Depression scores in a cohort of HIV positive women followed from diagnosis in pregnancy to eighteen months postpartum

Abstract

Background Depression has been found in the literature to be a major problem in people living with HIV/AIDS. Not only does this impact on their daily functioning but has been shown to have negative HIV related outcomes, and result in poorer adherence to antiretroviral medication. The population under study was pregnant at the time of diagnosis. It would seem likely that their risk for depression would be greater than even a general HIV infected population, because of the pregnancy and the fact that they might have concerns around the health and future of the unborn infant. There are a limited number of studies looking at levels of depression over time and possible determinants of this depression even in a general HIV infected population. It was thus felt necessary to establish levels of depression and to establish if there were any factors associated with changes over time in this pregnant population. Method Two hundred and ninety three women were recruited at antenatal clinics in Tshwane from June 2003 and December 2004. They were interviewed at approximately 28 weeks gestational age and were followed for 18 months after the birth. Data included socio demographic variables, a “self efficacy score”, past history of violence, disclosure, CD4 count and knowledge score. Psychological variables included measures of stigma, social support, self esteem and coping. Depression was measured using a modified CES-D (Center for Epidemiological Studies Depression Score) Repeated measures mixed linear analysis was used to assess if there were changes in depression scores over time and if there were factors associated with these changes. Results Two hundred and twenty four women were included in the mixed linear analysis. The mean age of the women was 26.5 years (standard deviation -5.1). Seventy six percent (152) were single with a partner. Seventy six percent (171) had some form of secondary education and 14% (32) had some form of tertiary education. Sixty percent (135) lived in a brick house and 35% (79) had running water in the house. Twenty nine percent (64) had a per capita income below the poverty line. The prevalence of borderline depression (CES-D scores above 12) for this group of women at baseline was 45%. There were significant changes in depression scores over time. This was not a linear relationship (significant quadratic time to interview term p=0.008). This was evidenced by the fall off in scores at 3-9 months followed by a subsequent rise. The factors associated with higher depression scores overall were lower active coping (p=0.004), higher avoidant coping (p=0.003), higher internalised stigma (p=0.001), higher housing scores (0.026), lower self–esteem (0.002), a history of violence (p<0.0001) and having no partner (p=0.005). No factors were associated with changes over time. Conclusion There are significant changes in depression scores over time in this cohort of women Depression scores while falling after the birth of the child as in other cohorts, start to rise again. Although there are no specific factors associated with these changes, overall women who have a history of violence, who have no partner, who live in better housing circumstances, who have poor self esteem, who have high levels of internalized stigma and make use of negative coping strategies are more likely to be depressed. Women who make use of active coping strategies are less likely to be depressed. There are a large number of women at baseline who have scores considered to be diagnostic of borderline depression and because of the potential negative consequences to the woman and child, an intervention aimed at addressing the above issues should be devised. This should start in the antenatal period and carry on beyond this time. Copyright