Correlated depressive symptoms within seroconcordant, expectant partners living with HIV in Zambézia Province, Mozambique: a cross-sectional study

ABSTRACT

Approximately 15% of people with HIV in sub-Saharan Africa have comorbid depression, which impacts treatment outcomes. We describe predictors of baseline depressive symptoms in 1079 female and 1079 male participants in a cluster-randomized trial in Zambézia Province, Mozambique from November 2017 to December 2020. We modeled each partners’ depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) using proportional odds models adjusted for enrollment date, age, body mass index [BMI], partner’s PHQ-9 score, district, relationship status, education, occupation, WHO HIV clinical stage, and antiretroviral therapy use history. A post hoc analysis assessed covariate-adjusted rank correlation between partner depressive symptoms. Females were younger than males (median 23 vs. 28 years) and more likely to report no education (20.7% vs. 7.9%). Approximately 10% screened positive for depression (PHQ-9 score ≥ 10). Partner depressive symptoms were predictive of higher participant PHQ-9 scores. A male partner PHQ-9 score of 10 (versus 5) increased the odds that the female partner would have a higher PHQ-9 score (adjusted odds ratio: 7.25, 95% Confidence Interval [CI]: 5.43–9.67). Partner PHQ-9 scores were highly correlated after covariate adjustment (Spearman’s rho 0.65, 95% CI 0.57–0.72). Interventions aimed to reduce depressive symptoms and improve HIV-related outcomes during pregnancy should address both partners’ depressive symptoms.

KEYWORDS:

• HIV
• sexual partners
• depression
• patient health questionnaire
• nonparametric statistics
• cross-sectional studies

Acknowledgements

The authors would like to thank the participants of the HoPS+ study for donating their time and effort to participating in the study-related activities, and our study team, including study assistants, couples’ counselors, and peer advocates for providing support to participants in their effort to adhere to HIV care and treatment. DES helped conceive the study, coordinated and conducted the data analysis, and wrote and edited the manuscript. AM also conducted part of the data analysis and AM and EG were involved in study design. AM, EG, AE, and CD were involved in data collection and manuscript revisions. BES provided input on the data analysis and was involved in substantive manuscript revisions. CMA helped conceive the study, coordinate data analysis, and was involved in substantive manuscript revisions. The authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Geolocation statement

This study was conducted in Zambézia Province, Mozambique.

Additional information

Funding

This work is supported by the National Institute of Mental Health [R01MH113478 [CMA] and F30MH123219 [DES]], NIGMS [T32GM007347 [DES]], NIAID [R01AI093234 [BES]], and NCATS [UL1TR000445] of the National Institutes of Health.