Antenatal depressive symptoms in Kenyan women living with HIV: contributions of recent HIV diagnosis, stigma, and partner violence

ABSTRACT

Depression among pregnant women living with HIV (WLWH) in sub-Saharan Africa leads to poor pregnancy and HIV outcomes. This cross-sectional analysis utilized enrollment data from a randomized trial (Mobile WAChX, NCT02400671) in six Kenyan public maternal and child health clinics. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), stigma with the Stigma Scale for Chronic Illness, and intimate partner violence (IPV) with the Abuse Assessment Screen. Correlates of moderate-to-severe depressive symptoms (“depression”, PHQ-9 score ≥10) were assessed using generalized estimating equation models clustered by facility. Among 824 pregnant WLWH, 9% had depression; these women had more recent HIV diagnosis than those without depression (median 0.4 vs. 2.0 years since diagnosis, p = .008). Depression was associated with HIV-related stigma (adjusted Prevalence Ratio [aPR]:2.36, p = .025), IPV (aPR:2.93, p = .002), and lower social support score (aPR:0.99, p = .023). Using population-attributable risk percent to estimate contributors to maternal depression, 81% were attributable to stigma (27%), recent diagnosis (24%), and IPV (20%). Integrating depression screening and treatment in prevention of mother-to-child HIV transmission programs may be beneficial, particularly in women recently diagnosed or reporting stigma and IPV.

KEYWORDS:

• Depression
• pregnancy
• HIV
• women
• Kenya
• Sub-Saharan Africa

Acknowledgements

The authors thank everyone who has been involved in this study, particularly the study participants who contributed the data used in this study.

Disclosure statement

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

Funding details

Funding for this study was provided by the National Institutes of Health (grants R01HD080460, K24HD054314 to G.J.S., P30AI027757 to G.J.S., K01AI116298 to A.L.D, K12HD001264 to J.A.U, K18MH122978 to K.R., F31HD101149 to A.L., D43TW009580 to L.O.) and the University of Washington Global Center for Integrated Health of Women Adolescents and Children (Global WACh).