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The Factor Structure and Presentation of Depression Among HIV-Positive Adults in Uganda

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Abstract

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.

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Acknowledgments

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).

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Authors and Affiliations

  1. Department of Psychiatry, Behavioral Medicine Service, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA

    Christina Psaros & Steven A. Safren

  2. Harvard Medical School, Boston, MA, USA

    Christina Psaros, Jessica E. Haberer, Alexander C. Tsai, David R. Bangsberg & Steven A. Safren

  3. Center for Global Health, Massachusetts General Hospital, Boston, MA, USA

    Jessica E. Haberer, Alexander C. Tsai & David R. Bangsberg

  4. Mbarara University of Science and Technology, Mbarara, Uganda

    Yap Boum II & David R. Bangsberg

  5. Department of Epidemiology and Biostatistics, University of San Francisco, San Francisco, CA, USA

    Jeffrey N. Martin

  6. Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, CA, USA

    Peter W. Hunt

  7. Epicentre Uganda Research Centre, Mbarara, Uganda

    Yap Boum II

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  1. Christina Psaros
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  2. Jessica E. Haberer
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Correspondence to Christina Psaros.

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Psaros, C., Haberer, J.E., Boum, Y. et al. The Factor Structure and Presentation of Depression Among HIV-Positive Adults in Uganda. AIDS Behav 19, 27–33 (2015). https://doi.org/10.1007/s10461-014-0796-x

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  • DOI: https://doi.org/10.1007/s10461-014-0796-x

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