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Comorbid Depression Adversely Affects ART Adherence, Quality of Life


Antiretroviral therapy (ART) adherence and quality of life were negatively correlated with the occurrence of major depressive disorder in people living with HIV or AIDS.

A study recently conducted in northwest Ethiopia is showing that among persons living with HIV or AIDS (PLWHA), having major depressive disorder (MDD) indicated a higher risk of nonadherence to antiretroviral therapy (ART) and lower overall quality of life (QOL), report the results published in BMC Psychiatry.

“Comorbid major depression contributes to a two-fold higher risk of mortality among PLWHA,” the study authors stated. “Understanding the relationships of major depression, adherence to antiretroviral therapy and QoL is important to identify areas for intervention.” They also point out that MDD is the most common mental disorder among this patient population, although exact measurements vary.

This finding has been pointed out in previous studies.

They also investigated the relationships between sociodemographic and clinical factors linked to MDD, ART adherence, and QOL through univariate and multivariate Poisson regressions and multivariate linear regression. MDD was assessed via Mini International Neuropsychiatric Interview, QOL by WHOQOL-HIV-BREF-Eth (measures physical, psychological, independence, social, environmental, and spiritual domains), and ART adherence by pill count data. No statistical association was identified between ART adherence and overall QPL.

The 393 patients included in the study analyses, conducted between July and October 2019, were recruited from the ART clinic of Felege-Hiwot referral hospital through random sampling. Most (99.5%) completed all interviews, 69.3% were women, the mean (SD) age was 38.7 (9.1) years, and 74.6% were on first-line ART.

PLWHA who had comorbid MDD were shown to have a QOL that was lower by 0.17 points compared with PLWHA who did not have MDD and lower ART adherence when controlling for functional disability (risk ratio [RR], 1.43; 95% CI, 1.05-1.96; P = .025).

Higher QOL was positively associated with higher level of education (P < .001), first-line vs second-line ART (P < .008), longer duration of ART adherence (< 6 vs 6-10 years; P = .022), good social support (P < .001), and no functional disability (P < .001).

Functional disability was evaluated using the World Health Organization Disability Assessment Schedule, with items measured on a scale from 0 (no difficulty) to 4 (extreme difficulty/cannot do). A score of 36 and above indicated severe or extreme difficulty. A total 65.5% of the study population was indicated to have functional disability, with the condition having a 5.07-fold greater risk of MDD (95% CI, 3.27-7.86; P < .001) and overall QOL (β = 0.29; 95% CI, 0.21-0.36; P < .001).

The prevalence of MDD did not vary among the men and women in the study, nor by age.

Reasons for MDD leading to worse health outcomes in PLWHA, according to the authors, include interference with immune system functioning, lack of positive thoughts for change, and indirect effects on financial security and employment status.

“We believe that this study could have several implications for health care providers and policy makers to consider mental health conditions as a priority and to act accordingly,” they concluded. “Specifically, routine screening services for depression and other mental disorders should be established at ART clinics and mental health services integrated with HIV care services in Ethiopia.”

Further studies need to investigate the causal relationships among MDD, ART adherence, and QOL of PLWHA to foster a greater understanding of areas to focus on for improvement, the authors wrote.


Asrat B, Lund C, Ambaw F, Garman EC, Schneider M. Major depressive disorder and its association with adherence to antiretroviral therapy and quality of life: cross-sectional survey of people living with HIV/AIDS in Northwest Ethiopia. BMC Psychiatry. Published online September 24, 2020. doi:10.1186/s12888-020-02865-w

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