Social support, perceived stigma, and depression among PLHIV on second-line antiretroviral therapy using structural equation modeling in a multicenter study in Northeast Ethiopia

Shambel Wedajo; Getu Degu; Amare Deribew; Fentie Ambaw

doi:10.1186/s13033-022-00536-9

Social support, perceived stigma, and depression among PLHIV on second-line antiretroviral therapy using structural equation modeling in a multicenter study in Northeast Ethiopia

Int J Ment Health Syst. 2022 Jun 13;16(1):27. doi: 10.1186/s13033-022-00536-9.

Authors

Shambel Wedajo¹, Getu Degu², Amare Deribew³, Fentie Ambaw²

Affiliations

¹ School of Public Health, CMHS, Wollo University, Dessie, Ethiopia. Swedajo@gmail.com.
² School of Public Health, CMHS, Bahir Dar University, Bahir Dar, Ethiopia.
³ Country Director, Nutrition International (NI) in Ethiopia, Addis Ababa, Ethiopia.

Abstract

Background: Depression has a multitude of clinical and public health consequences for HIV patients. The magnitude of HIV patients who failed first-line antiretroviral treatment and switched to second-line therapy is becoming a growing public health concern. However, unlike first-line therapy, to date, little attention has been given to mental health problems in such patients, particularly in the era of the COVID-19 pandemic. Thus, this research was conducted to determine the magnitude of depression and its determinants among HIV patients on second-line antiretroviral therapy.

Methods: A multi-centered cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling. Data were collected in personal interviews as well as document reviews. The nine-item patient health questionnaire score was used to assess depression, while the three-item Oslo Scale was used to assess social support. The associations between exogenous, mediating, and endogenous variables were identified simultaneously using structural equation modeling. Statistical significance was declared at a P-value less than 0.05, and the effect sizes were presented using 95% CI.

Results: Depression was reported in 27.7% of HIV patients on second-line therapy [95% CI: 24.7-31.1%]. Social support has a direct [[Formula: see text] = - 0.9, (95% CI: - 1.11 to - 0.69)] and indirect [[Formula: see text] = - 0.22, (95% CI: - 0.31 to - 0.13)] negative effect on depression. Perceived stigma was a mediator variable and significantly associated with depression [[Formula: see text] = 0.40, (95% CI: 0.23-0.57)]. Co-morbid illness [[Formula: see text] = 0.49, (95% CI: 0.35-0.63)], high viremia [[Formula: see text] = 0.17, (95% CI: 0.08-0.26], moderate and high-risk substance use [[Formula: see text] = 0.29, (95% CI: 0.18-0.39)], and not-workable functional status [[Formula: see text] = 0.2, (95% CI: 0.1-0.31)] were all positively associated with depression.

Conclusions: This study revealed that there was a high prevalence of depression among HIV patients on second-line antiretroviral therapy. Social and clinical factors were associated with depression risk. As a result, screening, prevention, and control strategies, including psychosocial support, should be strengthened in routine clinical care.

Keywords: Depression; HIV/AIDS; SEM; Second-line ART; Social support; Stigma.