Frequency and correlates of anxiety and mood disorders among TB- and HIV-infected Zambians

Abstract

We determined the frequency and correlates of current common mental disorders (CMDs) in a consecutive series of 649 adult patients with human immunodeficiency virus (HIV), tuberculosis (TB) or both receiving treatment at 16 primary health care centres across Zambia. Data on socio-demographic variables, clinical disease features, anxiety and mood disorders were collected. The frequency of any anxiety disorder (AD) was 30.8% and major depressive disorder (MDD) 11.3%. Although differences by disease group did not reach statistical significance, rates of suicidality (34.8%) and panic disorder (4.1%) were highest for the TB–HIV group (n = 269), while rates of generalised AD (13.3%), obsessive compulsive disorder (7.6%), posttraumatic stress disorder (7.4%) and any AD (37.8%) were highest for the HIV group (n = 149). Female gender (p = 0.004) predicted any current AD as well as current suicidality (p = 0.009), while lower education status (p < 0.001) predicted current MDD. World Health Organisation (WHO) clinical staging and antiretroviral treatment status were not significantly associated with MDD or anxiety in the HIV and co-infected groups. This study indicates the importance of early identification of CMDs in TB, HIV and co-infected patients, especially women and uneducated patients, newly initiated on treatment in primary care settings.

Keywords:

• anxiety disorders
• human immunodeficiency virus
• mood disorders
• tuberculosis
• Zambians

Acknowledgements

The fieldwork in Zambia was funded by the UK Department for International Development (DfID) through a research project consortium called “Evidence for Action on HIV Treatment and Care Systems”. Soraya Seedat was supported by the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation. Vikram Patel was supported by a Wellcome Trust Senior Research Fellowship in Clinical Science.