Anxiety, depression and treatment adherence among HIV-infected migrants

Figures & data

Figure 1. Flow diagram of patient inclusion and completion of questionnaires.

Table 1. Socio-demographic characteristics and psychosocial variables.

	All N=306	HADS ≥15 N = 106	HADS < 15 N = 200	P
Age (mean, sd)	41.7 (10.5)	40.9 (10.5)	42.2 (10.6)	0.30^a
Male gender (%)	175 (57.2)	54 (50.9)	121 (60.5)	0.11^b
1st generation immigrant (%)	288 (94.1)	99 (93.4)	189 (94.5)	0.69^b
Region of origin (%)				0.71^b
Sub-Saharan Africa	117 (38.2)	44 (41.5)	73 (36.5)
Caribbean	61 (19.9)	18 (17.0)	43 (21.5)
Latin America	72 (23.5)	26 (24.5)	46 (23.0)
Other	56 (18.3)	18 (17.0)	38 (19.0)
Receiving cART (%)^#				0.22^c
>6 months	259 (84.6)	87 (82.1)	172 (86.0)
<6 months	22 (7.2)	11 (10.4)	11 (5.5)
No cART	22 (7.2)	6 (5.7)	16 (8.0)
CD4 cell count (%)				0.47^c
<200 cells/mm^3	19 (6.2)	8 (7.5)	11 (5.5)
200–349 cells/mm^3	34 (11.1)	9 (8.5)	25 (12.5)
≥350 cells/mm^3	253 (82.7)	89 (84.0)	164 (82.0)
HIV-RNA >50 copies/ml (%)*	27 (10.4)	11 (12.6)	16 (9.3)	0.41^b
Sexual orientation (%)^e				0.54^c
Heterosexual	186 (60.8)	68 (64.2)	118 (59.0)
Homosexual/Bisexual	110 (35.9)	34 (32.1)	76 (38.0)
Does not know	7 (2.3)	3 (2.8)	4 (2.0)
Living situation (%)				0.62^b
With family	127 (41.5)	45 (42.5)	82 (41.0)
Alone	110 (35.9)	34 (32.1)	76 (38.0)
Single parent	48 (15.7)	20 (18.9)	28 (14.0)
Other	21 (6.9)	7 (6.6)	14 (7.0)
Children (%)	172 (56.2)	60 (56.6)	112 (44.0)	0.92^b
Educational attainment (%)^e				0.57^b
No formal education / Primary school	63 (20.6)	26 (24.5)	37 (18.5)
Secondary school	96 (31.4)	33 (31.1)	63 (31.5)
Higher vocational school	77 (25.2)	23 (21.7)	54 (27.0)
University	68 (22.2)	23 (21.7)	45 (22.5)
Employment status (%)				<0.001^b
Paid employment	133 (43.5)	31 (29.2)	102 (51.0)
Unemployed	79 (25.8)	33 (31.1)	46 (23.0)
On sick leave	33 (10.8)	23 (17.9)	10 (5.0)
Other	61 (19.9)	19 (17.9)	42 (21.0)
Alcohol (%)
Alcohol in the past 30 days	178 (58.2)	62 (58.8)	116 (58.0)	0.93^b
Alcohol use ≥3 days/week	51 (16.7)	19 (17.9)	32 (16.0)	0.67^b
Drugs (%)
Drugs in the past 3 days	53 (17.3)	21 (19.8)	32 (16.0)	0.40^b
Drugs use ≥3 days/week	30 (9.8)	12 (11.3)	18 (9.0)	0.52^b
Psychosocial variables (median, IQR)^e
Social support	32 (22–37)	62.5 (31.3–84.4)	79.7 (50.0–93.8)	<0.001^d
Internalized HIV-related stigma	15 (12–18.3)	17 (13.8–21.0)	14 (12–17)	<0.001^d
Adherence self-efficacy	104 (89.3–115)	99 (80–111)	109 (95–117)	<0.001^d
Quality of life (physical)	52.4 (42.6–56.4)	46.0 (35-1–54.6)	53.8 (46.8–56.6)	<0.001^d
Quality of life (mental)	48.9 (37.6–56.6)	35.9 (30.1–45.2)	53.6 (44.2–58.7)	<0.001^d
Self-reported adherence (%)*
Adherence				<0.001^b
Adherent	121 (46.7)	25 (28.7)	96 (55.8)
Non-adherent	137 (52.9)	62 (71.3)	75 (43.6)

IQR, interquartile range; cART, combination antiretroviral therapy; Int., internalized.

^#Participants who were previously treated with cART due to an acute HIV-infection (n = 3) were excluded from this analyses.

*Participants who were >6 months on cART (N = 259). In HADS = <15 group, 1 participant had a missing value for self-reported adherence.

^aT-test.

^bChi-square.

^cFisher-Freeman-Halton Exact.

^dMann-Whitney Test.

^eMissing values: sexual orientation (N = 3), educational attainment (N = 2), social support (N = 16), internalized HIV related stigma (N = 12), treatment adherence self-efficacy (N = 50), physical quality of life (N = 4), and mental quality of life (N = 4).

Table 2. Summary statistics of the HADS-A, HADS-D, and HADS-T.

	Median (IQR)	Subscale score 8–10 (%)	Subscale score ≥11 (%)	Cronbach’s α
HADS-A	6.0 (3.0–10.0)	46 (15.0)	71 (23.2)	0.79
HADS-D	5.0 (2.0–8.0)	46 (15.0)	39 (12.7)	0.76
HADS-T	11.0 (6.0–17.0)			0.87

A, anxiety; D, depression; T, total.

Table 3. Association between HADS and CIDI.

	HADS+^a	HADS−^a	Total
CIDI+	21	4	25
CIDI-	16^b	19	35
Total	37	23	60^c

HADS+, HADS score ≥; HADS−, HADS score <15; CIDI+, diagnosis on depression or anxiety; CIDI-, no diagnosis on depression or anxiety.

^aIn this analyses the HADS results are those from the HADS that was completed just before the CIDI. In 58 participants, these are the results from the second assessment. All these participants had a HADS+ in the first assessment.

^bIn four participants with a HADS+ the results from the CIDI showed minor symptoms or an anxiety or depressive disorder, but no official diagnosis. They were categorized in the CIDI- group.

^cFive participants partially completed the CIDI due to a language barrier, lack of time, and emotional reaction to the questions. One was excluded from analyses as no section was completed. Four were included as they completed the anxiety section.