The Factor Structure and Presentation of Depression Among HIV-Positive Adults in Uganda
- 277 Downloads
Depression is one of the most prevalent psychiatric comorbidities of HIV and one of the greatest barriers to HIV self-care and adherence. Despite this, little consensus exists on how to best measure depression among people living with HIV/AIDS (PLWHA) in African settings. Measurement of depression among PLWHA may be confounded by somatic symptoms. Some research recommends excluding these items to enhance measurement validity; sensitivity may be lost with this approach. We sought to characterize depression among a cohort (N = 453) of PLWHA initiating antiretroviral therapy in Uganda via factor analysis of a widely used measure of depression, the Hopkins Symptom Checklist (HSCLD). Common factor analysis was performed, associations between HSCLD and the Mental Health subscale of the Medical Outcomes Study HIV (MOS-HIV) estimated, and a Cronbach’s alpha calculated to examine validity. Factor analysis yielded two factors: (1) somatic-cognitive symptoms and (2) behavioral disengagement. Persons with more versus less advanced disease (CD4 cell count of ≤200 cells/mm3) showed no statistically significant differences in depression scores (1.7 vs. 1.7, P ≥ 0.5). Both factors were significantly associated with the MOS-HIV (P < .01). Factor one was highly reliable (α = .81); factor two had only modest reliability (α = .65). Somatic-cognitive symptoms of depression and disengagement from life’s activities appear to be distinct components of depression in this sample. Consideration of somatic items may be valuable in identifying depression in this setting.
KeywordsHIV/AIDS Depression Assessment Validity
We would like to thank the UARTO study participants for sharing their experiences with us and the Mbarara-based study team, including Dr. Conrad Muzoora, Dr. Bosco Bwana, Annet Kembabazi and Dr. Anna Baylor, for providing study coordination and support. This work was funded by U.S. National Institutes of Health R01MH054907 and P30AI27763. The authors acknowledge the following additional sources of salary support: K23MH096651 (Psaros), K23MH087228 (Haberer), K23MH096620 (Tsai), K24MH087227 (Bangsberg), K24MH094214 (Safren).
- 6.Tsai AC, Bangsberg DR, Frongillo EA, Hunt PW, Muzoora C, Martin JN, et al. Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med 1982. 2012 Jun;74(12):2012–9.Google Scholar
- 7.UNAIDS. Global Fact Sheet [Internet]. 2012. Available from: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/gr2012/20121120_FactSheet_Global_en.pdf. Accessed 20 May 2014.
- 8.Byakika-Tusiime J, Crane J, Oyugi JH, Ragland K, Kawuma A, Musoke P, et al. Longitudinal antiretroviral adherence in HIV+ Ugandan parents and their children initiating HAART in the MTCT-Plus family treatment model: role of depression in declining adherence over time. AIDS Behav. 2009;13(Suppl 1):82–91.PubMedCrossRefGoogle Scholar
- 22.International HIV Antiretroviral adherence, resistance and survival. ClinicalTrials.gov [Internet]. [cited 2013 Aug 19]. Available from: http://clinicaltrials.gov/ct2/show/NCT01596322. Accessed 20 May 2014.
- 28.The Medical Outcomes Study HIV Health Survey (MOS-HIV) [Internet]. Johns Hopkins Bloomberg School of Public Health. [cited 2013 Aug 19]. Available from: http://www.jhsph.edu/research/affiliated-programs/medical-outcomes-study-HIV/index.html. Accessed 20 May 2014.
- 32.Cattell R. The meaning and strategic use of factor analysis. In: Cattell R, editor. Handbook of multivariate experimental psychology. Chicago, IL: Rand McNally; 1966.Google Scholar
- 36.Shacham E. Self-reported psychological distress symptoms of individuals self-seeking HIV-related psychosocial support in Western Kenya. Bloomington, ID: Indiana University; 2006.Google Scholar
- 41.American Psychiatric Association, American Psychiatric Association, Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association; 2000.Google Scholar
- 43.Nezu AM, Nezu CM, D’Zurilla TJ. Problem-solving therapy: a treatment manual. 2013.Google Scholar
- 44.Tsai AC, Karasic DH, Hammer GP, Charlebois ED, Ragland K, Moss AR, et al. Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults: a randomized controlled trial. Am J Public Health. 2013;103(2):308–15.PubMedCentralPubMedCrossRefGoogle Scholar
- 46.Tsai AC, Weiser SD, Petersen ML, Ragland K, Kushel MB, Bangsberg DR. A marginal structural model to estimate the causal effect of antidepressant medication treatment on viral suppression among homeless and marginally housed persons with HIV. Arch Gen Psychiatry. 2010;67(12):1282–90.PubMedCentralPubMedCrossRefGoogle Scholar