Share This Article:

Depression and Its Relationship to Work Status and Income among HIV Clients in Uganda

Abstract Full-Text HTML Download Download as PDF (Size:107KB) PP. 126-134
DOI: 10.4236/wja.2012.23018    3,730 Downloads   6,084 Views   Citations


Purpose: Despite high levels of depression among persons living with HIV (PLWHIV), little research has investigated the relationship of depression to work status and income in PLWHIV in sub-Saharan Africa, which was the focus of this analysis. Methods: Baseline data from a prospective longitudinal cohort of 798 HIV patients starting antiretroviral therapy in Kampala, Uganda were examined. In separate multivariate analyses, we examined whether depressive severity and symptom type [as measured by the Patient Health Questionnaire (PHQ-9)] and major depression [diagnosed with the Mini International Neuropsychiatric Interview (MINI)] were associated with work status and income, controlling for demographics, physical health functioning, work self-efficacy, social support and internalized HIV stigma. Results: 14% of the sample had Major Depression and 66% were currently working. Each measure of depression (PHQ-9 total score, somatic and cognitive subscales; Major Depression diagnosis) was associated with not working and lower average weekly income in bivariate analysis. However, none of the depression measures remained associated with work and income in multivariate analyses that controlled for other variables associated with these economic outcomes. Conclusions: These findings suggest that while depression is related to work and income, its influence may only be indirect through its relationship to other factors such as work self-efficacy and physical health functioning.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

G. J. Wagner, B. Ghosh-Dastidar, D. Akena, N. Nakasujja, E. Okello, E. Luyirika and S. Musisi, "Depression and Its Relationship to Work Status and Income among HIV Clients in Uganda," World Journal of AIDS, Vol. 2 No. 3, 2012, pp. 126-134. doi: 10.4236/wja.2012.23018.


[1] United Nations Programme on HIV/AIDS (UNAIDS), “Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector,” Progress Report, 2008.
[2] R. Brandt, “The Mental Health of People Living with HIV/AIDS in Africa: A Systematic Review,” African Journal of AIDS Research, Vol. 8, No. 2, 2009, pp. 123-133. doi:10.2989/AJAR.2009.
[3] P. Y. Collins, A. R. Homan, M. C. Freeman and V. Patel, “What Is the Relevance of Mental Health to HIV/AIDS Care and Treatment Programs in Developing Countries? A Systematic Review,” AIDS, Vol. 20, No. 12, 2006, pp. 1571-1582. doi:10.1097/01.aids.0000238402.70379.d4
[4] L. Myer, J. Smit, L. L. Le Roux, S. Parker, D. J. Stein and S. Seedat, “Common Mental Disorders among HIV-Infected Individuals in South Africa: Prevalence, Predictors, and Validation of Brief Psychiatric Rating Scales,” AIDS Patient Care STDs, Vol. 22, No. 2, 2008, pp. 147-157. doi:10.1089/apc.2007.0102
[5] B. O. Olleya, S. Seedat and D. J. Stein, “Persistence of Psychiatric Disorders in a Cohort of HIV/AIDS Patients in South Africa: A 6-Month Follow-Up Study,” Journal of Psychosomatic Research, Vol. 61, No. 4, 2006, pp. 479-484. doi:10.1016/j.jpsychores.2006.03.010
[6] M. B. Sebit, M. Tombe, S. Siziya, S. Balus, S. D. Nkomo and P. Maramba, “Prevalence of HIV/AIDS and Psychiatric Disorders and their Related Risk Factors among Adults in Epworth, Zimbabwe,” East African Medical Journal, Vol. 80, No. 10, 2003, pp. 503-512.
[7] P. Bolton, C. M. Wilk and L. Ndogoni. “Assessment of Depression Prevalence in Rural Uganda Using Symptom and Function Criteria,” Social Psychiatry and Psychiatric Epidemiology, Vol. 39, No. 6, 2004, pp. 442-447. doi:10.1007/s00127-004-0763-3
[8] A. Ammassari, A. Antinori, M. S. Aloisi, M. P. Trotta, R. Murri, L. Bartoli, A. D. Monforte, A. W. Wu and F. Starace, “Depressive Symptoms, Neurocognitive Impairment, and Adherence to Highly Active Antiretroviral Therapy among HIV-Infected Persons,” Psychosomatics, Vol. 45, No. 5, 2004, pp. 394-402. doi:10.1176/appi.psy.45.5.394
[9] G. J. Wagner, K. Goggin, R. H. Remien, M. I. Rosen, J. Simoni, D. R. Bangsberg, H. Liu and MACH14 Investigators, “A Closer Look at Depression and Its Relationship to HIV Antiretroviral Adherence,” Annals of Behavioral Medicine, Vol. 42, No. 3, 2011, pp. 352-360. doi:10.1007/s12160-011-9295-8
[10] J. R. Ickovics, M. E. Hamburger, D. Vlhaov, E. E. Schoenbaum, P. Schuman, R. J. Boland, J. Moore and HIV Epidemiology Research Study Group, “Mortality, CD4 Cell Count Decline, and Depressive Symptoms among HIV Sero-Positive Women: Longitudinal Analysis from the HIV Epidemiology Research Study,” Journal of the American Medical Association, Vol. 285, No. 11, 2001, pp. 1466-1474. doi:10.1001/jama.285.11.1466
[11] G. Antelman, S. Kaaya, R. Wei, J. Mbwambo, G. I. Msamanga, W. W. Fawzi and M. C. Fawzi, “Depressive Symptoms Increase Risk of HIV Disease Progression and Mortality among Women in Tanzania,” Journal of Acquired Immune Deficiency Syndromes, Vol. 44, No. 4, 2007, pp. 470-477. doi:10.1097/QAI.0b013e31802f1318
[12] W. S. Comulada, M. J. Rotheram-Borus, W. Pequegnat, R. E. Weiss, K. A. Desmond, E. M. Arnold, R. H. Remien, S. F. Morin, L. S. Weinhardt, M. O. Johnson and M. A. Chesney, “Relationships over Time between Mental Health Symptoms and Transmission Risk among Persons Living with HIV,” Psychology of Addictive Behaviors, Vol. 24, No. 1, 2010, pp. 109-118. doi:10.1037/a0018190
[13] G. J. Wagner, B. Ghosh-Dastidar, I. Holloway, C. Kityo, and P. Mugyenyi, “Depression in the Pathway of HIV Antiretroviral Effects on Sexual Risk Behavior among Patients in Uganda,” AIDS &Behavior, 2012, in Press.
[14] G. J. Wagner, G. Ryan, A. Huynh, C. Kityo and P. Mugyenyi, “A Qualitative Analysis of the Economic Impact of HIV and Antiretroviral Therapy on Individuals and Households in Uganda,” AIDS Patient Care and STDs, Vol. 23, No, 9, 2009, pp. 793-798. doi:10.1089/apc.2009.0028
[15] A. Bandura, “Social Foundations of Thought and Action: A Social Cognitive Theory,” Prentice Hall, Englewood Cliffs, 1986.
[16] M. Preau, A. Bonnet, A. D. Bouhnik, L. Fernandez, Y. Obadia, B. Spire B and VESPA, “Anhedonia and Depressive Symptomatology among HIV-Infected Patients with Highly Active Antiretroviral Therapies (ANRS-EN12-VESPA),” Encephale, Vol. 34, No. 4, 2008, pp. 385-393.
[17] E. Okello and S. Neema, “Explanatory Models and Help Seeking Behavior: Pathways to Psychiatric Care among Patients Admitted for Depression in Mulago Hospital, Kampala, Uganda,” Qualitative Health Research, Vol. 17, No, 1, 2007, pp. 14-25. doi:10.1177/1049732306296433
[18] G. J. Wagner, I. Holloway, B. Ghosh-Dastidar, C. Kityo and P. Mugyenyi, “Understanding the Influence of Depression on Self-Efficacy, Work Status and Condom Use among HIV Clients in Uganda,” Journal of Psychosomatic Research, Vol. 70, No. 5, 2010, pp. 440-448. doi:10.1016/j.jpsychores.2010.10.003
[19] American Psychiatric Association, “American Psychiatric Association, Diagnostic Statistical Manual of Mental Disorders,” 4th Edition, American Psychiatric Association, Washington, 1994.
[20] K. Kroenke, R. L. Spitzer and J. B. W. Williams, “The PHQ-9: Validity of a Brief Depression Severity Measure,” Journal of General Internal Medicine, Vol. 16, No. 9, 2001, pp. 606-613. doi:10.1046/j.1525-1497.2001.016009606.x
[21] P. O. Monahan, E. Shacham, M. Reece, K. Kroenke, W. O. Ong’or, O. Omollo, V. N. Yebei and C. Oiwang, “Validity/Reliability of PHQ-9 and PHQ-2 Depression Scales among Adults Living with HIV/AIDS in Western Kenya,” Journal of General Internal Medicine, Vol. 24, No. 2, 2009, pp. 189-197. doi:10.1007/s11606-008-0846-z
[22] D. V. Sheehan, Y. Lecrubier,K. H. Sheehan, J. Janavs, E. Weiller, A. Keskiner, J. Schinka, E. Knapp, M. Sheehan and G. Dunbar, “The Validity of the Mini International Neuropsychiatric Interview (MINI) According to the SCID-P and Its Reliability,” European Psychiatry, Vol. 12, No. 5, 1997, pp. 232-241. doi:10.1016/S0924-9338(97)83297-X
[23] T. C. Mast, G. Kigozi, F. Wabwire-Mangen, R. Black, N. Sewankambo, D. Serwadda, R. Gray, M. Wawer and A. W. Wu, “Measuring Quality of Life among HIV-Infected Women Using a Culturally Adapted Questionnaire in Rakai District, Uganda,” AIDS Care, Vol. 16, No. 1, 2004, pp. 81-94. doi:10.1080/09540120310001633994
[24] S. C. Kalichman, L. C. Simbayi, S. Jooste, Y. Toefy, D. Cain, C. Cherry and A. Kagee, “Development of a Brief Scale to Measure AIDS-Related Stigma in South Africa,” AIDS & Behavior, Vol. 9, No. 2, 2005, pp. 135-143. doi:10.1007/s10461-005-3895-x
[25] M. A. Chesney, J. R. Ickovics, D. B. Chambers, A. L. Gifford, J. Neidig, B. Zwickl B, A. W. Wu, “Self-Reported Adherence to Antiretroviral Medications among Participants in HIV Clinical Trials: The AACTG Adherence Instruments: Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG),” AIDS Care, Vol. 12, No. 3, 2000, pp. 255-266. doi:10.1080/09540120050042891
[26] Central Intelligence Agency, “The World Factbook,” 2009.
[27] E. Kinyanda, P. Woodburn, J. Tugumisirize, J. Kagugube, S. Ndyanabangi and V. Patel, “Poverty, Life Events and the Risk for Depression in Uganda,” Social Psychiatry and Psychiatric Epidemiology, Vol. 46, No. 1, 2011, pp. 35-44. doi:10.1007/s00127-009-0164-8
[28] F. M. Kaharuza, R. Bunnell, S. Moss, D. W. Purcell, W. Bikaako-Kajura, N. Wamai, R. Downing, P. Solberg, A. Coutinho and J. Mermin, “Depression and CD4 Cell Count among Persons with HIV Infection in Uganda,” AIDS & Behavior, Vol. 10, No. 4, 2006, pp. S105-111. doi:10.1007/s10461-006-9142-2
[29] D. J. Bwakali, “Gender Inequality in Africa: Contemporary Review,” 2001.

comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.