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Erschienen in: Annals of General Psychiatry 1/2018

Open Access 01.12.2018 | Primary research

Undetected psychiatric morbidity among HIV/AIDS patients attending Comprehensive Care Clinic (CCC) in Nairobi Kenya: towards an integrated mental health care

verfasst von: Pauline W. Ng’ang’a, Muthoni Mathai, Anne Obondo, Teresia Mutavi, Manasi Kumar

Erschienen in: Annals of General Psychiatry | Ausgabe 1/2018

Abstract

Background

Psychiatric morbidity is commonly associated with HIV disease and may have adverse effects. This aspect may be overlooked at comprehensive HIV care centers in Low and Middle-Income Countries.

Objectives

The aim of this study was to determine the prevalence of undetected psychiatric morbidity among HIV/AIDS adult patients attending Comprehensive Care Centre in a semi-urban clinic, in Nairobi, Kenya.

Design

Descriptive cross-sectional study of adult HIV patients not receiving any psychiatric treatment was conducted.

Participants/methods

The participants consisted of consecutive sample of adults (n = 245) attending HIV Comprehensive Care Clinic at Kangemi Health Centre, Nairobi. The Mini International Neuropsychiatric Interview (MINI) was administered to screen for undetected psychiatric morbidity. Socio-demographic characteristics were recorded in a questionnaire. Sample descriptive analysis was performed and prevalence of undetected psychiatric morbidity calculated. Chi-square test for independence was used to examine the associations between patient characteristics and undetected morbidity. Multivariable logistic regression analysis was performed to determine independent predictors of undetected psychiatric morbidity.

Results

The mean age of our participants was 37.3 years (SD 9.2) Three-quarters (75.9%) of participants were females and median duration of HIV illness was 5 years. The prevalence of (previously undetected) psychiatric morbidity was 71.4% (95% CI 65.3–77). The leading psychiatric disorders were MDD (32.2%), PTSD (18.4%), Dysthymia (17.6%), and OCD (17.6%). Overall psychiatric morbidity was associated with low income (<USD 30), p = 0.035. MDD was associated with older age and female gender. There were no statistically significant associations between overall psychiatric morbidity and social determinants such as gender, marital status, level of education, religious affiliation, and occupation or employment status.

Conclusion

The burden of psychiatric morbidity in Kenyan HIV patients remains high and is most significantly associated with lower socioeconomic status. There is need to provide holistic care including screening for mental well-being all through the treatment of HIV patients in low-income settings.

Background

Several studies have consistently reported higher neuropsychiatric impairments in patients with HIV/AIDS [1]. Estimates from a systematic review of HIV-infected adults from Africa show that about one-half of HIV-infected adults have some form of psychiatric disorder [2]. People living with HIV/AIDS (PLWHA) are more susceptible to psychiatric morbidity compared to the general population [3] and major depressive disorder is the most common psychiatric diagnosis [4]. Other frequently reported psychiatric morbidities in HIV include suicidality, anxiety, post-traumatic stress disorder (PTSD), alcohol, and substance use disorders [5]. On one hand, psychiatric patients are at higher risk for acquiring HIV infection. On the other hand, patients infected with HIV are susceptible to developing psychiatric illness [6].
Despite the fact that sub-Saharan African (SSA) countries carry more than 90% of the burden of HIV/AIDS and studies report a high prevalence of mental health disorders related to HIV, common mental disorders often go undiagnosed and untreated in this population [7].
HIV-related deaths have declined significantly since the initiation of antiretroviral therapy (ART) worldwide in the year 1996 [8]. The reported success with scale-up of ART programs has brought to the fore the underlying burden of psychiatric morbidity in HIV/AIDS. Firstly, HIV/AIDS is now managed as a chronic illness using existing ARV drugs. While chronic illnesses are known risk factors for psychiatric morbidity, these psychiatric illnesses can also contribute to poor adherence and HIV treatment failure [9, 10]. Secondly, initial ARV guidelines recommended nucleoside reverse transcriptase inhibitors (NRTIs) and non- nucleoside reverse transcriptase inhibitors (NNRTIs) as first-line ARVs [11]. The association between NRTIs and NNRTIs with central nervous system manifestations including mania and psychosis led to significant increase in prevalence of undetected psychiatric morbidity [12]. These first-line ARVS were subsequently replaced by drugs with limited CNS effects.
In the Kenyan health care context, patients have limited access to mental health services and this is coupled with a shortage of mental health professionals, a fact that is documented globally about LMICs [13]. There have been specific efforts in Kenya to integrate mental healthcare into the management of PLWHA with national guidelines now recommending inclusion of psychosocial support, mental health screening, and management in the standard package of care for HIV. The National AIDS and STI control program (NASCOP) in Kenya recently launched new guidelines that recommend basic screening of depression before initiating ART and annual screening thereafter [14]. This study sought to determine the prevalence of undetected psychiatric morbidity among HIV/AIDS adult patients attending Comprehensive Care Centre (CCC) in a semi-urban clinic in Nairobi, Kenya.

Methods

This was a descriptive, cross-sectional study conducted to determine the prevalence and types of previously undetected psychiatric morbidity in a low-income urban informal settlement population receiving comprehensive care for HIV/AIDS at a government-sponsored Health Centre in Nairobi from March to August, 2014. The clinic operates twice a week (Tuesdays and Thursdays) and serves approximately 80 eligible patients on each day. Patient selection was done through consecutive sampling of clients on arrival at the clinic. We recruited 245 participants based on a precision of 5% around an estimated prevalence of 80–90% for psychiatric disorders reported in HIV-positive adults by Musisi and Kinyanda [15]. Adult patients were eligible to participate if they were not on treatment for any psychiatric illness and provided consent. Patients were excluded if they were too ill.
The interviews were conducted at a Comprehensive Care Centre in Kangemi Health Centre by two research assistants along with the first author. This work contributed towards the first author’s dissertation for degree course in Masters of Medicine in Psychiatry at the University of Nairobi. The remaining authors acted as her mentors. The first author trained the assistants on administration of the Mini International Neuropsychiatric Interview (MINI plus), a diagnostic interview used for screening individuals for psychiatric diagnoses [16]. Individual interviews lasting between 30 and 45 min were carried out while the patients waited to be seen by the CCC medical officer. During the interview, each participant had the MINI plus administered and also completed a questionnaire on socio-demographic characteristics.
Data analysis was performed using IBM SPSS statistics for Windows, version 19 [17]. Descriptive analysis of sample characteristics was conducted by calculating means (SD) for continuous data and frequency summaries (counts and percentages) for categorical data. The main outcome was calculated as the proportion of HIV patients attending comprehensive care who screened positive for previously undetected psychiatric morbidity (using the MINI plus). Chi-square test for independence was used to examine associations between patient characteristics and undetected psychiatric morbidity. Similar analysis was conducted for each of the common psychiatric morbidities. Multivariable logistic regression analysis was then performed to determine independent predictors of undetected psychiatric morbidity. Variables that showed significant association with psychiatric morbidity in the Chi-square tests based on p value (< 0.05) were selected for inclusion in the logistic regression model as independent variables while the variable for prevalence of psychiatric morbidity was used as the dependent variable.

Results

Sample characteristics

We recruited 281 HIV-positive adults in the study; however, only 245 were included in the final analysis. Thirty-six (36) patients were excluded during recruitment and data collection. This was due to illness, declining to participate after intake due to undisclosed reasons, others left before they could complete the MINI interview. See Fig. 1 which presents a flow chart of patient selection and recruitment.
The mean age (± SD) of participants was 37.3 years (± 9.2) with a range of 19–70 years. Of the 245 participants, 75.9% (n = 186) were females, 46.5% (n = 114) were married, and 55.1% (n = 135) had basic to no formal education (see Table 1). Most patients were unemployed 53.5% (n = 131), engaged as unskilled workers or casual workers 69.8% (n = 171), and 52.2% reported a monthly income < KES 3000 (approximately USD 30).
Table 1
Demographic characteristics and unidentified psychiatric morbidity in adult HIV/AIDS patients attending CCC in Nairobi suburbs
Socio-demographic characteristics
Total (n = 245)
Undetected psychiatric morbidity
p value
N
%
Present (n = 175), N (N %)
Absent (n = 70), N (N %)
Sex
 Male
59
24.1
38 (64.4)
21 (35.6)
0.17
 Female
186
75.9
137 (73.7)
49 (26.3)
 
Marital status
 Single
39
15.9
27 (69.2)
12 (30.8)
0.91
 Married
114
46.5
81 (71.1)
33 (28.9)
 
 Separated (divorced/widowed)
92
37.6
67 (72.8)
25 (27.2)
 
Level of education
 Primary or none
135
55.1
97 (71.9)
38 (28.1)
0.59
 Secondary
89
36.3
65 (73.0)
24 (27.0)
 
 College/university
21
8.6
13 (61.9)
8 (38.1)
 
Reported monthly income
 Less than KES 3000 (USD 30)
117
47.8
91 (77.8)
26 (22.2)
0.03
 More than KES 3000 (USD 30)
128
52.2
84 (65.6)
44 (34.4)
 
Religious affiliation
 Catholic
68
27.8
50 (73.5)
18 (26.5)
0.57
 Protestant
162
66.1
116 (71.6)
46 (28.4)
 
 Other
15
6.1
9 (60.0)
6 (40.0)
 
Currently employed
 Yes
114
46.5
77 (67.5)
37 (32.5)
0.21
 No
131
53.5
98 (74.8)
33 (25.2)
 
Current occupation
 Skilled
74
30.2
49 (66.2)
25 (33.8)
0.235
 Unskilled
171
69.8
126 (73.7)
45 (26.3)
 

Burden of previously undetected psychiatric morbidity

We found that about 71.4% (175 out of 245 participants) of HIV-positive adults attending care had psychiatric morbidity detected through the MINI. The most common diagnoses were major depressive disorder (32.2%), post-traumatic stress disorder (18.4%), dysthymia (17.6%), obsessive compulsive disorder (17.6%), low-risk suicidality (16.3%), and mania (11.4%).

Association between psychiatric morbidity and socio-demographic factors

A significant association between income status and presence of psychiatric morbidity, which was more prevalent among patients with low (< 30 USD) compared to high-income [χ2 = 4.4 (1), p = 0.03] participants was found. Though we did not find any significant associations between the presence of psychiatric morbidity and participant demographic characteristics such as sex, marital status, level of education, religious affiliation, and occupation or employment status (see Table 1).

Duration of HIV illness, CD4, and partner attributes

The mean duration (± SD) of HIV illness was 5.7 years (± 4.1). Out of the 245 patients, 17.6% (n = 38) had CD4 counts < 200 cell/mm3, 18% (n = 44) reported that the partner had died, and 10.6% (n = 26) had a child with HIV-positive diagnosis. These factors did not show a significant association with prevalence of undetected psychiatric morbidity (see Table 2).
Table 2
Duration of HIV/AIDS diagnosis, CD4 count, partner status, and prevalence of unidentified psychiatric morbidity in adult HIV/AIDS patients attending CCC in Nairobi suburbs
Variables
N
%
Undetected psychiatric morbidity
p value
Present (n = 175)
Absent (n = 70)
CD 4 count (cells/mm3)
 > 200
178
82.4
122 (68.5)
56 (31.5)
0.532
 < 200
38
17.6
28 (73.7)
10 (26.3)
 
HIV duration (years)
 < 5 
103
42
70 (68.0)
33 (32.0)
0.59
 5–9 
107
43.7
79 (73.8)
28 (26.2)
 
 10 years and above
35
14.3
26 (74.3)
9 (25.7)
 
Child status
 Positive
26
10.6
21 (80.8)
5 (19.2)
0.10
 Negative
171
69.8
122 (71.3)
49 (28.7)
 
 Unknown
26
10.6
14 (53.8)
12 (46.2)
 
 No children
22
9
18 (81.8)
4 (18.2)
 
Partner died
 Yes
44
18
34 (77.3)
10 (22.7)
0.34
 No
201
82
141 (70.1)
60 (29.9)
 
Partner status HIV positive
 Yes
58
51.3
41 (70.7)
17 (29.3)
0.98
 No
55
48.7
39 (70.9)
16 (29.1)
 

Previously undetected major depressive disorder (MDD) and its risk factors

Table 3 shows that undetected MDD occurred in older patients (mean age 39.4 versus 36.3 years, p = 0.013), and that MDD was more prevalent in females compared to males (36% versus 20.35, p = 0.025) and patients in households with lower monthly income (41 versus 21.3%, p = 0.005). There was no association between MDD and religion, marital and employment status, education, or occupation.
Table 3
Unidentified major depressive disorder in adult HIV/AIDS patients attending CCC in Nairobi suburbs
Variables
N
%
Undetected MDD
p value
Presence
Absence
Mean age (± SD), 37.3 (9.2)
  
39.4 (± 9.0)
36.3 (± 9.1)
0.013*
Gender
 Male
59
24.1
12 (20.3)
47 (79.7)
0.025*
 Female
186
75.9
67 (36.0)
119 (64.0)
 
Marital status
 Single
39
15.9
12 (30.8)
27 (69.2)
0.64
 Married
114
46.5
34 (29.8)
80 (70.2)
 
 Separated (divorced or widowed)
92
37.6
33 (35.9)
59 (64.1)
 
Level of education
 Primary or none
135
55.1
42 (31.1)
93 (68.9)
0.10
 Secondary
89
36.3
34 (38.2)
55 (61.8)
 
 College/university
21
8.6
3 (14.3)
18 (85.7)
 
Currently employed
 Yes
114
46.5
35 (30.7)
79 (69.3)
0.63
 No
131
53.5
44 (33.6)
87 (66.4)
 
Reported monthly income
 Less than KES 3000
117
47.8
48 (41.0)
69 (59.0)
0.005*
 More than KES 3000
128
52.2
31 (24.2)
97 (75.8)
 
Religious affiliation
 Catholic
68
27.8
19 (27.9)
49 (72.1)
0.325
 Protestant
162
66.1
57 (35.2)
105 (64.8)
 
 Other
15
6.1
3 (20.0)
12 (80.0)
 
Occupation
 Skilled
74
30.2
21 (28.4)
53 (71.6)
0.394
 Unskilled
171
69.8
58 (33.9)
113 (66.1)
 
*significant p value of less than 0.05
We did not conduct multivariable regression for overall prevalence of undetected psychiatric morbidity because none of the factors were associated with this outcome in the univariable analysis. Multivariate logistic regression with MDD as dependent variable and age, sex, and income as predictors was conducted. CD4, duration of HIV diagnosis, and formal education were included in the model as a priori confounders of the prevalence of undetected MDD. Table 4 shows that after adjusting for the effect of CD4, HIV illness duration, and education level, the odds of undetected MDD among females were three-fold higher compared to males (OR = 3.33; 95% CI 1.32–8.45) and these odds increased by 4% for unit increase in patients age (OR = 1.04; 1.00–1.08).
Table 4
Logistic regression of independent predictors of MDD in HIV/AIDS patients attending CCC in Nairobi suburbs
Variables
OR (95% CI)
p value
Age in years
1.04 (1.00–1.08)
0.031*
Sex
 Male
1.0 (ref)
 
 Female
3.33 (1.32–8.45)
0.011*
Monthly income
 Less than KES 3000
1.0 (ref)
 
 More than KES 3000
0.60 (0.31–1.14)
0.12
Level of education
 None or primary
1.0 (ref)
 
 Secondary
1.89 (0.96–3.73)
0.066
 Tertiary
0.62 (0.16–2.37)
0.488
Cell count (cells/mm3)
 > 200
1.0 (ref)
 
 < 200
0.72 (0.31–1.67)
0.443
HIV duration (years)
 < 5 
1.0 (ref)
 
 5–9 
1.28 (0.64–2.57)
0.488
 10 years and above
1.41 (0.54–3.66)
0.477
*significant p value of less than 0.05

Discussion

The purpose of this study was to determine the prevalence of undetected psychiatric disorders among a low-income urban informal settlement population receiving comprehensive care for HIV/AIDS at a government-sponsored Health Centre in Nairobi. We found that 71% of patients, who were not currently receiving psychiatric treatment, had a psychiatric disorder needing an integrated management. The principal correlate of psychiatric disorders was low income, being of older age, and being a female.
Our findings resonate with other HIV studies reported in SSA. The reported prevalence of common mental disorders among HIV-infected people in low-income countries is variable. Literature points to ranges from 82.6% in Mulago Hospital in Kampala, Uganda [18], 63% in Yaounde, Cameroon, [19] 38.3% in Nigeria [20] to 11.2% in Dilla Hospital in south region of Ethiopia [21].
Depression is the most common mental health co-morbidity experienced by people living with HIV; the prevalence of depression among people with HIV is around 8–57% [22]. Our study found a prevalence of 32.2% of depression in our sample. The high prevalence found in studies such as North Central Nigeria in 2013 with 56.7% [23] and a study from three hospitals in Tigray region, Ethiopia, with 43.9% [24] may be due to different tools that were used and may also be attributed to childhood trauma, negative life events, and less social support factors that were not investigated in this study but may impact depression severity.

Nature of previously undetected psychiatric morbidity

The leading co-morbidities were MDD (32.2%), PTSD (18.4%), Dysthymia (17.6%), and OCD (17.6%). This concurs with prevalence studies from LMIC which have reported rates of psychiatric disorder based on diagnostic interviews or psychiatric symptom scales.
Mental or psychological disorders often seem to be related to the severity of HIV/AIDS, medication side effects, younger age, higher viral load, the loss of health, a decrease in functioning, the deterioration of bodily integrity, anticipatory loss of life, pain, poor family support, and presence of AIDS in the spouse, and cultural factors like stigma, relative lack of appropriate treatment facilities, poor access to health care, and low educational level could have significantly contributed [25]. Though factors that could explain varying levels of exposure to negative life events, e.g., conflict, were not investigated in this study, the impact of negative life events in an HIV-positive individual’s life can be enormous and these risk factors whether distal or proximal need to be understood further.
Generalized anxiety disorder had a low prevalence of 2.5%. Our study finds a lower prevalence estimate as compared to a study done in Kenyatta National Hospital (KNH) CCC on HIV/AIDS adult patients [26] which found a prevalence of anxiety to be 77.25%. A possible explanation for the lower prevalence in this study could be that the study tools used were different. In the KNH study, Becks Anxiety Inventory Scale was used while this study used the MINI plus to assess anxiety. Another possible explanation is that new patients were excluded from the study and it is often found that anxiety is prominent following initial HIV diagnosis and anxiety symptoms can frequently recur and escalate in response to disease progression [27]. In our study, approximately 60% (n = 147) of patients with psychiatric illness had at least two existing psychiatric morbidities.
Additionally, the current study was carried out in a resource-constrained setting where it is conceivable that issues related to purchasing power associated with medication, poor nutrition, and poverty may have significantly contributed to the reduced psychosocial well-being of patients which in turn contributed to the presence of psychiatric morbidity.
It is in this regard that WHO 2001 [28], recommends that attention to the psychosocial needs of people with AIDS should be an integral part of HIV care. This includes assistance with employment, income, housing, informed decision making, coping with illness and discrimination, and prevention and treatment of mild and serious mental health problems [28].
There were several limitations to our study; first and foremost, the researcher was not able to collect comprehensive HIV morbidity-related data, explore social determinants in detail, and follow up on those diagnosed with psychiatric disorders. The cross-sectional design also presents a limitation with regards to determining causal associations. This work was also part of a postgraduate thesis project and therefore had narrow focus. Factors that could explain varying levels of exposure to negative life events, e.g., conflict, were not investigated in this study. The impact of negative life events in an HIV-positive individual’s life can be enormous and these risk factors whether distal or proximal need to be understood further. Follow-up was outside the domain of the current study. It is also likely that the mental illness in our participants was due to HIV or prior adverse experiences which we were not able to sufficiently study.
It was also difficult to tell whether the psychiatric morbidity was due to the side effects of ARVs that the patients were taking or HIV-related stigma or adversities that the patients may have been experiencing in their families, communities, or interaction with the health facility. This work was part of the first authors’ Master of Medicine degree in Psychiatry, therefore, due to the short duration of the study in which it had to be completed, it was not possible to follow up patients diagnosed with mental illness after initiation of treatment.
Despite these shortcomings we believe our study contributes to the existing literature on psychiatric morbidity in adult HIV population in Sub-Saharan Africa as few studies have specifically focused on undetected psychiatric morbidity. The study also used a validated and reliable screening tool as opposed to clinical diagnosis that is widespread, yielding robust estimates of the prevalence of psychiatric illness. The external validity of our study is high because it was conducted in the primary care setting where the majority of HIV/AIDS patients receive care.

Conclusion

The results of this study show that patients with HIV/AIDS receiving follow-up care experience considerable undetected psychiatric morbidity. The most important associated features of major depression disorder were low socioeconomic status and female sex. Since the psychiatric morbidity had been previously undetected, there is need to provide holistic care including screening for mental well-being all through the treatment of HIV patients in low-income settings. The occurrence of psychiatric symptoms at different stages of disease is poorly defined and therefore focus should be put on the psychiatric manifestations in relation to the CD4 counts. More rigorous research is needed to put mental health services for people living with HIV/AIDS in Africa on the healthcare agenda.

Authors’ contributions

The work was carried out by PN who is the lead author and her mentors AO, MM, and MK made conceptual contributions and TM co-wrote the manuscript including checking the statistics and proofing the manuscript for submission. All authors read and approved the final manuscript.

Acknowledgements

The leading author attended a PAM-D-funded manuscript workshop in Cape Town during the preparation of the initial draft of this manuscript. The authors would like to thank Francis Creed and Martin Kidd for their comments on the initial analysis and at different stages of preparing this manuscript. We would also like to thank Professors Francis Creed and Martin Kidd who assisted with rethinking the statistical analyses and gave advice on the organizing of the paper as part of Dr Ng’ang’a’s participation in the Partnerships for mental health development in Sub-Saharan Africa (PAM-D), MDB006-MD104-0044-11-2016 workshop on manuscript writing held in the University of Stellenbosch in Cape Town, from 14–16 November 2016.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The dataset is available from the corresponding author who is also the Principal Investigator of the study.
The participants signed the consent form accepting to participate and also for permission to published.
Institutional Ethical clearance was obtained from Kenyatta National Hospital/University of Nairobi Research and Ethics Committee (clearance no P449/8/2013). Further, permission to carry out the research at HIV care clinic was sought from Ministry of Science and Technology (clearance no 954, cleared on February 11, 2014). The first author and the research assistants were trained on ethical issues in research involving human subjects prior to starting the study under the oversights of her University mentors. Patients who screened positive for undetected psychiatric morbidity were referred to mental health specialists available at the facility. Informed consent was sought from each potential participant after full explanation of the study without coercion.

Funding

The study was part of the first author’s Masters in Medicine degree program and all the costs were borne by her.

Publisher’s Note

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.
Literatur
1.
Zurück zum Zitat Dirks M, et al. Persistent neuropsychiatric impairment in HCV patients despite clearance of the virus?! J Viral Hepat. 2017;24:541–50.CrossRefPubMed Dirks M, et al. Persistent neuropsychiatric impairment in HCV patients despite clearance of the virus?! J Viral Hepat. 2017;24:541–50.CrossRefPubMed
2.
Zurück zum Zitat Blissenbach M, Grewe B, Hoffmann B, Brandt S, Überla K. Nuclear RNA export and packaging functions of HIV-1 Rev revisited. J Virol. 2010;84(13):6598–604.CrossRefPubMedPubMedCentral Blissenbach M, Grewe B, Hoffmann B, Brandt S, Überla K. Nuclear RNA export and packaging functions of HIV-1 Rev revisited. J Virol. 2010;84(13):6598–604.CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Fraser A, Gatherer A, Hayton P. Mental health in prisons: great difficulties but are there opportunities? Public Health. 2009;123(6):410–4.CrossRefPubMed Fraser A, Gatherer A, Hayton P. Mental health in prisons: great difficulties but are there opportunities? Public Health. 2009;123(6):410–4.CrossRefPubMed
4.
Zurück zum Zitat McCrory P, et al. Consensus statement on concussion in sport—the 4th International Conference on Concussion in Sport held in Zurich, November 2012. J Sci Med Sport. 2013;16(3):178–89.CrossRefPubMed McCrory P, et al. Consensus statement on concussion in sport—the 4th International Conference on Concussion in Sport held in Zurich, November 2012. J Sci Med Sport. 2013;16(3):178–89.CrossRefPubMed
5.
Zurück zum Zitat Primeau MM, Avellaneda V, Musselman D, Jean GS, Illa L. Treatment of depression in individuals living with HIV/AIDS. Psychosomatics. 2013;54(4):336–44.CrossRefPubMed Primeau MM, Avellaneda V, Musselman D, Jean GS, Illa L. Treatment of depression in individuals living with HIV/AIDS. Psychosomatics. 2013;54(4):336–44.CrossRefPubMed
6.
Zurück zum Zitat Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58(2):181–7.CrossRefPubMed Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58(2):181–7.CrossRefPubMed
7.
Zurück zum Zitat Chandra PS, Desai G, Ranjan S. HIV & psychiatric disorders. Indian J Med Res. 2005;121(4):451.PubMed Chandra PS, Desai G, Ranjan S. HIV & psychiatric disorders. Indian J Med Res. 2005;121(4):451.PubMed
9.
Zurück zum Zitat Vinikoor MJ, et al. Age at antiretroviral therapy initiation predicts immune recovery, death, and loss to follow-up among HIV-infected adults in urban Zambia. AIDS Res Hum Retrovir. 2014;30(10):949–55.CrossRefPubMedPubMedCentral Vinikoor MJ, et al. Age at antiretroviral therapy initiation predicts immune recovery, death, and loss to follow-up among HIV-infected adults in urban Zambia. AIDS Res Hum Retrovir. 2014;30(10):949–55.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Arseniou S, Arvaniti A, Samakouri M. HIV infection and depression. Psychiatry Clin Neurosci. 2014;68(2):96–109.CrossRefPubMed Arseniou S, Arvaniti A, Samakouri M. HIV infection and depression. Psychiatry Clin Neurosci. 2014;68(2):96–109.CrossRefPubMed
11.
Zurück zum Zitat Chou R, Fu R, Huffman LH, Korthuis PT. Initial highly-active antiretroviral therapy with a protease inhibitor versus a non-nucleoside reverse transcriptase inhibitor: discrepancies between direct and indirect meta-analyses. Lancet. 2006;368(9546):1503–15.CrossRefPubMed Chou R, Fu R, Huffman LH, Korthuis PT. Initial highly-active antiretroviral therapy with a protease inhibitor versus a non-nucleoside reverse transcriptase inhibitor: discrepancies between direct and indirect meta-analyses. Lancet. 2006;368(9546):1503–15.CrossRefPubMed
12.
Zurück zum Zitat Owe-Larsson B, Sall L, Salamon E, Allgulander C. HIV infection and psychiatric illness. Afr J Psychiatry. 2009;12(2):115–28.CrossRef Owe-Larsson B, Sall L, Salamon E, Allgulander C. HIV infection and psychiatric illness. Afr J Psychiatry. 2009;12(2):115–28.CrossRef
13.
Zurück zum Zitat Ndetei DM, Khasakhala L, Omolo JO. Incentives for health worker retention in Kenya: an assessment of current practice. EQUINET. 2008;62:29. Ndetei DM, Khasakhala L, Omolo JO. Incentives for health worker retention in Kenya: an assessment of current practice. EQUINET. 2008;62:29.
14.
Zurück zum Zitat Grabbe KL, et al. Increasing access to HIV counseling and testing through mobile services in Kenya: strategies, utilization and cost-effectiveness. J Acquir Immune Defic Syndr. 2010;54(3):317.CrossRefPubMedPubMedCentral Grabbe KL, et al. Increasing access to HIV counseling and testing through mobile services in Kenya: strategies, utilization and cost-effectiveness. J Acquir Immune Defic Syndr. 2010;54(3):317.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Musisi S, Kinyanda E. Psychiatric problems of HIV/AIDS and their management in Africa. 2009. ISBN:9789970027538. Musisi S, Kinyanda E. Psychiatric problems of HIV/AIDS and their management in Africa. 2009. ISBN:9789970027538.
16.
Zurück zum Zitat Sheehan DV, et al. The validity of the mini international neuropsychiatric interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry. 1997;12(5):232–41.CrossRef Sheehan DV, et al. The validity of the mini international neuropsychiatric interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry. 1997;12(5):232–41.CrossRef
17.
Zurück zum Zitat Corp IBM. IBM SPSS statistics for windows, version 22.0. NY IBM Corp: Armonk; 2013. Corp IBM. IBM SPSS statistics for windows, version 22.0. NY IBM Corp: Armonk; 2013.
18.
Zurück zum Zitat Petrushkin H, Boardman J, Ovuga E. Psychiatric disorders in HIV-positive individuals in urban Uganda. Psychiatrist. 2005;29(12):455–8. Petrushkin H, Boardman J, Ovuga E. Psychiatric disorders in HIV-positive individuals in urban Uganda. Psychiatrist. 2005;29(12):455–8.
19.
Zurück zum Zitat L’akoa RM, Noubiap JJN, Fang Y, Ntone FE, Kuaban C. Prevalence and correlates of depressive symptoms in HIV-positive patients: a cross-sectional study among newly diagnosed patients in Yaoundé, Cameroon. BMC Psychiatry. 2013;13(1):228.CrossRefPubMedPubMedCentral L’akoa RM, Noubiap JJN, Fang Y, Ntone FE, Kuaban C. Prevalence and correlates of depressive symptoms in HIV-positive patients: a cross-sectional study among newly diagnosed patients in Yaoundé, Cameroon. BMC Psychiatry. 2013;13(1):228.CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Jibrin YB, Ali AB, Saad ST, Kolo PM. Prevalence of treatment failure among pulmonary tuberculosis patients in Federal Medical Centre, Gombe, Northeastern Nigeria. ISRN Infect Dis. 2013;2013(2013):4. Art ID:461704. https://doi.org/10.5402/2013/461704. Jibrin YB, Ali AB, Saad ST, Kolo PM. Prevalence of treatment failure among pulmonary tuberculosis patients in Federal Medical Centre, Gombe, Northeastern Nigeria. ISRN Infect Dis. 2013;2013(2013):4. Art ID:461704. https://​doi.​org/​10.​5402/​2013/​461704.
21.
Zurück zum Zitat Tesfaw G, et al. Prevalence and correlates of depression and anxiety among patients with HIV on-follow up at Alert Hospital, Addis Ababa, Ethiopia. BMC Psychiatry. 2016;16(1):368.CrossRefPubMedPubMedCentral Tesfaw G, et al. Prevalence and correlates of depression and anxiety among patients with HIV on-follow up at Alert Hospital, Addis Ababa, Ethiopia. BMC Psychiatry. 2016;16(1):368.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS. 2006;20(12):1571.CrossRefPubMedPubMedCentral Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS. 2006;20(12):1571.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Shittu RO, et al. Prevalence and correlates of depressive disorders among people living with HIV/AIDS, North Cent. NigerJ AIDS Clin Res. 2013;4(251):2. Shittu RO, et al. Prevalence and correlates of depressive disorders among people living with HIV/AIDS, North Cent. NigerJ AIDS Clin Res. 2013;4(251):2.
24.
Zurück zum Zitat Berhe H, Bayray A. Prevalence of depression and associated factors among people living with HIV/AIDS in Tigray, North Ethiopia: a Cross sectional hospital based study. Int J Pharm Sci Res. 2013;4(2):765. Berhe H, Bayray A. Prevalence of depression and associated factors among people living with HIV/AIDS in Tigray, North Ethiopia: a Cross sectional hospital based study. Int J Pharm Sci Res. 2013;4(2):765.
25.
Zurück zum Zitat W. H. Organization and R. for I. T. Control. WHO report on the global tobacco epidemic, 2008: the MPOWER package. Geneva: World Health Organization; 2008. p. 2008. W. H. Organization and R. for I. T. Control. WHO report on the global tobacco epidemic, 2008: the MPOWER package. Geneva: World Health Organization; 2008. p. 2008.
26.
Zurück zum Zitat Ng’ang’a PW, Mathai M, Obondo A. Prevalence of anxiety and depression among HIV/AIDS patients attending the comprehensive Care Centre (CCC), Kenyatta National Hospital (KNH). Kenya: University of Nairobi; 2011. Ng’ang’a PW, Mathai M, Obondo A. Prevalence of anxiety and depression among HIV/AIDS patients attending the comprehensive Care Centre (CCC), Kenyatta National Hospital (KNH). Kenya: University of Nairobi; 2011.
27.
Zurück zum Zitat Junqueira JC, et al. Oral colonization by yeasts in HIV-positive patients in Brazil. Rev Inst Med Trop Sao Paulo. 2012;54(1):17–24.CrossRefPubMed Junqueira JC, et al. Oral colonization by yeasts in HIV-positive patients in Brazil. Rev Inst Med Trop Sao Paulo. 2012;54(1):17–24.CrossRefPubMed
28.
Zurück zum Zitat WHO. The World Health Report 2001: mental health: new understanding, new hope. Geneva: World Health Organization; 2001. WHO. The World Health Report 2001: mental health: new understanding, new hope. Geneva: World Health Organization; 2001.
Metadaten
Titel
Undetected psychiatric morbidity among HIV/AIDS patients attending Comprehensive Care Clinic (CCC) in Nairobi Kenya: towards an integrated mental health care
verfasst von
Pauline W. Ng’ang’a
Muthoni Mathai
Anne Obondo
Teresia Mutavi
Manasi Kumar
Publikationsdatum
01.12.2018
Verlag
BioMed Central
Erschienen in
Annals of General Psychiatry / Ausgabe 1/2018
Elektronische ISSN: 1744-859X
DOI
https://doi.org/10.1186/s12991-018-0179-1

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