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      Untreated depression among persons living with human immunodeficiency virus in Kazakhstan: A cross-sectional study

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          Abstract

          Background

          In Kazakhstan, scarce official prevalence data exists for mood disorders. This study investigates the occurrence of depressive symptoms among people living with HIV/AIDS (PLWHA), and the relationship between depressive symptoms, HIV treatment initiation and antiretroviral treatment (ART) adherence.

          Methods

          A cross-sectional study was conducted among patients seen at the Almaty AIDS Center between April and December 2013. Two data sources were used: 1) self-administered survey that included the Patient Health Questionnaire (PHQ-9) to capture depression symptoms and 2) medical record review. Two primary outcomes were evaluated with log-binomial models and Fisher’s exact test: the relationship between depression symptoms and 1) HIV treatment group, and 2) HIV adherence.

          Results

          Of the 564 participants, 9.9% reported symptoms consistent with a depressive disorder. None had received treatment for depression. Among those not on ART, a relationship between depressive symptoms and low CD4 counts (≤ 350 cells/mm 3) was evident (7.1% for CD4 ≤ 350 cells/mm 3 vs. 0.9% for CD4 > 350 cells/mm 3, p = 0.029). In multivariable analysis, a higher prevalence of depressive symptoms was statistically associated with ART treatment, positive hepatitis C virus (HCV) status, and being unmarried. For those taking ART, treatment adherence was not statistically associated with a lower prevalence of depressive symptoms (12.5% vs 20.0%, p = 0.176); limited power may have impacted statistical significance.

          Conclusions

          Untreated depression was found among PLWHA suggesting the need to evaluate access to psychiatric treatment. A collaborative strategy may be helpful to optimize HIV treatment outcomes.

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          Most cited references63

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          Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population.

          The aim of this study was to assess the validity of the Patient Health Questionnaire depression module (PHQ-9). It has been subject to studies in medical settings, but its validity as a screening for depression in the general population is unknown. A representative population sample (2,066 subjects, 14-93 years) filled in the PHQ-9 for diagnosis [major depressive disorder, other depressive disorder, depression screen-positive (DS+) and depression screen-negative (DS-)] and other measures for distress (GHQ-12), depression (Brief-BDI) and subjective health perception (EuroQOL; SF-36). A prevalence rate of 9.2% of a current PHQ depressive disorder (major depression 3.8%, subthreshold other depressive disorder 5.4%) was identified. The two depression groups had higher Brief-BDI and GHQ-12 scores, and reported lower health status (EuroQOL) and health-related quality of life (SF-36) than did the DS- group (P's < .001). Strong associations between PHQ-9 depression severity and convergent variables were found (with BDI r = .73, with GHQ-12 r = .59). The results support the construct validity of the PHQ depression scale, which seems to be a useful tool to recognize not only major depression but also subthreshold depressive disorder in the general population.
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            Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis.

            We meta-analyzed the relationship between depression and HIV medication nonadherence to calculate the overall effect size and examine potential moderators. Overall, across 95 independent samples, depression was significantly (P < 0.0001) associated with nonadherence (r = 0.19; 95% confidence interval = 0.14 to 0.25). Studies evaluating medication adherence via interview found significantly larger effects than those using self-administered questionnaires. Studies measuring adherence along a continuum found significantly stronger effects than studies comparing dichotomies. Effect size was not significantly related to other aspects of adherence or depression measurement, assessment interval (ie, cross-sectional vs. longitudinal), sex, IV drug use, sexual orientation, or study location. The relationship between depression and HIV treatment nonadherence is consistent across samples and over time, is not limited to those with clinical depression, and is not inflated by self-report bias. Our results suggest that interventions aimed at reducing depressive symptom severity, even at subclinical levels, should be a behavioral research priority.
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              Sex and depression in the National Comorbidity Survey. I: Lifetime prevalence, chronicity and recurrence.

              Basic epidemiologic prevalence data are presented on sex differences in DSM-III-R major depressive episodes (MDE). The data come from the National Comorbidity Survey (NCS), the first survey in the U.S. to administer a structured psychiatric interview to a nationally representative sample of the general population. Consistent with previous research, women are approximately 1.7 times as likely as men to report a lifetime history of MDE. Age of onset analysis shows that this sex difference begins in early adolescence and persists through the mid-50s. Women also have a much higher rate of 12-month depression than men. However, women with a history of depression do not differ from men with a history of depression in either the probability of being chronically depressed in the past year or in the probability of having an acute recurrence in the past year. This means that the higher prevalence of 12-month depression among women than men is largely due to women having a higher risk of first onset. The implications of these results for future research are discussed in a closing section of the paper.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Project administrationRole: Writing – review & editing
                Role: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Formal analysisRole: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                28 March 2018
                2018
                : 13
                : 3
                : e0193976
                Affiliations
                [1 ] Department of HIV infection and Infection Control, Asfendiyarov Kazakh National Medical University (KNMU), Almaty, Kazakhstan
                [2 ] Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, United States of America
                [3 ] Almaty City AIDS Centre, Almaty, Kazakhstan
                [4 ] Department of Public Health, Asfendiyarov Kazakh National Medical University (KNMU), Almaty, Kazakhstan
                [5 ] Albany College of Pharmacy & Health Sciences, Albany, New York, United States of America
                [6 ] Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States of America
                [7 ] Department of Psychiatry, Albany Medical College, Albany, New York, United States of America
                [8 ] Institute for Health and the Environment, University at Albany, State University of New York, Rensselaer, New York, United States of America
                The University of New South Wales, Neuroscience Research Australia, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-7815-0004
                Article
                PONE-D-16-41608
                10.1371/journal.pone.0193976
                5873996
                29590151
                b06c13c1-79b4-4e05-9667-895b5e83b81a
                © 2018 Terloyeva et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 18 October 2016
                : 22 February 2018
                Page count
                Figures: 0, Tables: 5, Pages: 18
                Funding
                This study was supported by a Kazakh National Medical University Research Grant and New York State International Training and Research Program (NYS-ITRP) sponsored by the Fogarty International Centre and National Institute of Drug Abuse, National Institutes of Health, USA (NIH Grant D43 TW000233). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Medicine and health sciences
                Diagnostic medicine
                HIV clinical manifestations
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Antiviral Therapy
                Antiretroviral Therapy
                Medicine and Health Sciences
                Immunology
                Vaccination and Immunization
                Antiviral Therapy
                Antiretroviral Therapy
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Vaccination and Immunization
                Antiviral Therapy
                Antiretroviral Therapy
                Medicine and health sciences
                Diagnostic medicine
                HIV diagnosis and management
                Medicine and health sciences
                Epidemiology
                HIV epidemiology
                Medicine and Health Sciences
                Mental Health and Psychiatry
                People and Places
                Geographical Locations
                Asia
                Kazakhstan
                People and Places
                Geographical Locations
                Europe
                Kazakhstan
                Medicine and Health Sciences
                Infectious Diseases
                Viral Diseases
                AIDS
                Custom metadata
                The data are confidential due to the possibility to identify individuals. The study was approved by the Research Ethics Committee at the Kazakh National Medical University (KazNMU) with the agreement of confidentiality. Interested researchers can request data access from the Chair of the Local Ethics Committee is Dr. Lyazzat Eralieva, her e-mail is l.eralieva@ 123456mail.ru .

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                Uncategorized

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