Reliability and validity of the Center for Epidemiologic Studies- Depression scale in screening for depression among HIV infected and uninfected pregnant women attending antenatal services in northern Uganda

Authors: Barnabas K. Natamba; Thomas O. Oyok; Angela Arbach; Jane Achan; Shibani Ghosh; Saurabh Mehta; Rebecca J. Stoltzfus; Jeffrey K. Griffiths; Sera L. Young Journal: BMC Psychiatry

In the two decades since the first Global Burden of Disease (GBD) report was released in 1990, the impacts that HIV infection and major depressive disorders (MDDs) have had on medical and public health systems have changed profoundly. The 2010 GBD report indicates that HIV infection has risen from being the 33rd to the 5th contributor to the global burden of disease (Murray et al. 2013). At the same time, the disease burden attributable to MDDs has risen from being the 15th to the 11th. Whereas there has been a surge in information and strategies for managing or preventing HIV infection, practical strategies for managing MDDs are still very limited, particularly in resource poor settings.

In various settings in Sub-Saharan Africa, prevalence rates of MDDs among adults living with HIV ranging from 71.3% in Zambia (Chishinga et al. 2011) to 47% in Uganda (Kaharuza et al. 2006), 43.7% in South Africa (Myer et al. 2008), and 30% in Zimbabwe (Chibanda et al 2010) have been documented. A number of biological factors, psychosocial variables, and mental history or comorbid psychiatric illnesses may help explain why persons with HIV are at a higher risk of depression (Arseniou et al. 2014). Importantly, depression has been associated with increased rates of HIV disease progression and mortality (Antelman et al. 2007), inequity in decision-making and relationship power among heterosexual couples (Hatcher et al. 2012), and AIDS related stigma (Simbayi et al. 2007). Whereas reports indicate that as many as 30% of persons living with HIV/AIDS develop depressive disorders during the course of their illness (Ciesla et al. 2001; Nakimuli-Mpungu et al. 2011), most studies reporting the prevalence or incidence of depressive symptoms among people living with HIV (PLHIV) have not compared this to HIV negative persons. In one small cross-sectional study, where the prevalence of depression in newly tested HIV positive pregnant women were compared to that of HIV negative women, authors did not find an association between HIV infection status and depression (Rochat et al. 2006). Understanding the prevalence and drivers of MDDs among HIV infected and uninfected persons need further clarification so as to enable mental health providers and planners in resource poor settings better target appropriate care for those that are affected most.