Table 2.
Factors associated with moderate-to-severe depressive symptoms by PHQ-9
| Total patients | Number with moderate to severe depression | Univariate | Multivariate | |||||
|---|---|---|---|---|---|---|---|---|
| OR | 95% CI | p | aOR | 95% CI | p | |||
| Total | 864 | 161 | ||||||
| Age at study assessment (years) | < 0.001 | < 0.001 | ||||||
| ≤ 30 | 203 | 55 | 1 | 1 | ||||
| 31–40 | 270 | 57 | 0.72 | (0.47, 1.10) | 0.131 | 0.81 | (0.51, 1.28) | 0.358 |
| 41–50 | 255 | 31 | 0.37 | (0.23, 0.61) | < 0.001 | 0.39 | (0.23, 0.66) | < 0.001 |
| > 50 | 136 | 18 | 0.41 | (0.23, 0.74) | 0.003 | 0.40 | (0.21, 0.75) | 0.004 |
| Sex | ||||||||
| Male | 758 | 149 | 1 | |||||
| Female | 106 | 12 | 0.52 | (0.28, 0.98) | 0.042 | |||
| Employment | < 0.001 | |||||||
| No | 180 | 49 | 2.41 | (1.59, 3.66) | < 0.001 | |||
| Full time | 499 | 67 | 1 | |||||
| Part time | 123 | 34 | 2.46 | (1.54, 3.95) | < 0.001 | |||
| Not reported/unknown | 62 | 11 | ||||||
| Household income (USD) per month | < 0.001 | < 0.001 | ||||||
| ≤ $500 | 212 | 59 | 1 | 1 | ||||
| $501-$2000 | 258 | 40 | 0.48 | (0.30, 0.75) | 0.001 | 0.52 | (0.31, 0.87) | 0.013 |
| > $2000 | 257 | 28 | 0.32 | (0.19, 0.52) | < 0.001 | 0.31 | (0.16, 0.58) | < 0.001 |
| Not reported/unknown | 137 | 34 | ||||||
| Highest education level | ||||||||
| No education | 4 | 0 | N/A | |||||
| Primary to high school | 277 | 52 | 1.01 | (0.70, 1.45) | 0.975 | |||
| College to university | 562 | 105 | 1 | |||||
| Not reported/unknown | 21 | 4 | ||||||
| HIV mode of exposure | 0.031 | |||||||
| Heterosexual contact | 276 | 48 | 1 | |||||
| MSM | 460 | 78 | 0.97 | (0.65, 1.44) | 0.880 | |||
| Injecting drug use | 15 | 6 | 3.17 | (1.08, 9.31) | 0.036 | |||
| Other/Unknown | 113 | 29 | 1.64 | (0.97, 2.77) | 0.065 | |||
| Year of ART initiation | 0.066 | |||||||
| < 2010 | 236 | 31 | 1 | |||||
| 2010–2012 | 115 | 18 | 1.23 | (0.65, 2.30) | 0.524 | |||
| 2013–2015 | 189 | 41 | 1.83 | (1.10, 3.06) | 0.021 | |||
| 2016–2020 | 313 | 69 | 1.87 | (1.18, 2.97) | 0.008 | |||
| No ART/unknown | 11 | 2 | 1.47 | (0.30, 7.12) | 0.633 | |||
| Viral load at study assessment (copies/mL) | 0.016 | |||||||
| < 50 | 535 | 82 | 1 | |||||
| 50–399 | 37 | 7 | 1.29 | (0.55, 3.03) | 0.561 | |||
| 400–999 | 4 | 1 | 1.84 | (0.19, 17.92) | 0.599 | |||
| ≥ 1000 | 49 | 14 | 2.21 | (1.14, 4.29) | 0.019 | |||
| Not tested | 239 | 57 | ||||||
| CD4 at study assessment (cells/µL) | < 0.001 | |||||||
| ≤ 200 | 73 | 23 | 1 | |||||
| 201–350 | 94 | 21 | 0.63 | (0.31, 1.25) | 0.184 | |||
| 351–500 | 123 | 21 | 0.45 | (0.23, 0.88) | 0.021 | |||
| > 500 | 319 | 43 | 0.34 | (0.19, 0.61) | < 0.001 | |||
| Not tested | 255 | 53 | ||||||
| Current ART | 0.035 | |||||||
| NRTI + NNRTI | 455 | 88 | 1 | |||||
| NRTI + PI | 55 | 14 | 1.42 | (0.74, 2.73) | 0.286 | |||
| INSTI | 320 | 48 | 0.74 | (0.50, 1.08) | 0.119 | |||
| Other | 11 | 2 | 0.93 | (0.20, 4.37) | 0.923 | |||
| None/unknown | 23 | 9 | 2.68 | (1.12, 6.39) | 0.026 | |||
| ART adverse events in the previous year | ||||||||
| No | 603 | 88 | 1 | |||||
| Yes | 93 | 15 | 1.13 | (0.62, 2.04) | 0.698 | |||
| Not reported/unknown | 168 | 58 | ||||||
| ART adherence in the previous year | ||||||||
| ≥ 95 | 566 | 80 | 1 | 1 | ||||
| < 95 | 58 | 16 | 2.31 | (1.24, 4.31) | 0.008 | 2.41 | (1.23, 4.75) | 0.011 |
| Not reported/unknown | 240 | 65 | ||||||
| Prior AIDS diagnosis | ||||||||
| No | 556 | 85 | 1 | |||||
| Yes | 202 | 37 | 1.24 | (0.81, 1.90) | 0.316 | |||
| Not reported | 106 | 39 | ||||||
| HIV disclosure status | 0.173 | |||||||
| Full | 41 | 9 | 1 | |||||
| Partial | 617 | 122 | 0.88 | (0.41, 1.88) | 0.735 | |||
| None, to no one | 162 | 22 | 0.56 | (0.24, 1.33) | 0.187 | |||
| No response/not reported/unknown | 44 | 8 | ||||||
| Hepatitis B co-infection | ||||||||
| Negative | 297 | 36 | 1 | |||||
| Positive | 34 | 3 | 0.70 | (0.20, 2.41) | 0.574 | |||
| Not tested | 533 | 122 | ||||||
| Hepatitis C co-infection | ||||||||
| Negative | 410 | 46 | 1 | |||||
| Positive | 30 | 3 | 0.88 | (0.26, 3.01) | 0.838 | |||
| Not tested | 424 | 112 | ||||||
| History of STIs in the past 5 years | ||||||||
| No | 413 | 58 | 1 | |||||
| Yes | 263 | 43 | 1.20 | (0.78, 1.84) | 0.413 | |||
| Not reported/unknown | 188 | 60 | ||||||
| Current chronic comorbid condition | ||||||||
| No | 352 | 58 | 1 | |||||
| Yes | 150 | 32 | 1.37 | (0.85, 2.22) | 0.195 | |||
| Not reported/unknown | 362 | 71 | ||||||
| Previous mental health diagnosis | ||||||||
| No | 639 | 83 | 1 | 1 | ||||
| Yes | 67 | 25 | 3.99 | (2.31, 6.88) | < 0.001 | 2.97 | (1.65, 5.32) | < 0.001 |
| Not reported/unknown | 158 | 53 | ||||||
| Family history of mental health diagnoses | ||||||||
| No | 739 | 125 | 1 | |||||
| Yes | 34 | 9 | 1.77 | (0.81, 3.88) | 0.155 | |||
| Not reported/unknown | 91 | 27 | ||||||
| Previous stressors | ||||||||
| No | 369 | 32 | 1 | 1 | ||||
| Yes | 437 | 116 | 3.81 | (2.50, 5.79) | < 0.001 | 3.05 | (1.95, 4.75) | < 0.001 |
| Not reported/unknown | 58 | 13 | ||||||
| Moderate to high risk substance use | ||||||||
| No | 439 | 68 | 1 | |||||
| Yes | 425 | 93 | 1.53 | (1.08, 2.16) | 0.016 | |||
| World Bank country income grouping | ||||||||
| High | 334 | 52 | 1 | 1 | ||||
| Upper-middle and lower-middle | 530 | 109 | 1.40 | (0.98, 2.02) | 0.067 | 0.82 | (0.49, 1.36) | 0.435 |
Not reported values were included in the analysis as a separate category but were excluded from test for heterogeneity
Global p-value for age, viral load, CD4, household income were test for trend
OR odds ratio, aOR adjusted odds ratio, CI confidence interval, ART antiretroviral therapy, STIs sexually transmitted infections, MSM men who have sex with men, NRTI nucleoside reverse transcriptase inhibitors, NNRTI non-NRTI, PI protease inhibitors, INSTI integrase inhibitors