Skip to main content

Advertisement

SpringerLink
Log in

Depressive Symptoms, the Impact on ART Continuation, and Factors Associated with Symptom Improvement Among a Cohort of People Living with HIV in British Columbia, Canada

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Depressive symptoms among people living with HIV (PLWH) are associated with poorer overall health outcomes. We characterized depressive symptoms and improvements in symptomology among PLWH (≥ 19 years old) in British Columbia (BC), Canada. We also examined associations between depressive symptomology and antiretroviral therapy (ART) treatment interruptions. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10), within a longitudinal cohort study with three surveys administered 18-months apart. We used multivariable logistic regression to model factors associated with improvements in depressive symptoms (CES-D-10 scores from ≥ 10 to < 10). Of the 566 participants eligible for analysis 273 (48.2%) had CES-D scores indicating significant depressive symptoms (score ≥ 10) at enrollment. Improvements in symptoms at first follow-up were associated with greater HIV self-care on the Continuity of Care Scale (adjusted odds ratio: 1.17; 95% CI 1.03–1.32), and not having a previously reported mental health disorder diagnosis (aOR 2.86; 95% CI 1.01–8.13). Those reporting current cocaine use (aOR 0.33; 95% CI 0.12–0.91) and having a high school education, vs. less than, (aOR 0.25; 95% CI 0.08–0.82) had lower odds of improvement in depressive symptomatology. CES-D scores ≥ 10 were not significantly associated with ART treatment interruptions during follow-up (aOR: 1.08; 95% CI:0.65–1.8). Supporting greater self-care and consideration of mental health management strategies in relation to HIV may be useful in promoting the wellbeing of PLWH who experience depressive symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

The British Columbia Center for Excellence in HIV/AIDS (BC-CfE) is prohibited from making individual-level data available publicly due to provisions in our service contracts, institutional policy, and ethical requirements. In order to facilitate research, we make such data available via data access requests. Some BC-CfE data is not available externally due to prohibitions in service contracts with our funders or data providers. For more information or to make a request, please contact Mark Helberg, Senior Director, Internal and External Relations, and Strategic Development: mhelberg@bccfe.ca. All data related to this manuscript are provided in the main body of the paper and Supporting Information files.

Code Availability

(Not applicable)

References

  1. Patterson S, Cescon A, Samji H, Chan K, Zhang W, Raboud J, et al. Life expectancy of HIV-positive individuals on combination antiretroviral therapy in Canada. BMC Infect Dis. 2015;15(1):1–10.

    Article  Google Scholar 

  2. Kerkerian G, Kestler M, Carter A, Wang L, Kronfli N, Sereda P, et al. Attrition across the HIV cascade of care among a diverse cohort of women living with HIV in Canada. JAIDS. 2018;79(2):226–36.

    PubMed  Google Scholar 

  3. Lourenco L, Colley G, Nosyk B, Shopin D, Montaner JS, Lima VD. High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada. PLoS ONE. 2014;9(12):e115277.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jongbloed K, Pooyak S, Sharma R, Mackie J, Pearce ME, Laliberte N, et al. Experiences of the HIV Cascade of care among indigenous peoples: a systematic review. AIDS Behav. 2019;23(4):984–1003.

    Article  PubMed  Google Scholar 

  5. Rebeiro PF, Abraham AG, Horberg MA, Althoff KN, Yehia BR, Buchacz K, et al. Sex, race, and HIV risk disparities in discontinuity of HIV care after antiretroviral therapy initiation in the United States and Canada. AIDS Patient Care STDs. 2017;31(3):129–44.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Katz IT, Maughan-Brown B. Improved life expectancy of people living with HIV: who is left behind? The Lancet HIV. 2017;4(8):e324–e6.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nanditha NGA, Paiero A, Tafessu HM, St-Jean M, McLinden T, Justice AC, et al. Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study. BMJ Open. 2021;11(1):e041734.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L. Depression in HIV infected patients: a review. Curr Psychiatry Rep. 2015;17(1):1–11.

    Article  Google Scholar 

  9. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–30.

    Article  CAS  PubMed  Google Scholar 

  10. World Health Organization. Depression and other Common Mental Disorders: Global Health estimates. Geneva, Switzerland: World Health Organization; 2017.

    Google Scholar 

  11. Tran BX, Ho R, Ho CS, Latkin CA, Phan HT, Ha GH, et al. Depression among patients with HIV/AIDS: research development and effective interventions (GAPRESEARCH). Int J Environ Res Public Health. 2019;16(10):1772.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rezaei S, Ahmadi S, Rahmati J, Hosseinifard H, Dehnad A, Aryankhesal A, et al. Global prevalence of depression in HIV/AIDS: a systematic review and meta-analysis. BMJ Supportive & Palliative Care. 2019;9(4):404–12.

    Google Scholar 

  13. Pence BW, O’Donnell JK, Gaynes BN. Falling through the cracks: the gaps between depression prevalence, diagnosis, treatment, and response in HIV care. AIDS. 2012;26(5):656.

    Article  PubMed  Google Scholar 

  14. Bengtson AM, Pence BW, Crane HM, Christopoulos K, Fredericksen RJ, Gaynes BN, et al. Disparities in depressive symptoms and antidepressant treatment by gender and race/ethnicity among people living with HIV in the United States. PLoS ONE. 2016;11(8):e0160738.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. JAIDS. 2011;58(2).

  16. Lima VD, Geller J, Bangsberg DR, Patterson TL, Daniel M, Kerr T, et al. The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating HAART. AIDS. 2007;21(9):1175–83.

    Article  PubMed  Google Scholar 

  17. Ickovics JR, Hamburger ME, Vlahov D, Schoenbaum EE, Schuman P, Boland RJ, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA. 2001;285(11):1466–74.

    Article  CAS  PubMed  Google Scholar 

  18. Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav. 2012;16(8):2119–43.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rivera-Rivera Y, Vázquez-Santiago FJ, Albino E, Sánchez MdC, Rivera-Amill V. Impact of depression and inflammation on the progression of HIV disease. J Clin Cell Immunol. 2016;7(3).

  20. Arseniou S, Arvaniti A, Samakouri M. HIV infection and depression. J Neuropsychiatry Clin Neurosci. 2014;68(2):96–109.

    Google Scholar 

  21. Effendy E, Amin MM, de Vega L, Utami N. The association between CD-4 level, stress and depression symptoms among people living with HIV/AIDS. Open access Macedonian Journal of Medical Sciences. 2019;7(20):3459.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Armoon B, Fleury M-J, Bayat A-H, Fakhri Y, Higgs P, Moghaddam LF, et al. HIV related stigma associated with social support, alcohol use disorders, depression, anxiety, and suicidal ideation among people living with HIV: a systematic review and meta-analysis. Int J Mental Health Syst. 2022;16(1):1–17.

    Article  Google Scholar 

  23. Rooney AS, Moore RC, Paolillo EW, Gouaux B, Umlauf A, Letendre SL, et al. Depression and aging with HIV: Associations with health-related quality of life and positive psychological factors. J Affect Disord. 2019;251:1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bever A, Salters K, Tam C, Moore DM, Sereda P, Wang L et al. Cohort profile: the STOP HIV/AIDS program evaluation (SHAPE) study in British Columbia, Canada. BMJ Open. 2020;10(5).

  25. British Columbia Ministry of Health. From Hope to Health: Towards an AIDS-free Generation. 2012.

  26. Hogg RS, Heath KV, Yip B, Craib KJ, O’shaughnessy MV, Schechter MT, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279(6):450–4.

    Article  CAS  PubMed  Google Scholar 

  27. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D. Am J Prev Med. 1994;10(2):77–84.

    Article  CAS  PubMed  Google Scholar 

  28. Zhang W, O’Brien N, Forrest JI, Salters KA, Patterson TL, Montaner JS, et al. Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada. PLoS ONE. 2012;7(7):e40793.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  30. Choi SK, Boyle E, Burchell AN, Gardner S, Collins E, Grootendorst P, et al. Validation of six short and ultra-short screening instruments for depression for people living with HIV in Ontario: results from the Ontario HIV treatment network cohort study. PLoS ONE. 2015;10(11):e0142706.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kranzer K, Ford N. Unstructured treatment interruption of antiretroviral therapy in clinical practice: a systematic review. Tropical Med Int Health. 2011;16(10):1297–313.

    Article  Google Scholar 

  32. Wang L, Min JE, Zang X, Sereda P, Harrigan RP, Montaner JS, et al. Characterizing human immunodeficiency virus antiretroviral therapy interruption and resulting disease progression using population-level data in British Columbia, 1996–2015. Clin Infect Dis. 2017;65(9):1496–503.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Health Canada. Canadian Community Health Survey, cycle 2.2, Nutrition (2004): income-related Household Food Security in Canada. Health Canada, Ottawa, Canada; 2007.

  34. Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric properties of the drug abuse screening test. J Subst Abuse Treat. 2007;32(2):189–98.

    Article  PubMed  Google Scholar 

  35. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14.

    Article  CAS  PubMed  Google Scholar 

  36. Dolovich LR, Nair KM, Ciliska DK, Lee HN, Birch S, Gafni A, et al. The diabetes continuity of Care Scale: the development and initial evaluation of a questionnaire that measures continuity of care from the patient perspective. Health Soc Care Commun. 2004;12(6):475–87.

    Article  Google Scholar 

  37. Logie CH, Kennedy VL, Tharao W, Ahmed U, Loutfy MR. Engagement in and continuity of HIV care among african and caribbean black women living with HIV in Ontario, Canada. Int J STD AIDS. 2017;28(10):969–74.

    Article  PubMed  Google Scholar 

  38. Herek GM, Capitanio JP. Symbolic prejudice or fear of infection? A functional analysis of AIDS-related stigma among heterosexual adults. Basic Appl Soc Psychol. 1998;20(3):230–41.

    Article  Google Scholar 

  39. Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale¶. Res Nurs Health. 2001;24(6):518–29.

    Article  CAS  PubMed  Google Scholar 

  40. Wright K, Naar-King S, Lam P, Templin T, Frey M. Stigma scale revised: reliability and validity of a brief measure of stigma for HIV + youth. J Adolesc Health. 2007;40(1):96–8.

    Article  PubMed  Google Scholar 

  41. Pruden H. In:. Two-Spirit Conversations & Work: subtle and at the same time radically different. APHA; 2019. APHA’s 2019 Annual Meeting and Expo (Nov 2-Nov 6).

  42. Duggal M, Chakrapani V, Liberti L, Satyanarayna V, Varghese M, Singh P, et al. Acceptability of mobile phone-based nurse-delivered counseling intervention to improve HIV treatment adherence and self-care behaviors among HIV-positive women in India. AIDS Patient Care STDs. 2018;32(9):349–59.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Chou F-Y, Holzemer WL. Linking HIV/AIDS clients’ self-care with outcomes. J Assoc Nurses AIDS Care. 2004;15(4):58–67.

    Article  PubMed  Google Scholar 

  44. Tufts KA, Wessell J, Kearney T. Self-care behaviors of african american women living with HIV: a qualitative perspective. J Assoc Nurses AIDS Care. 2010;21(1):36–52.

    Article  PubMed  Google Scholar 

  45. Lin EH, Katon W, Von Korff M, Rutter C, Simon GE, Oliver M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27(9):2154–60.

    Article  PubMed  Google Scholar 

  46. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association; 2013.

    Book  Google Scholar 

  47. Köhler S, Chrysanthou S, Guhn A, Sterzer P. Differences between chronic and nonchronic depression: systematic review and implications for treatment. Depress Anxiety. 2019;36(1):18–30.

    Article  PubMed  Google Scholar 

  48. Moroz N, Moroz I, D’Angelo MS, editors. Mental health services in Canada: barriers and cost-effective solutions to increase access. Healthcare Management Forum; 2020: SAGE Publications Sage CA: Los Angeles, CA.

  49. Choi SK, Boyle E, Cairney J, Gardner S, Collins EJ, Bacon J, et al. Adequacy of mental health services for HIV-positive patients with depression: Ontario HIV Treatment Network Cohort Study. PLoS ONE. 2016;11(6):e0156652.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Johnson JG, Rabkin JG, Lipsitz JD, Williams JB, Remien RH. Recurrent major depressive disorder among human immunodeficiency virus (HIV)-positive and HIV-negative intravenous drug users: findings of a 3-year longitudinal study. Compr Psychiatr. 1999;40(1):31–4.

    Article  CAS  Google Scholar 

  51. Rood BA, McConnell EA, Pantalone DW. Distinct coping combinations are associated with depression and support service utilization in men who have sex with men living with HIV. Psychol Sex Orientat Gend Divers. 2015;2(1):96.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Skalski LM, Sikkema KJ, Heckman TG, Meade CS. Coping styles and illicit drug use in older adults with HIV/AIDS. Psychol Addict Behav. 2013;27(4):1050.

    Article  PubMed  Google Scholar 

  53. Javanbakht M, Shoptaw S, Ragsdale A, Brookmeyer R, Bolan R, Gorbach PM. Depressive symptoms and substance use: changes overtime among a cohort of HIV-positive and HIV-negative MSM. Drug Alcohol Depend. 2020;207:107770.

    Article  CAS  PubMed  Google Scholar 

  54. Delaney JA, Nance RM, Whitney BM, Altice FL, Dong X, Trejo MEP, et al. Reduced use of illicit substances, even without abstinence, is associated with improved depressive symptoms among people living with HIV. JAIDS. 2018;79(3):283.

    PubMed  Google Scholar 

  55. Shokoohi M, Bauer GR, Kaida A, Logie CH, Lacombe-Duncan A, Milloy MJ, et al. Patterns of social determinants of health associated with drug use among women living with HIV in Canada: a latent class analysis. Addiction. 2019;114(7):1214–24.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Tapp C, Milloy M, Kerr T, Zhang R, Guillemi S, Hogg RS, et al. Female gender predicts lower access and adherence to antiretroviral therapy in a setting of free healthcare. BMC Infect Dis. 2011;11(1):1–7.

    Article  Google Scholar 

  57. Kim J, Lee E, Park B-J, Bang JH, Lee JY. Adherence to antiretroviral therapy and factors affecting low medication adherence among incident HIV-infected individuals during 2009–2016: a nationwide study. Sci Rep. 2018;8(1):1–8.

    Google Scholar 

  58. Puskas CM, Forrest JI, Parashar S, Salters KA, Cescon AM, Kaida A, et al. Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep. 2011;8(4):277–87.

    Article  PubMed  Google Scholar 

  59. Sauceda JA, Johnson MO, Saberi P. Nonadherence as 4-day antiretroviral therapy interruptions: do depression and race/ethnicity matter as much in the modern antiretroviral therapy era? AIDS Behav. 2016;20(11):2624–8.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Tufano CS, Amaral RAd, Cardoso LRD, Malbergier A. The influence of depressive symptoms and substance use on adherence to antiretroviral therapy. A cross-sectional prevalence study. Sao Paulo Med J. 2014;133:179–86.

    Article  PubMed  Google Scholar 

  61. Roux P, Lions C, Cohen J, Winnock M, Salmon-Céron D, Bani-Sadr F, et al. Impact of HCV treatment and depressive symptoms on adherence to HAART among HIV–HCV-coinfected patients: results from the ANRS-CO13-HEPAVIH cohort. Antivir Ther. 2014;19(2):171–8.

    Article  PubMed  Google Scholar 

  62. Borran M, Dashti-Khavidaki S, Khalili H. The need for an integrated pharmacological response to the treatment of HIV/AIDS and depression. Expert Opin Pharmacother. 2021;22(9):1179–92.

    Article  PubMed  Google Scholar 

  63. Tam CWL, Bacani N, Wesseling T, Grieve S, Salters K, et al. editors. The Role of Peer Research Associates in Collecting Data in Longitudinal Health Surveys. Canadian Association for HIV Research Conference: Hope, Victories, and Perseverance beyond 2020; Quebec City, Quebec.

Download references

Acknowledgements

We would like to thank all those who contributed their time and expertise to this project, including the SHAPE PRAs, co-investigators, collaborators, partner organizations and clinics, as well as the BC-CfE for their ongoing support and guidance. We are particularly grateful to SHAPE participants for sharing their life experiences with us, without whom this work could not be possible. We respectfully acknowledge that our work takes place on ancestral traditional and unceded territories across British Columbia, and we recognize and acknowledge the ongoing harms of colonialism, which contribute to pervasive health equities and disproportionately impact Indigenous people living with HIV. The SHAPE study is funded by the BC Ministry of Health and BC Centre for Excellence in HIV/AIDS. DMM is supported by a Scholar Award from the Michael Smith Foundation for Health Research.

Funding

Funding was provided by the BC Ministry of Health and the BC Centre for Excellence in HIV/AIDS.

Author information

Authors and Affiliations

  1. BC Centre for Excellence in HIV/AIDS, 608 – 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada

    Tatiana E. Pakhomova, Clara Tam, Lu Wang, Kate Salters, David M. Moore, Justin Barath, Simon Elterman, Nicole Dawydiuk, Tim Wesseling, Sean Grieve, Paul Sereda, Robert Hogg & Rolando Barrios

  2. Simon Fraser University, Burnaby, Canada

    Kate Salters & Robert Hogg

  3. University of British Columbia, Vancouver, Canada

    David M. Moore & Rolando Barrios

Authors
  1. Tatiana E. Pakhomova
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clara Tam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kate Salters
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David M. Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Justin Barath
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Simon Elterman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nicole Dawydiuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tim Wesseling
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sean Grieve
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Paul Sereda
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Robert Hogg
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Rolando Barrios
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Each of the listed co-authors contributed substantively to this manuscript. The study was conceived and established by RB and RH. TP drafted the initial manuscript with contributions from CT, KS, DMM, and ND. SG and TW collected data; LW and JB conducted statistical and data analyses. All authors (TP, CT, LW, KS, DMM, JB, ND, SE, TW, SG, PS, RH, RB) contributed substantially to the critical review of the final manuscript.

Corresponding author

Correspondence to Tatiana E. Pakhomova.

Ethics declarations

Conflict of Interest

Authors have no conflicts of interest to disclose.

Ethics Statement

This study was granted ethical approval by the University of British Columbia/Providence Health Care research ethics boards (REB number: H15-01807).

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

(Not applicable)

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pakhomova, T.E., Tam, C., Wang, L. et al. Depressive Symptoms, the Impact on ART Continuation, and Factors Associated with Symptom Improvement Among a Cohort of People Living with HIV in British Columbia, Canada. AIDS Behav 28, 43–58 (2024). https://doi.org/10.1007/s10461-023-04156-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-023-04156-3

Keywords

Search

Navigation