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AIDS Care
Psychological and Socio-medical Aspects of AIDS/HIV
Volume 35, 2023 - Issue 11
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Research Article

Prevalence and correlates of internalized stigma among adults with HIV and major depressive disorder in rural Malawi

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Pages 1775-1785 | Received 14 Nov 2022, Accepted 20 Mar 2023, Published online: 31 Mar 2023

References

  • Abas, M., Ali, G.-C., Nakimuli-Mpungu, E., & Chibanda, D. (2014). Depression in people living with HIV in sub-Saharan Africa: Time to act. Tropical Medicine & International Health, 19(12), 1392–1396. https://doi.org/10.1111/tmi.12382
  • Alemayehu, Y., Demilew, D., Asfaw, G., Asfaw, H., Alemnew, N., & Tadesse, A. (2020). Internalized stigma and associated factors among patients with major depressive disorder at the outpatient department of amanuel mental specialized hospital, Addis Ababa, Ethiopia, 2019: A cross-sectional study. Psychiatry Journal, 2020, e7369542. https://doi.org/10.1155/2020/7369542
  • Armoon, B., Higgs, P., Fleury, M.-J., Bayat, A.-H., Moghaddam, L. F., Bayani, A., & Fakhri, Y. (2021). Socio-demographic, clinical and service use determinants associated with HIV related stigma among people living with HIV/AIDS: A systematic review and meta-analysis. BMC Health Services Research, 21(1), 1004. https://doi.org/10.1186/s12913-021-06980-6
  • Ashaba, S., Cooper-Vince, C., Maling, S., Rukundo, G. Z., Akena, D., & Tsai, A. C. (2018). Internalized HIV stigma, bullying, major depressive disorder, and high-risk suicidality among HIV-positive adolescents in rural Uganda. Global Mental Health (Cambridge, England), 5, e22. https://doi.org/10.1017/gmh.2018.15
  • Assefa, D., Shibre, T., Asher, L., & Fekadu, A. (2012). Internalized stigma among patients with schizophrenia in Ethiopia: A cross-sectional facility-based study. BMC Psychiatry, 12(1), 239. https://doi.org/10.1186/1471-244X-12-239
  • Bedaso, A., Workie, K., Gobena, M., & Kebede, E. (2022). The magnitude and correlates of internalized stigma among people with mental illness attending the outpatient department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. Heliyon, 8(5), https://doi.org/10.1016/j.heliyon.2022.e09431
  • Boyd, J. E., Adler, E. P., Otilingam, P. G., & Peters, T. (2014a). Internalized stigma of mental illness (ISMI) scale: A multinational review. Comprehensive Psychiatry, 55(1), 221–231. https://doi.org/10.1016/j.comppsych.2013.06.005
  • Boyd, J. E., Otilingam, P. G., & Deforge, B. R. (2014b). Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: Psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination. Psychiatric Rehabilitation Journal, 37(1), 17–23. https://doi.org/10.1037/prj0000035
  • Brandt, R. (2009). The mental health of people living with HIV/AIDS in Africa: A systematic review. African Journal of AIDS Research, 8(2), 123–133. https://doi.org/10.2989/AJAR.2009.8.2.1.853
  • Bronshteyn, M., Yang, F. N., Shattuck, K. F., Dawson, M., Kumar, P., Moore, D. J., Ellis, R. J., & Jiang, X. (2021). Depression is associated with hippocampal volume loss in adults with HIV. Human Brain Mapping, 42(12), 3750–3759. https://doi.org/10.1002/hbm.25451
  • Brooke-Sumner, C., Selohilwe, O., Mazibuko, M. S., & Petersen, I. (2018). Process evaluation of a pilot intervention for psychosocial rehabilitation for service users with schizophrenia in north west province, South Africa. Community Mental Health Journal, 54(7), 1089–1096. https://doi.org/10.1007/s10597-018-0318-9
  • Bukenya, B., Kasirye, R., Lunkuse, J., Kinobi, M., Vargas, S. M., Legha, R., Tang, L., & Miranda, J. (2022). Depression, anxiety, and suicide risk among Ugandan youth in vocational training. Psychiatric Quarterly, 93(2), 513–526. https://doi.org/10.1007/s11126-021-09959-y
  • Christopoulos, K. A., Neilands, T. B., Dilworth, S., Lisha, N., Sauceda, J., Mugavero, M. J., Crane, H. M., Fredericksen, R. J., Mathews, W. C., Moore, R. D., Mayer, K. H., Napravnik, S., & Johnson, M. O. (2020). Internalized HIV stigma predicts subsequent viremia in US HIV patients through depressive symptoms and antiretroviral therapy adherence. AIDS (London, England), 34(11), 1665–1671. https://doi.org/10.1097/QAD.0000000000002595
  • Crabb, J., Stewart, R. C., Kokota, D., Masson, N., Chabunya, S., & Krishnadas, R. (2012). Attitudes towards mental illness in Malawi: A cross-sectional survey. BMC Public Health, 12(1), 541. https://doi.org/10.1186/1471-2458-12-541
  • Cresswell, J. A., Barbour, K. D., Chou, D., McCaw-Binns, A., Filippi, V., Cecatti, J. G., Barreix, M., Petzold, M., Kostanjsek, N., Cottler-Casanova, S., & Say, L. (2020). Measurement of maternal functioning during pregnancy and postpartum: Findings from the cross-sectional WHO pilot study in Jamaica, Kenya, and Malawi. BMC Pregnancy and Childbirth, 20(1), 518. https://doi.org/10.1186/s12884-020-03216-z
  • dos Santos, M. M., Kruger, P., Mellors, S. E., Wolvaardt, G., & van der Ryst, E. (2014). An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa: The People Living with HIV Stigma Index. BMC Public Health, 14(1), 80. https://doi.org/10.1186/1471-2458-14-80
  • Drapalski, A. L., Lucksted, A., Perrin, P. B., Aakre, J. M., Brown, C. H., DeForge, B. R., & Boyd, J. E. (2013). A model of internalized stigma and its effects on people with mental illness. Psychiatric Services (Washington, D.C.), 64(3), 264–269. https://doi.org/10.1176/appi.ps.001322012
  • Dubreucq, J., Plasse, J., & Franck, N. (2021). Self-stigma in serious mental illness: A systematic review of frequency, correlates, and consequences. Schizophrenia Bulletin, 47(5), 1261–1287. https://doi.org/10.1093/schbul/sbaa181
  • Earnshaw, V. A., Bogart, L. M., Laurenceau, J.-P., Chan, B. T., Maughan-Brown, B. G., Dietrich, J. J., Courtney, I., Tshabalala, G., Orrell, C., Gray, G. E., Bangsberg, D. R., & Katz, I. T. (2018). Internalized HIV stigma, ART initiation and HIV-1 RNA suppression in South Africa: Exploring avoidant coping as a longitudinal mediator. Journal of the International AIDS Society, 21(10), e25198. https://doi.org/10.1002/jia2.25198
  • Emlet, C. A., Brennan, D. J., Brennenstuhl, S., Rueda, S., Hart, T. A., & Rourke, S. B. (2015). The impact of HIV-related stigma on older and younger adults living with HIV disease: Does age matter? AIDS Care, 27(4), 520–528. https://doi.org/10.1080/09540121.2014.978734
  • Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Simon & Schuster.
  • Gomes, D. R. A. S., Zanetti, A. C. G., Miasso, A. I., Castro, F. F. S., & Vedana, K. G. G. (2021). Internalized stigma in people with mood disorders: Predictors and associated factors. Journal of Nervous & Mental Disease, 209(1), 54–58. https://doi.org/10.1097/NMD.0000000000001257
  • Habtamu, K., Alem, A., Medhin, G., Fekadu, A., & Hanlon, C. (2018). Functional impairment among people with severe and enduring mental disorder in rural Ethiopia: A cross-sectional study. Social Psychiatry and Psychiatric Epidemiology, 53(8), 803–814. https://doi.org/10.1007/s00127-018-1546-6
  • Hargreaves, J. R., Pliakas, T., Hoddinott, G., Mainga, T., Mubekapi-Musadaidzwa, C., Donnell, D., Piwowar-Manning, E., Agyei, Y., Mandla, N. F., Dunbar, R., Macleod, D., Floyd, S., Bock, P., Fidler, S., Hayes, R. J., Seeley, J., Stangl, A., Bond, V., Ayles, H., & HPTN 071 (PopART) Study Team. (2020). Hiv stigma and viral suppression Among people living With HIV in the context of universal test and treat: Analysis of data from the HPTN 071 (PopART) trial in Zambia and South Africa. Journal of Acquired Immune Deficiency Syndromes, 85(5), 561–570. https://doi.org/10.1097/QAI.0000000000002504
  • Hua, J., Emrick, C. B., Golin, C. E., Liu, K., Pan, J., Wang, M., Wan, X., Chen, W., & Jiang, N. (2014). Hiv and stigma in liuzhou, China. AIDS and Behavior, 18(2), 203–211. https://doi.org/10.1007/s10461-013-0637-3
  • Institute for Health Metrics and Evaluation. (2015, September 9). Malawi. Institute for Health Metrics and Evaluation. https://www.healthdata.org/malawi.
  • Jacobi, C. A., Atanga, P. N. J. I., Bin, L. K., Mbome, V. N., Akam, W., Bogner, J. R., Kropf, S., & Malfertheiner, P. (2013). HIV/AIDS-related stigma felt by people living with HIV from Buea, Cameroon. AIDS Care, 25(2), 173–180. https://doi.org/10.1080/09540121.2012.701715
  • Kalichman, S. C., Simbayi, L. C., Jooste, S., Toefy, Y., Cain, D., Cherry, C., & Kagee, A. (2005). Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS and Behavior, 9(2), 135–143. https://doi.org/10.1007/s10461-005-3895-x
  • Kaushik, A., Kostaki, E., & Kyriakopoulos, M. (2016). The stigma of mental illness in children and adolescents: A systematic review. Psychiatry Research, 243, 469–494. https://doi.org/10.1016/j.psychres.2016.04.042
  • Kauye, F., Jenkins, R., & Rahman, A. (2014). Training primary health care workers in mental health and its impact on diagnoses of common mental disorders in primary care of a developing country, Malawi: A cluster-randomized controlled trial. Psychological Medicine, 44(3), 657–666. https://doi.org/10.1017/S0033291713001141
  • Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  • Lau, J. T. F., & Tsui, H. Y. (2005). Discriminatory attitudes towards people living with HIV/AIDS and associated factors: A population based study in the Chinese general population. Sexually Transmitted Infections, 81(2), 113–119. https://doi.org/10.1136/sti.2004.011767
  • Li, Z., Morano, J. P., Khoshnood, K., Hsieh, E., & Sheng, Y. (2018). HIV-related stigma among people living with HIV/AIDS in rural Central China. BMC Health Services Research, 18(1), 453. https://doi.org/10.1186/s12913-018-3245-0
  • Lightner, J. S., Rajabiun, S., Cabral, H. J., Flaherty, J., Shank, J., & Brooks, R. (2021). Associations of internalized and anticipated HIV stigma with returning to work for persons living with HIV. PLoS One, 16(6), e0252783. https://doi.org/10.1371/journal.pone.0252783
  • Lo, L. L. H., Suen, Y. N., Chan, S. K. W., Sum, M. Y., Charlton, C., Hui, C. L. M., Lee, E. H. M., Chang, W. C., & Chen, E. Y. H. (2021). Sociodemographic correlates of public stigma about mental illness: A population study on Hong Kong’s Chinese population. BMC Psychiatry, 21(1), 274. https://doi.org/10.1186/s12888-021-03301-3
  • Loutfy, M. R., Logie, C. H., Zhang, Y., Blitz, S. L., Margolese, S. L., Tharao, W. E., Rourke, S. B., Rueda, S., & Raboud, J. M. (2012). Gender and ethnicity differences in HIV-related stigma experienced by people living with HIV in Ontario, Canada. PLOS ONE, 7(12), e48168. https://doi.org/10.1371/journal.pone.0048168
  • Ma, P. H. X., Chan, Z. C. Y., & Loke, A. Y. (2019). Self-Stigma reduction interventions for people living with HIV/AIDS and their families: A systematic review. AIDS and Behavior, 23(3), 707–741. https://doi.org/10.1007/s10461-018-2304-1
  • Mak, W. W. S., Mo, P. K. H., Ma, G. Y. K., & Lam, M. Y. Y. (2017). Meta-analysis and systematic review of studies on the effectiveness of HIV stigma reduction programs. Social Science & Medicine, 188, 30–40. https://doi.org/10.1016/j.socscimed.2017.06.045
  • Malawi Network of People Living with HIV. (2016). The people living with HIV stigma index—Malawi report April 2016. Global Network of People Living with HIV. https://www.stigmaindex.org/wp-content/uploads/2022/04/Malawi-SI-report-2016.pdf.
  • McBain, R. K., Mwale, O., Ruderman, T., Kayira, W., Connolly, E., Chalamanda, M., Kachimanga, C., Khongo, B. D., Wilson, J., Wroe, E., Raviola, G., Smith, S., Coleman, S., Kelly, K., Houde, A., Tebeka, M. G., Watson, S., Kulisewa, K., Udedi, M., & Wagner, G. (2021). Stepped care for depression at integrated chronic care centers (IC3) in Malawi: Study protocol for a stepped-wedge cluster randomized controlled trial. Trials, 22(1), 630. https://doi.org/10.1186/s13063-021-05601-1
  • Meffert, S. M., Neylan, T. C., McCulloch, C. E., Maganga, L., Adamu, Y., Kiweewa, F., Maswai, J., Owuoth, J., Polyak, C. S., Ake, J. A., & Valcour, V. G. (2019). East African HIV care: Depression and HIV outcomes. Global Mental Health (Cambridge, England), 6, e9. https://doi.org/10.1017/gmh.2019.6
  • Mills, H., Mulfinger, N., Raeder, S., Rüsch, N., Clements, H., & Scior, K. (2020). Self-help interventions to reduce self-stigma in people with mental health problems: A systematic literature review. Psychiatry Research, 284, 112702. https://doi.org/10.1016/j.psychres.2019.112702
  • Moradzadeh, R., & Zamanian, M. (2021). HIV-Related stigma Among people living With HIV in Iran: A cross-sectional study. Journal of the Association of Nurses in AIDS Care, 32(5), 610–618. https://doi.org/10.1097/JNC.0000000000000251
  • Moussa, A. B., Delabre, R. M., Villes, V., Elkhammas, M., Bennani, A., Ouarsas, L., Filali, H., Alami, K., Karkouri, M., & Castro, D. R. (2021). Determinants and effects or consequences of internal HIV-related stigma among people living with HIV in Morocco. BMC Public Health, 21(1), 163. https://doi.org/10.1186/s12889-021-10204-1
  • Nakimuli-Mpungu, E., Bass, J. K., Alexandre, P., Mills, E. J., Musisi, S., Ram, M., Katabira, E., & Nachega, J. B. (2012). Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: A systematic review. AIDS and Behavior, 16(8), 2101–2118. https://doi.org/10.1007/s10461-011-0087-8
  • Nanni, M. G., Caruso, R., Mitchell, A. J., Meggiolaro, E., & Grassi, L. (2015). Depression in HIV infected patients: A review. Current Psychiatry Reports, 17(1), 530. https://doi.org/10.1007/s11920-014-0530-4
  • Oexle, N., Müller, M., Kawohl, W., Xu, Z., Viering, S., Wyss, C., Vetter, S., & Rüsch, N. (2018). Self-stigma as a barrier to recovery: A longitudinal study. European Archives of Psychiatry and Clinical Neuroscience, 268(2), 209–212. https://doi.org/10.1007/s00406-017-0773-2
  • Pearson, C. A., Johnson, M. O., Neilands, T. B., Dilworth, S. E., Sauceda, J. A., Mugavero, M. J., Crane, H. M., Fredericksen, R. J., Mathews, W. C., Moore, R. D., Napravnik, S., Mayer, K. H., & Christopoulos, K. A. (2021). Internalized HIV stigma predicts suboptimal retention in care Among people living with HIV in the United States. AIDS Patient Care and STDs, 35(5), 188–193. https://doi.org/10.1089/apc.2020.0244
  • Pederson, A. B., Burnett-Zeigler, I., Fokuo, J. K., Wisner, K. L., Zumpf, K., & Oshodi, Y. (2020). Mental health stigma among university health care students in Nigeria: A cross-sectional observational study. Pan African Medical Journal, 37, 5. https://doi.org/10.11604/pamj.2020.37.5.24898
  • Peltzer, K., & Pengpid, S. (2019). Prevalence and associated factors of enacted, Internalized And anticipated stigma Among people living With HIV In South Africa: Results Of The first national survey. HIV/AIDS (Auckland, N.Z.), 11, 275–285. https://doi.org/10.2147/HIV.S229285
  • Philippi, C. L., Reyna, L., Nedderman, L., Chan, P., Samboju, V., Chang, K., Phanuphak, N., Ratnaratorn, N., Hellmuth, J., Benjapornpong, K., Dumrongpisutikul, N., Pothisri, M., Robb, M. L., Ananworanich, J., Spudich, S., Valcour, V., & Paul, R. (2020). Resting-state neural signatures of depressive symptoms in acute HIV. Journal of Neurovirology, 26(2), 226–240. https://doi.org/10.1007/s13365-020-00826-3
  • Ran, M.-S., Zhang, T.-M., Wong, I. Y.-L., Yang, X., Liu, C.-C., Liu, B., Luo, W., Kuang, W.-H., Thornicroft, G., & Chan, C. L.-W. (2018a). Internalized stigma in people with severe mental illness in rural China. International Journal of Social Psychiatry, 64(1), 9–16. https://doi.org/10.1177/0020764017743999
  • Ran, M.-S., Zhang, T.-M., Wong, I. Y.-L., Yang, X., Liu, C.-C., Liu, B., Luo, W., Kuang, W.-H., Thornicroft, G., & Chan, C. L.-W. (2018b). Internalized stigma in people with severe mental illness in rural China. International Journal of Social Psychiatry, 64(1), 9–16. https://doi.org/10.1177/0020764017743999
  • Rao, D., Chen, W. T., Pearson, C. R., Simoni, J. M., Fredriksen-Goldsen, K., Nelson, K., Zhao, H., & Zhang, F. (2012). Social support mediates the relationship between HIV stigma and depression/quality of life among people living with HIV in Beijing, China. International Journal of STD & AIDS, 23(7), 481–484. https://doi.org/10.1258/ijsa.2009.009428
  • Rice, W. S., Crockett, K. B., Mugavero, M. J., Raper, J. L., Atkins, G. C., & Turan, B. (2017). Association between internalized HIV-related stigma and HIV care visit adherence. JAIDS Journal of Acquired Immune Deficiency Syndromes, 76(5), 482–487. https://doi.org/10.1097/QAI.0000000000001543
  • Saliu, A., & Akintunde, B. (2014). Knowledge, attitude, and preventive practices among prison inmates in Ogbomoso prison at Oyo state, south west Nigeria. International Journal of Reproductive Medicine, 2014, 364375. https://doi.org/10.1155/2014/364375
  • Sano, Y., Antabe, R., Atuoye, K. N., Hussey, L. K., Bayne, J., Galaa, S. Z., Mkandawire, P., & Luginaah, I. (2016). Persistent misconceptions about HIV transmission among males and females in Malawi. BMC International Health and Human Rights, 16(1), 16. https://doi.org/10.1186/s12914-016-0089-8
  • Sardá Jr, J., Nicholas, M. K., Asghari, A., & Pimenta, C. A. M. (2009). The contribution of self-efficacy and depression to disability and work status in chronic pain patients: A comparison between Australian and Brazilian samples. European Journal of Pain, 13(2), 189–195. https://doi.org/10.1016/j.ejpain.2008.03.008
  • Sayles, J. N., Hays, R. D., Sarkisian, C. A., Mahajan, A. P., Spritzer, K. L., & Cunningham, W. E. (2008). Development and psychometric assessment of a multidimensional measure of internalized HIV stigma in a sample of HIV-positive adults. AIDS and Behavior, 12(5), 748–758. https://doi.org/10.1007/s10461-008-9375-3
  • Shumet, S., W/Michele, B., Angaw, D., Ergete, T., & Alemnew, N. (2021). Magnitude of internalised stigma and associated factors among people with bipolar disorder at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: A cross-sectional study. BMJ Open, 11(4), e044824. https://doi.org/10.1136/bmjopen-2020-044824
  • Simbayi, L. C., Strebel, A., Cloete, A., Henda, N., & Mqeketo, A. (2007). Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Social Science & Medicine, 64(9), 1823–1831. https://doi.org/10.1016/j.socscimed.2007.01.006
  • Sorsdahl, K. R., Kakuma, R., Wilson, Z., & Stein, D. J. (2012). The internalized stigma experienced by members of a mental health advocacy group in South Africa. International Journal of Social Psychiatry, 58(1), 55–61. https://doi.org/10.1177/0020764010387058
  • Stewart, R. C., Umar, E., Tomenson, B., & Creed, F. (2014). Validation of the multi-dimensional scale of perceived social support (MSPSS) and the relationship between social support, intimate partner violence and antenatal depression in Malawi. BMC Psychiatry, 14(1), 180. https://doi.org/10.1186/1471-244X-14-180
  • Subedi, B., Timilsina, B. D., & Tamrakar, N. (2019). Perceived stigma among people living with HIV/AIDS in Pokhara, Nepal. HIV/AIDS (Auckland, N.Z.), 11, 93–103. https://doi.org/10.2147/HIV.S181231
  • Takada, S., Weiser, S. D., Kumbakumba, E., Muzoora, C., Martin, J. N., Hunt, P. W., Haberer, J. E., Kawuma, A., Bangsberg, D. R., & Tsai, A. C. (2014). The dynamic relationship between social support and HIV-related stigma in rural Uganda. Annals of Behavioral Medicine, 48(1), 26–37. https://doi.org/10.1007/s12160-013-9576-5
  • Tandon, S. D., Latimore, A. D., Clay, E., Mitchell, L., Tucker, M., & Sonenstein, F. L. (2015). Depression outcomes associated with an intervention implemented in employment training programs for low-income adolescents and young adults. JAMA Psychiatry, 72(1), 31–39. https://doi.org/10.1001/jamapsychiatry.2014.2022
  • Tesfaye, E., Worku, B., Girma, E., & Agenagnew, L. (2020). Internalized stigma among patients with mood disorders in Ethiopia: A cross-sectional facility-based study. International Journal of Mental Health Systems, 14(1), 32. https://doi.org/10.1186/s13033-020-00365-8
  • Teshale, A. B., & Tesema, G. A. (2022). Discriminatory attitude towards people living with HIV/AIDS and its associated factors among adult population in 15 sub-Saharan African nations. PloS One, 17(2), e0261978. https://doi.org/10.1371/journal.pone.0261978
  • Tsai, A. C. (2015). Socioeconomic gradients in internalized stigma among 4,314 persons with HIV in sub-Saharan Africa. AIDS and Behavior, 19(2), 270–282. https://doi.org/10.1007/s10461-014-0993-7
  • Turan, B., Smith, W., Cohen, M. H., Wilson, T. E., Adimora, A. A., Merenstein, D., Adedimeji, A., Wentz, E. L., Foster, A. G., Metsch, L., Tien, P. C., Weiser, S. D., & Turan, J. M. (2016). Mechanisms for the negative effects of internalized HIV-related stigma on antiretroviral therapy adherence in women. JAIDS Journal of Acquired Immune Deficiency Syndromes, 72(2), 198–205. https://doi.org/10.1097/QAI.0000000000000948
  • Udedi, M. (2014). The prevalence of depression among patients and its detection by primary health care workers at Matawale Health Centre (Zomba). Malawi Medical Journal: The Journal of Medical Association of Malawi, 26(2), 34–37.
  • Udedi, M., Muula, A. S., Stewart, R. C., & Pence, B. W. (2019). The validity of the patient health Questionnaire-9 to screen for depression in patients with type-2 diabetes mellitus in non-communicable diseases clinics in Malawi. BMC Psychiatry, 19(1), 81. https://doi.org/10.1186/s12888-019-2062-2
  • Werner, P., Stein-Shvachman, I., & Heinik, J. (2009). Perceptions of self-stigma and its correlates among older adults with depression: A preliminary study. International Psychogeriatrics, 21(6), 1180–1189. https://doi.org/10.1017/S1041610209990470
  • Woon, L. S.-C., Khoo, S. I., Baharudin, A., & Midin, M. (2020). Association between insight and internalized stigma and other clinical factors among patients with depression: A cross-sectional study. Indian Journal of Psychiatry, 62(2), 186–192. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_612_19
  • The World Bank. (2022). Prevalence of HIV, total (% of population ages 15-49)—Malawi. The World Bank Data. https://data.worldbank.org/indicator/SH.DYN.AIDS.ZS?locations=MW.
  • World Health Organization. (2012). Measuring health and disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0) (p. 88) [Manual]. World Health Organization. https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health/who-disability-assessment-schedule
  • Wroe, E. B., Kalanga, N., Dunbar, E. L., Nazimera, L., Price, N. F., Shah, A., Dullie, L., Mailosi, B., Gonani, G., Ndarama, E. P. L., Talama, G. C., Bukhman, G., Kerr, L., Connolly, E., & Kachimanga, C. (2020). Expanding access to non-communicable disease care in rural Malawi: Outcomes from a retrospective cohort in an integrated NCD–HIV model. BMJ Open, 10(10), e036836. https://doi.org/10.1136/bmjopen-2020-036836
  • Yator, O., Mathai, M., Albert, T., & Kumar, M. (2021). Burden of HIV-related stigma and post-partum depression: A cross-sectional study of patients attending prevention of mother-to-child transmission clinic at kenyatta national hospital in Nairobi. Frontiers in Psychiatry, 11, https://www.frontiersin.org/articles/10.3389fpsyt.2020.532557. https://doi.org/10.3389/fpsyt.2020.532557
  • Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2