Depression underdiagnosis and the effects on quality of life in outpatients with HIV at a Nigerian university teaching hospital

Abstract

The study aimed to determine the frequency of depressive disorder in a sample of patients with HIV and its level of underdiagnosis by attending physicians. The  study also explored the effect of depressive disorder on the quality of life (QOL) of patients with HIV. A sociodemographic questionnaire was administered to patients with HIV attending a medical out-patient clinic at Ahmadu Bello University Teaching Hospital, central northern Nigeria. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to screen for depressive symptoms, and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used to confirm the diagnosis of depressive disorder. The patients’ medical records were screened for documentation of depressive symptoms or previous treatment with antidepressants by an attending physician. The World Health Organization Quality of Life assessment short version (WHOQOL-BREF) was used to measure six domains of QOL. A total of 310 patients with HIV participated in the study; of these, 14.2% (n = 44) met the diagnostic criteria for depressive disorder, according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). All of these cases of depressive disorder had not been previously recognised by any attending physician. Of the 310 participants, 58 (18.7%) had a ‘poor’ score and 252 (81.3%) had an ‘average or above’ score for overall QOL. Of the 44 with depressive disorder, 28 (63.6%) were among those with a poor score for overall QOL. A fairly similar pattern was observed for all the other domains, with patients with depressive disorder accounting for greater proportions of the  participants with poor domain scores. Thus, the authors found that depression is common but seldom clinically recognised in people with HIV, and that it is associated with a reduction in quality of life. Identifying and treating depression in patients with HIV will improve functioning and general wellbeing. 

Keywords: Africa, depressive disorder, mental health, outpatients, prevalence, primary healthcare, psychological aspects, surveys, symptoms

African Journal of AIDS Research 2011, 10(3): 247–254