Depression among HIV/AIDS Sudanese patients: a cross-sectional analytic study

Introduction Depression and HIV/AIDS are common morbid health problems; the relationship is bidirectional exacerbating each other with deleterious consequences. There are limited studies on this topic in Sudan. In this study, we investigated depression among HIV/AIDS in Sudan. Methods A cross-sectional analytic study was conducted among 362 HIV/AIDS patients from three centers in Khartoum, Sudan. Data were collected by the Hospital Depression and Anxiety (HADS) questionnaire. Chi-square was used for testing the significance and a P. Value of ≥ 0.05 was considered as statistically significant. Results Depression was evident in 332 (63.1%) of patients 68 (19.3%) had mild depression, 114 (32.4%) moderate depression, and 40 (11.4%) severe depression. Depression was commoner among women, illiterate, married/widowed, not receiving counseling, delaying the result of the test, P-value <0.05, no significant differences were found regarding test and treatment type P- Value >0.05. Conclusion Depression was prevalent among HIV/AIDS patients, especially females, low level of education, and widowed/married patients, and those not receiving counseling and post diagnosis sessions.


Introduction
HIV/AIDS is a major public health concern with about half of new infections occurring in young people; it has become one of the most devastating diseases humanity has ever faced. Sub-Saharan Africa is one of the most severely affected regions in spite the fact that only 10% of the Word population live in this region, with the highest prevalence among the age 15-24 years, putting more pressure on health authorities and policy makers to take measures to reduce mortality and morbidity among this productive age group [1][2][3].
Depression is usually missed or dismissed by primary health physicians despite its high prevalence in the community. It is estimated that about one-half to two-thirds are missed in primary care clinics [4]. People with the diagnosis of HIV/AIDS often face social stigma which adds more to their suffering; they have the restriction of employment and marriage, in some cases it may lead to divorce and family rejection [5]. Patients with HIV may feel anxious due to many reasons like fear of disease progression, body decay, pain, and death [6]. AIDS may affect the brain leading to depression as were AIDS medications, on the other hands depression may affect the patient´s adherence to drugs and may enhance the progression of HIV infection towards AIDS. We are not aware of researchers who have studied depression among HIV/AIDS patients in Sudan; thus, we conducted this research to investigate the prevalence of this serious disorder among Sudanese patients with HIV/AIDS.

Methods
This cross-sectional descriptive study was carried out at Khartoum Hospital during the period from January 2015-January 2016. Three hundred and sixty-two patientswith the diagnosis of HIV were interviewed using the HAD Anxiety and Depression Scale (HADS).
The Questionnaire is well validated for use as a screening tool for depression in general medical outpatient clinics [7] but is now

Discussion
In the present study the prevalence of depression among HIV/AIDS patients was 63.1%, similar researchers reported a prevalence of 72.9% in HIV patients [8]; other researchers observed that 58.7% of HIV patients were depressed [9]. The sample size and the diagnostic tools used may explain the difference. The prevalence concluded in the current study was higher than that reported by research conducted among elderly Sudanese population and found a prevalence of 47.5% [10]. Our data in collaboration with these studies pointed out that depression is highly frequent among Sudanese HIV patients. In the present study mild depression was found in 19.3% of patients, while 43.8% of patients had moderate to severe depression, similarly researchers from Ethiopia reported mild depression, and moderate to severe depression in 27.3%, and 42% respectively [11]. In the current study women with HIV were more depressed than men (68.2% vs 60%) with significant statistical difference P-value 0.002, similarly Nogueira et al., [12] had reported an increased prevalence of depression among women.
The present data found that depression was commoner among the illiterate patients (73.3%), and lowest among University graduates in accordance with the previous researchers [10]. In the present study, married or divorced//widowers were more likely to have depression than single patients, this can be explained by the fact that single patients may not have the pressure of looking after children or feeling guilty about transferring the disease to their children or husbands, also due to religious issues HIV/AIDS is more stigmatizing to married people than singles. Previous literature [13] concluded that depressed HIV patients were six times more likely to miss the medications with the grave consequences on their health.
In the present data, depression was lesser in those who received counseling and depression sessions. Furthermore, groups' sessions can substantially reduce depressive symptoms. Similar to our findings social and community interventions were found to reduce depressive symptoms and improve the quality of life in HIV patients [14]. In the present study no significant statistical difference was evident between different HIV/AIDS modalities in contrast to previous study that concluded higher rates of depression among those taking the combination of efavirenz, lamivudine and stavudine [15].

Conclusion
In conclusion, depression is prevalent among patients with HIV/AIDS and was commoner among uneducated and married/widowed women. Group sessions could substantially reduce depression/anxiety symptoms.
What is known about this topic  Depression is prevalent among HIV/AIDS patients;  Depression is commoner among women specially among lower educated.

What this study adds
 The importance of post diagnostic cessions and counseling in alleviating patients symptoms.
 We studied the effects of various HIV/AIDS therapies on rates of depression.

Competing interests
The authors declare t no competing interests.

Authors' contributions
Abdulateef Elbadawi is the correspondence author: the concept and design, data acquisition and interpretation, data analysis, substantial contribution in writing of the manuscript and revising it critically before submission for review. Hyder Mirghani: a substantial contribution in data analysis, the paper writing, and revision before submission for review. Both authors approved the manuscript submission.