic and Statistical Manual of Mental Disorders; GAD-7, Generalized Anxiety Disorder Scale; HADS, Hospital Anxiety and Depression Scale; HAS, Hamilton Anxiety Scale; HIV, human immunodeficiency virus; ICD, International Classification of Diseases; M.I.N.I., Mini-International Neuropsychiatric Interview; PLWHA, persons living with HIV/AIDS; PTSD, post-traumatic stress disorder; QoL, quality of life; SCAN, Schedule for clinical assessment in neuropsychiatry; SCID-NP, Structured Clinical Interview for DSM-IV non-patient; SRAS, Zung Self-Rating Anxiety Scale; STAI, State-Trait Anxiety Inventory; NA, not available.

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