Prevalence and factors associated with depression in people living with HIV in sub-Saharan Africa: A systematic review and meta-analysis

Depression, one of the most common psychiatric disorders, is two- to three-times more prevalent in people living with HIV (PLHIV) than in the general population in many settings as shown in western countries but remains neglected in sub-Saharan Africa (SSA). We aimed to summarize the available evidence on the prevalence of depression and associated factors according to the scales used and the treatment status in PLHIV in SSA. The pooled prevalence estimates of depression ranged between 9% and 32% in PLHIV on antiretroviral treatment (ART) and in untreated or mixed (treated/untreated) ones, with a substantial variability according to the measurement scale used and also for a given scale. Low socio-economic conditions in PLHIV on ART, female sex and immunosuppression in mixed/untreated PLHIV were frequently reported as associated factors but with no consensus. As depression could have deleterious consequences on the PLHIV life, it is critical to encourage its screening and management, integrating these dimensions in HIV care throughout SSA.

抑郁症作为最常见的精神障碍之一，在诸多地区（如西方国家）的调研中，人类免疫缺陷病毒感染者（People Living with HIV, PLHIV）的抑郁症患病率为普通人群的2至3倍，但在撒哈拉以南非洲（sub-Saharan Africa, SSA）地区，该问题仍未得到足够重视。本研究旨在依据所使用的评估量表及治疗状态，总结撒哈拉以南非洲地区HIV感染者群体中抑郁症患病率及其相关影响因素的现有研究证据。针对接受抗反转录病毒治疗（Antiretroviral Treatment, ART）的HIV感染者，以及未接受治疗或混合接受/未接受治疗的感染者群体，抑郁症的合并患病率估计值介于9%至32%之间；且该患病率因所使用的评估量表不同而存在显著差异，即便针对同一评估量表亦是如此。研究频繁报道的相关影响因素包括：接受抗反转录病毒治疗的HIV感染者社会经济地位较低、女性性别，以及混合/未接受治疗的HIV感染者存在免疫抑制状态，但目前尚未形成统一定论。鉴于抑郁症会对HIV感染者的生活产生诸多有害影响，因此在撒哈拉以南非洲地区的HIV诊疗服务中纳入抑郁症筛查与管理环节，具有至关重要的意义。