Prevalence and correlates of depression among HIV-infected and -affected older people in rural South Africa ^☆

• M. Nyirenda^{a, b, ,} ,
• S. Chatterji^c, ,
• T. Rochat^{a, d,} ,
• P. Mutevedzi^a, ,
• M.-L. Newell^{a, e,}

• ^a Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
• ^b School of Social Sciences, University of Southampton, Highfield, Southampton, UK
• ^c Multi-Country Studies Unit, Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
• ^d Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
• ^e Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK

Received 18 March 2013

Accepted 3 May 2013

Available online 31 May 2013

Keywords

• Depression;
• Major depressive episode;
• Brief depressive episode;
• Older people;
• HIV-infected;
• South Africa

1. Background

Depression is a leading cause of disease burden globally (Collins et al., 2011, Patel et al., 2011 and Mathers and Loncar, 2006), and with the growing proportions of older people, the overall numbers of people with depressive symptoms are expected to rise. Projections suggest that by 2030 unipolar depressive disorders will contribute 6.2% to the global burden of disease in terms of disability-adjusted life years, roughly equal to the contribution of heart disease (WHO, 2008). Estimates of depression in older people vary widely across regions and populations. Early estimates from a systematic review of community-based studies of older people put the weighted average of major depression at about 2% (Beekman et al., 1999). More recently, substantially higher estimates have been reported from various settings: between 8% and 20% (Barry et al., 2008, Beekman et al., 2001 and Blazer, 2003); in a European study, estimated prevalence ranged from 18% in Denmark to 37% in Spain. (Castro-Costa et al., 2007) and a review of studies in Africa, South America and Asia reported estimates from 11% to 53% (Akena et al., 2012). However, a recent study from South Africa reported a low prevalence of depression in older people of 4% (Peltzer and Phaswana-Mafuya, 2013). Overall, the prevalence of depression in older people in sub-Saharan Africa remains poorly quantified, partly because it is rarely diagnosed in the public health care systems, partly because older people are seldom research subjects, and lastly because differences in diagnostic methodology hinder the interpretation of differences in prevalence estimates (Robins and Cottler, 2004).

While frequently under-diagnosed, depression in older people is fairly commonplace and debilitating (Lapid and Rummans, 2003 and Reynolds et al., 2008); is associated with increased disability (Castro-Costa et al., 2007 and Arnow et al., 2006); increased burden on public health service utilization (García-Peña et al., 2008, Lapid and Rummans, 2003 and Rowan et al., 2002) and increased risk of mortality (Snowden et al., 2008 and Antelman et al., 2007). Older people are also at risk of other chronic morbidities such as hypertension, arthritis, heart disease and diabetes (Mayosi et al., 2009b, Christensen et al., 2009 and He et al., 2012); the management and outcomes of which may be impacted by undiagnosed depression (Demyttenaere et al., 2004). When depression occurs in the context of these chronic diseases it is known to complicate help-seeking, diagnosis (Cuijpers et al., 2004 and Pilling et al., 2009) and can adversely impact health status (Moussavi et al., 2007) and adherence to medical treatments (Kagee, 2010 and Andrews, 2001).

Sub-Saharan Africa faces a triple burden of HIV, TB and chronic disease epidemics. In South Africa, communicable and non-communicable disease burden is high (Coovadia et al., 2009, Karim et al., 2009 and Mayosi et al., 2009a) as is the burden of depression (Tomlinson et al., 2009). Psychological distress has been associated with HIV as well as hypertension and diabetes (Kagee, 2010). However, the relationship between depression and HIV is complex (Gupta et al., 2010). Some studies report a HIV diagnosis to be associated with becoming depressed (Hand et al., 2006 and Boarts et al., 2009), while others report that depression is associated with rapid HIV disease progression (Ickovics et al., 2001) either directly, or through inconsistent use or poor adherence to antiretroviral treatment (Carrico et al., 2011 and Gonzalez et al., 2011). There is even evidence of an increased risk of onset of HIV-related dementia among depression patients (Farinpour et al., 2003), but less information on the impact of antiretroviral treatment (ART) on this relationship.