Association between maternal HIV status and postpartum depressive symptoms in Botswana

ABSTRACT

Few studies have evaluated postpartum depression (PPD) in women living with HIV (WLHIV) in Botswana, a high prevalence HIV setting. The Edinburgh Postnatal Depression Scale (EPDS) was used to evaluate PPD symptoms in WLHIV (n = 300) and women who are HIV-uninfected (n = 131) in the Tshilo Dikotla study, an observational cohort study with a nested randomized trial. The EPDS was administered at 2, 6, and 12 months postpartum. We assessed the association of (1) HIV infection and (2) antiretroviral therapy (ART) with odds of PPD symptoms (EPDS ≥ 10 or thoughts of self-harm) in the first year postpartum using generalized estimating equations. Of WLHIV, 24 (8.00%) had PPD symptoms at one or more follow-up time points, compared to 9 (6.9%) women who were HIV-seronegative. There was no association between HIV status and PPD symptoms (adjusted odds ratio [aOR]:1.69, 95% confidence interval [CI]: 0.73–3.93, p = 0.225); however, WLHIV on efavirenz-based ART regimens had higher odds of experiencing PPD symptoms compared to dolutegravir-based ART (aOR:3.05, 95% CI:1.16–8.03, p = 0.024).

KEYWORDS:

• Mental health
• well-being
• Health

SDG KEYWORDS:

• SDG 3: Good health and well-being

Acknowledgements

The authors would like to express their sincere gratitude to the Tshilo Dikotla study participants for volunteering their time to this study. We would also like thank our colleagues at Botswana-Harvard Health Institute Partnership for the invaluable support throughout this study.

Disclosure statement

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

Author contributions

JJ conceptualized the study. YL and KNM wrote the first draft. YL and LBB analyzed the data. LBB made significant edits to the Methods/Results sections. JJ made significant edits to the Intro, Results and Discussion. All authors reviewed the manuscript. LBB had primary responsibility for the final content and approval of the paper.

Ethics approval

Institutional Review Boards at the Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine, Massachusetts General Hospital, and the Health Research Development Committee in Botswana approved the protocol.

Consent to participate

All women provided written informed consent for their study participation and that of their infant prior to participating.

Availability of data and material

De-identified data are available upon request. Code availability: Code is available upon request.

Additional information

Funding

This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) through R01DK109881.