A comparative study of the prevalence and clinical features associated with depression among HIV- positive and HIV- negative elderly patients in Mulago Hospital

Abstract

INTRODUCTION HIV/AIDS still remains a global health problem. Depression is a leading contributor to the burden of disease worldwide, a critical barrier to HIV care and as well as prevention and a common serious HIV co-morbidity especially in the Sub- Saharan Africa. However, it’s not clear whether the depression among the elderly HIV/AIDS positive individuals has the same characteristics as that in elderly HIV/AIDS negative individuals. Objectives To compare the prevalence and clinical features associated with depression among elderly HIV positive and HIV negative patients in Mulago Hospital. Methods This was a comparative cross sectional study of HIV positive and HIV negative individuals aged ≥ 60 years. They were enrolled from the Assessment Centre and the AIDS clinic, Mulago Hospital. The Geriatric Depression Scale was used to screen for depression, individuals with a score of ≥10 had the diagnosis of depression confirmed using the Mini-International Neuropsychiatric Interview (M.I.N.I.plus). Data was entered using ACCESS data -base and analyzed using STATA version 11.0 software. Cross tabulations were done for the two groups using means, chi-squares and frequencies. Univariate, logistic regression, and multivariate analysis were done to determine which clinical features were associated with depression among the HIV positive elderly individuals. Results Of 940 elderly patients screened at the 2 study sites, 238(26.4%) had significant depression symptoms having scored above the cutoff point of ≥ 10. Their mean age was 66.8, SD 6.07. The prevalence of major depression was higher among the HIV positive elderly (47.9%) than the HIV negative elderly individuals (22.7%). However, the prevalence of Dysthymia and Adjustment disorder with depressed mood were higher among the HIV negative positive elderly than the HIV positive elderly individuals (68.9% versus 50.4%) and (8.4% versus 1.7%) respectively. Regarding clinical features associated with depression, HIV positive depressed elderly were more likely to report suicidal ideation (p< 0.04), Sleep problems (p<0.03), feeling tired (p<0.04) and feeling worthless (P<0.01). Conclusion The clinical features associated with depression among the elderly HIV-positive patients which differ from those of HIV-negative elderly patients. This requires a different approach in the management and care strategies related to HIV and depression among the elderly. These findings call for routine screening and treatment of depressive illnesses in all HIV infected elderly individuals especially the late onset depressive illness and in populations highly endemic for HIV/AIDS. Key words: Clinical features; Depression; Elderly; HIV/AIDS; Uganda

INTRODUCTION HIV/AIDS still remains a global health problem. Depression is a leading contributor to the burden of disease worldwide, a critical barrier to HIV care and as well as prevention and a common serious HIV co-morbidity especially in the Sub- Saharan Africa. However, it’s not clear whether the depression among the elderly HIV/AIDS positive individuals has the same characteristics as that in elderly HIV/AIDS negative individuals. Objectives To compare the prevalence and clinical features associated with depression among elderly HIV positive and HIV negative patients in Mulago Hospital. Methods This was a comparative cross sectional study of HIV positive and HIV negative individuals aged ≥ 60 years. They were enrolled from the Assessment Centre and the AIDS clinic, Mulago Hospital. The Geriatric Depression Scale was used to screen for depression, individuals with a score of ≥10 had the diagnosis of depression confirmed using the Mini-International Neuropsychiatric Interview (M.I.N.I.plus). Data was entered using ACCESS data -base and analyzed using STATA version 11.0 software. Cross tabulations were done for the two groups using means, chi-squares and frequencies. Univariate, logistic regression, and multivariate analysis were done to determine which clinical features were associated with depression among the HIV positive elderly individuals. Results Of 940 elderly patients screened at the 2 study sites, 238(26.4%) had significant depression symptoms having scored above the cutoff point of ≥ 10. Their mean age was 66.8, SD 6.07. The prevalence of major depression was higher among the HIV positive elderly (47.9%) than the HIV negative elderly individuals (22.7%). However, the prevalence of Dysthymia and Adjustment disorder with depressed mood were higher among the HIV negative positive elderly than the HIV positive elderly individuals (68.9% versus 50.4%) and (8.4% versus 1.7%) respectively. Regarding clinical features associated with depression, HIV positive depressed elderly were more likely to report suicidal ideation (p< 0.04), Sleep problems (p<0.03), feeling tired (p<0.04) and feeling worthless (P<0.01). Conclusion The clinical features associated with depression among the elderly HIV-positive patients which differ from those of HIV-negative elderly patients. This requires a different approach in the management and care strategies related to HIV and depression among the elderly. These findings call for routine screening and treatment of depressive illnesses in all HIV infected elderly individuals especially the late onset depressive illness and in populations highly endemic for HIV/AIDS. Key words: Clinical features; Depression; Elderly; HIV/AIDS; Uganda

INTRODUCTION HIV/AIDS still remains a global health problem. Depression is a leading contributor to the burden of disease worldwide, a critical barrier to HIV care and as well as prevention and a common serious HIV co-morbidity especially in the Sub- Saharan Africa. However, it’s not clear whether the depression among the elderly HIV/AIDS positive individuals has the same characteristics as that in elderly HIV/AIDS negative individuals. Objectives To compare the prevalence and clinical features associated with depression among elderly HIV positive and HIV negative patients in Mulago Hospital. Methods This was a comparative cross sectional study of HIV positive and HIV negative individuals aged ≥ 60 years. They were enrolled from the Assessment Centre and the AIDS clinic, Mulago Hospital. The Geriatric Depression Scale was used to screen for depression, individuals with a score of ≥10 had the diagnosis of depression confirmed using the Mini-International Neuropsychiatric Interview (M.I.N.I.plus). Data was entered using ACCESS data -base and analyzed using STATA version 11.0 software. Cross tabulations were done for the two groups using means, chi-squares and frequencies. Univariate, logistic regression, and multivariate analysis were done to determine which clinical features were associated with depression among the HIV positive elderly individuals. Results Of 940 elderly patients screened at the 2 study sites, 238(26.4%) had significant depression symptoms having scored above the cutoff point of ≥ 10. Their mean age was 66.8, SD 6.07. The prevalence of major depression was higher among the HIV positive elderly (47.9%) than the HIV negative elderly individuals (22.7%). However, the prevalence of Dysthymia and Adjustment disorder with depressed mood were higher among the HIV negative positive elderly than the HIV positive elderly individuals (68.9% versus 50.4%) and (8.4% versus 1.7%) respectively. Regarding clinical features associated with depression, HIV positive depressed elderly were more likely to report suicidal ideation (p< 0.04), Sleep problems (p<0.03), feeling tired (p<0.04) and feeling worthless (P<0.01). Conclusion The clinical features associated with depression among the elderly HIV-positive patients which differ from those of HIV-negative elderly patients. This requires a different approach in the management and care strategies related to HIV and depression among the elderly. These findings call for routine screening and treatment of depressive illnesses in all HIV infected elderly individuals especially the late onset depressive illness and in populations highly endemic for HIV/AIDS. Key words: Clinical features; Depression; Elderly; HIV/AIDS; Uganda

INTRODUCTION HIV/AIDS still remains a global health problem. Depression is a leading contributor to the burden of disease worldwide, a critical barrier to HIV care and as well as prevention and a common serious HIV co-morbidity especially in the Sub- Saharan Africa. However, it’s not clear whether the depression among the elderly HIV/AIDS positive individuals has the same characteristics as that in elderly HIV/AIDS negative individuals. Objectives To compare the prevalence and clinical features associated with depression among elderly HIV positive and HIV negative patients in Mulago Hospital. Methods This was a comparative cross sectional study of HIV positive and HIV negative individuals aged ≥ 60 years. They were enrolled from the Assessment Centre and the AIDS clinic, Mulago Hospital. The Geriatric Depression Scale was used to screen for depression, individuals with a score of ≥10 had the diagnosis of depression confirmed using the Mini-International Neuropsychiatric Interview (M.I.N.I.plus). Data was entered using ACCESS data -base and analyzed using STATA version 11.0 software. Cross tabulations were done for the two groups using means, chi-squares and frequencies. Univariate, logistic regression, and multivariate analysis were done to determine which clinical features were associated with depression among the HIV positive elderly individuals. Results Of 940 elderly patients screened at the 2 study sites, 238(26.4%) had significant depression symptoms having scored above the cutoff point of ≥ 10. Their mean age was 66.8, SD 6.07. The prevalence of major depression was higher among the HIV positive elderly (47.9%) than the HIV negative elderly individuals (22.7%). However, the prevalence of Dysthymia and Adjustment disorder with depressed mood were higher among the HIV negative positive elderly than the HIV positive elderly individuals (68.9% versus 50.4%) and (8.4% versus 1.7%) respectively. Regarding clinical features associated with depression, HIV positive depressed elderly were more likely to report suicidal ideation (p< 0.04), Sleep problems (p<0.03), feeling tired (p<0.04) and feeling worthless (P<0.01). Conclusion The clinical features associated with depression among the elderly HIV-positive patients which differ from those of HIV-negative elderly patients. This requires a different approach in the management and care strategies related to HIV and depression among the elderly. These findings call for routine screening and treatment of depressive illnesses in all HIV infected elderly individuals especially the late onset depressive illness and in populations highly endemic for HIV/AIDS. Key words: Clinical features; Depression; Elderly; HIV/AIDS; Uganda