Prevalence and correlates of probable depression diagnosis and suicidal ideation among patients receiving HIV care in Lilongwe, Malawi.

ABSTRACT

BACKGROUND: Depression and suicide ideation among people living with HIV (PLHIV) can threaten the success of HIV care and treatment programs, particularly within high HIV prevalence settings. We describe the prevalence and correlates associated with depression and suicidal ideation among PLHIV receiving HIV care in Lilongwe, Malawi. METHODS: From July to September 2013, 206 HIV clinic patients, who were ≥18 years of age and either pre-antiretroviral therapy (ART) or established on ART for ≥6 months prior to study, participated in a survey to assess the prevalence of a likely depressive disorder and suicidal ideation using the Patient Health Questionnaire-9. We explored factors associated with depression using bivariable linear regression and suicidal ideation using bivariable log-binomial regression. RESULTS: The prevalence of a likely depressive disorder and suicidal ideation was 12% (95% CI 8%, 17%) and 16% (95% CI 11%, 21%), respectively. Pre-ART patients (ß=1.17, 95% CI 0.03, 2.30, p-value=0.04) and those with problematic alcohol use (ß=0.49, 95% CI 0.07, 0.92, p-value=0.02) were associated with a higher depression severity. Suicidal ideation was relatively common (8%, 95% CI 5%, 13%) among those without a likely depressive disorder and significantly correlated with having no primary, secondary, or tertiary education (ß=-1.52, 95% CI -2.46, -0.59, p-value<0.01). CONCLUSIONS: Interventions that enhance identification and management of depressive disorders and suicidal ideation should be integrated within HIV care clinics in Malawi.